Quality oversight for specialized cancer services.

Abstract

103 Background: Cancer Care Ontario (CCO), a provincial agency responsible for continually improving cancer services in Ontario, Canada, reviews selected services with a view to understanding and resolving issues of access, quality, innovation, and funding. Specialized cancer services are low-volume, high-complexity, high-cost, and are not available in every region. They tend to be high-risk, involve a rapidly evolving scientific knowledge base, and a high degree of specialization. A specialized services oversight (SSO) approach has been implemented to address the challenge for optimization of service delivery while providing equitable access to safe, high-quality, best practice care. Methods: The SSO approach involves 1) establishing a provincial forum for expert clinical advice; 2) A regular and systematic process for literature and jurisdictional reviews; 3) provincial-level demand and capacity forecasting; 4) provincial funding linked to evidenced-based eligibility/quality criteria; 5) communication/awareness strategies for appropriate and equitable access. Enablers are CCO structures for performance management, stakeholder engagement, service planning, data management, and CCO’s guiding principles of "transparency, equity, evidence, performance-oriented, active engagement, and value for money." Results: The SSO approach has been implemented in full for PET scanning services, and in part for stem cell transplant (SCT), sarcoma, molecular oncology, prostate brachytherapy, and selected neuroendocrine cancer care. Stakeholder acceptance of the approach has been high. Outputs include provincial guidelines on indications for SCT, performance metrics and benchmarks, multicentre sharing of information, and inter-regional referral processes. Conclusions: Implementation of the SSO approach has introduced provincial-level system planning, formal evidence scanning, sharing of best practices, and performance measurement for high-complexity services where there was no such oversight in the past. The approach is anticipated to avoid access crises and support timely and equitable access to services of high quality, which make optimal use of resources.