Implementing quality assurance for pancreatic cancer within an integrated health system

Abstract

Background: Quality Assurance (QA) is a set of systematic actions which, when implemented, can lead to improved patient care, but can be challenging in the field of surgical oncology. In 2014 we set and implemented quality standards for the management of pancreatic cancer (PC) patients at our main hospital and affiliate sites within our health system. Methods: Patients with PC treated at the main hospital and 2 affiliate institutions from 2013 to 2016 were included. Implemented quality measures were: multi-disciplinary tumor board (MDTB) presentation, imaging upload, confirmation of pathology, and number of lymph nodes retrieved. Results: A total of 489 PC patients were included. At the main hospital, prior to the initiation of QA measures, 14.1% (n = 15/106) of patients were discussed at MDTB; in 2016 this number rose to 58.4% (n = 66/113). Of patients planned to undergo resection, 20% (n = 8/20) were presented at MDTB in 2013; this number rose to 96.9% (n = 32/33) in 2016. At the main hospital, external imaging was uploaded in 66.7% of cases (n = 12/18) in 2013 and rose to 97.7% in 2016 (n = 12/13). Confirmation of external pathology was 72.7% (n = 8/11) in 2013 and rose to 90.9% (n = 10/11) in 2016. In the same period, we observed an increase in pancreatic resection with 12 lymph nodes dissected, from 74.3% (n = 26/35) in 2013 to 84.0% (n = 37/44) in 2016. Lower volume affiliate hospitals have been slower to adopt these QA standards, but modest trends in improvement were seen across some measures. Conclusion: Setting QA standards leads to an increase in compliance, and is an effective way to standardize and improve the delivery of high quality care to PC patients. Since the introduction of the above standards, we observed a rapid improvement in their implementation at our main institution. Adoption of these measures at lower volume affiliate hospitals remains a challenge.