Abstract
BackgroundThe Canadian province of Manitoba covers a large geographical area but only has one major urban center, Winnipeg. We sought to determine if regional differences existed in the quality of colorectal cancer care in a publicly funded health care system.MethodsThis was a population-based historical cohort analysis of the treatment and outcomes of Manitobans diagnosed with colorectal cancer between 2004 and 2006. Administrative databases were utilized to assess quality of care using published quality indicators.ResultsA total of 2,086 patients were diagnosed with stage I to IV colorectal cancer and 42.2% lived outside of Winnipeg. Patients from North Manitoba had a lower odds of undergoing major surgery after controlling for other confounders (odds ratio (OR): 0.48, 95% confidence interval (CI): 0.26 to 0.90). No geographic differences existed in the quality measures of 30-day operative mortality, consultations with oncologists, surveillance colonoscopy, and 5-year survival. However, there was a trend towards lower survival in North Manitoba.ConclusionWe found minimal differences by geography. However, overall compliance with quality measures is low and there are concerning trends in North Manitoba. This study is one of the few to evaluate population-based benchmarks for colorectal cancer therapy in Canada.
Highlights
The Canadian province of Manitoba covers a large geographical area but only has one major urban center, Winnipeg
Since the quality of treatment for colorectal cancer (CRC) has recently become an important area for research and quality improvement initiatives [8,9,10], authors have developed a set of quality indicators for CRC treatment [11]
Information regarding all Manitobans diagnosed with a malignancy is collected by the Manitoba Cancer Registry (MCR) as cancer reporting is mandatory by Manitoba law [13]
Summary
The Canadian province of Manitoba covers a large geographical area but only has one major urban center, Winnipeg. We sought to determine if regional differences existed in the quality of colorectal cancer care in a publicly funded health care system. Canadian health care is publicly administered and universal for all insured residents [1]. Authors have raised concern over suboptimal or unequal access and quality of health care among certain Canadian populations [2,3]. In Manitoba, colorectal cancer (CRC) is the third most common malignancy and poses a major public health issue [4]. Manitoba covers a large geographic area with 56.5% of the population living in the major urban center of Winnipeg [5,6]. Utilization and application of quality indicators permits benchmarking between institutions
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