Cancer Quilts Project

1. Cancer Quilts Project Jane McCue MVCN Medical Director

2. MVCN Cancer Quilts • What are they? key features? • Why do we need them? • What have we achieved so far • The next stage • How should we use the Quilts?

3. What are Cancer Quilts? A way of bringing together information about a tumour site to help us see: • where we should focus our efforts to improve our services • what we have to be proud of • where we may have problem areas

4. Cancer Quilts • Primarily a tool for each NSSG and the Network to use - to ensure attention gets focussed on problem areas. • An effective way of communicating a complex set of information.

5. Key Features • Only includes data where performance can be quantified and value judged • All performance is measured in quintiles • Previous traffic light survival data was in quarters with large ‘Amber’ section • To be determined by NSSG unless national figures exist

6. Layout of Quilts • Measures are grouped and presented along patient pathway including supportive care • Data available by PCT/locality is presented alongside local Trust data • 1 Quilt per tumour site, generally

7. Details available behind each coloured cell • Actual figures, data source, year of data and threshold levels. • System is being automated into a business intelligence system so data refreshes are straightforward.

8. Measures • National targets included in all relevant Quilts e.g. Waiting times performance • Peer Review’s Clinical Lines of Enquiry included in relevant Quilts • Patient Experience and Productivity measures as well as clinical outcomes

9. Development of Quilts • Each NSSG needs to determine what measures are relevant for their tumour site • For individual clinical measures, NSSGs also need to decide appropriate thresholds • Ownership and maintenance of each Quilt should be with relevant NSSG (supported by Cancer Network)

10. Where we are now • Colorectal and Lung Quilts – most fully developed • Breast and Urology, in development • Gynae, H&N and Upper GI – initial discussions

11. MVCN Colorectal Cancer Quilt 54.13%: Average 55.3%: Good 41.1%: Worst 51.15%: Average • Awareness and Screening • Coverage for age band 60-69 by PCT (Dec 2010) • Data source: Open Exeter, Monthly • Quintile Thresholds • Best: >60% • Good: 55-60% • Average: 50-55% • Poor: 45-50% • Worst: <45%

12. MVCN Colorectal Cancer Quilt 76.06%: Good 64.18%: Worst 74.97%: Good Primary Care: 1 Year Survival by PCT Data Source: UKCIS & ECRiC National Ranking in Quintiles

13. MVCN Colorectal Cancer Quilt Awareness and Screening Bowel screening coverage age band 60-69 Primary Care One year survival (as proxy) One year survival changes Patient experience re Primary Care Treatment 5 year survival rates 5 year survival changes 2 WW 31 Day FDT 62 Day Standard Case ascertainment Data completeness for NBOCAP Staging Data Completeness (Pre-treatment, ECRiC) Staging Data Completeness (Duke, ECRiC) Peer Review Patient Satisfaction re Treatment Supportive/Palliative Care/End of Life Care Productivity

14. Extra Seconday Care Items – Colorectal • Proportion of surgically treated rectal patients having an MR scan pre-op       • Emergency Readmissions within 30 Days for Colectomy/Excision of Rectum       • Permanent colostomy for rectal cancer       • Anastomotic Leak rate       • Median number of excised lymph nodes       • Case mix adjusted post op mortality       • % of laparoscopic resection       • Patient Satisfaction re Treatment          • Average post Op length of episode for Colectomy/Excision of Rectum procedures      

15. Development Process • NSSGs need to agree what measures are relevant to their services and what data sources are best to use for each measure. • Need to agree what constitutes Very Good and Very Poor performance and thresholds in between • The Network (Shijuan Li, data analyst for Quilts) will find and analyse the Data

16. National Head and Neck Cancer Audit • DAHNO is the DAta system that holds data for the care and management of Head and Neck Oncology patients. • Developed in partnership with the British Association of Head and Neck Oncologists (BAHNO) and run by the Healthcare Quality Improvement Partnership (HQIP) • First report was 2004-2005 • Latest 6th Annual report covers Nov 2009 and Oct 2010. • NHS iView Head and Neck Cancer Audit shows, for each quarter, selected anonymised and aggregated data at trust and cancer network level

17. Data item focus - for 7th Annual Report Particular emphasis on 1, 2, and 3 - to enable us to undertake risk adjusted mortality. Please make every effort to collect these items Pre - treatment • 1. Pre treatment staging T N and include M • 2. Comorbidity score (ACE-27) • 3. Performance status

18. DAHNO Data Ascertainment:

19. DAHNO Data Quality:

20. Initial Exercise?? • How well do we currently know how our services are performing? • May wish to test knowledge of clinicians (anonymously) before completed quilts are revealed • Blank Quilts and felts tips available from Network

21. Using your Quilt • Review completed Quilt at NSSG meeting • Identify any data queries to raise with Network • Consider areas of good performance and poor performance and any patterns in the Quilt • Decide what areas of ‘poor performance’ should be prioritised. • Decide on actions needed and who will address each action – add to NSSG Action Plan.

22. Regular review • Review progress of ‘Quilt Action Plan’ as part of reviewing NSSG Work Plan at each meeting. • Include progress made on Quilts in each Annual Report. • Use as format for annual presentations to Network Board, Evidence for Peer Review

23. Finally, Greater awareness and understanding of our performance (in all areas) should lead naturally to service improvement, which is our ultimate aim!