Use of a community of practice (CoP) platform as a model in regional quality improvements in cancer surgery: The Ottawa model.

Abstract

68 Background: The Ottawa CoP model for developing multidisciplinary practitioner networks and integrating them with organizational processes was established in 2007 as a platform improving access to quality cancer surgery in one of the health regions (population 1,276,370) of Ontario, Canada. The three inter-disciplinary CoP collaboratives in breast, colorectal, and prostate cancer involve 230 care providers from 9 hospitals performing over 2,000 cancer surgeries per year. Objectives: 1) to address lack of coordination and standardization of care, 2) develop a regional platform for quality initiatives, and 3) bridge the gap between academic and community hospitals. Methods: Using the model, an academic tertiary care hospital and eight community hospitals partnered to support a regional quality improvement initiative that combines 1) educational outreach with audit and feedback to address variations in practice and 2) a unique platform for knowledge generation and innovation. Regional interdisciplinary teams developed a set of regional quality indicators (18) linked to mutually agreed standards and pathways. Regional registry was established to provide data feedback on performance against both provincial and regional standards. Best practices, innovations, and implementation progress are reviewed through sustained interactions between CoP members. Patient and care provider surveys are conducted. Results: The development and implementation of regional care standards and clinical pathways for three disease sites in 9 hospitals. Regional pathway compliance ranged 65-94%. Other significant improvements include: rectal cancer surgery centralization (80-90% per annum), increase in use of sentinel lymph node biopsies in breast cancer surgery (60-77% per annum) and a decreased positive prostate cancer surgical margin rate form 45% to 22%. Compliance with provincial guidelines for colon cancer surgery improved (20% increase 2006/2007 vs. 2010/2011). Increase in patient access to high-quality cancer surgery closer to home. Conclusions: Participation in the regional CoPs is associated with quality improvements at the system, patient, and professional levels.