Integrated Cancer Services Plan HNHB LHIN Dr. Bill Evans, Regional - - PowerPoint PPT Presentation

Integrated Cancer Services Plan HNHB LHIN

• Dr. Bill Evans, Regional Vice-President, CCO

Carol Rand, Director, Systemic, Supportive, Regional Cancer Programs

Organizational Structures for Regional Cancer Services

Regional Cancer Program Governance & Committee Structure

Hospital Administration

President & CEO HHS

• M. Martin

Executive V. P. Clinical Operations

• B. Flaherty

Cancer Administration

CEO, Cancer Care Ontario

• M. Sherar

Vice President, Regional Cancer Programs Judy Burns

President JHCC Regional Vice President,

• B. Evans

Director, Regional Cancer Program Carol Rand Regional Cancer Program Priorities & Planning Committee *

Development of Disease Site Specific Cancer Committees

Regional Programs and Networks Systemic, Radiation, Surgical Oncology, Integrated Cancer Screening, Palliative Care, Aboriginal, Primary Care, Patient Education, Diagnostic Imaging, Pathology

* Membership includes Designated Cancer Leads from each hospital in the LHIN

Hospital Cancer Councils

Development of the Integrated Services Plan (ICSP) guided by:

• Hamilton Niagara Haldimand Brant LHIN Vision
• A health care system that helps keep people healthy, gets them

good care when they are sick, and will be there for our children and grandchildren.

• Cancer Care Ontario Vision and Mission
• Working together to create the best cancer system in the world.
• We will improve the performance of the cancer system by driving

quality, accountability and innovation in all cancer-related services

• HNHB Regional Cancer Program Vision
• Equal access to coordinated system of high quality cancer

services across the continuum of care, from prevention and early detection through to palliative care, across the region

Development of the ICSP

Leadership from:

• Regional Vice-President
• Deputy RVP
• Regional Cancer Program Director
• Regional Planning and Priorities Committee
• Medical Discipline Heads and Network Leaders
• Directors of Cancer Programs and Networks

RCP Priorities and Planning Committee

Purpose: The Regional Cancer Program (RCP) Priorities & Planning Committee will provide strategic oversight and direction for the development and implementation of all cancer services, as defined through a Memorandum of Agreement (MFA), across HNHB LHIN. The membership is committed to the development of a strong and innovative RCP in the LHIN. Objectives: 1. To support the RCP RVP to lead cancer services planning within the LHIN as part of the province-wide cancer planning. 2. To identify strategies to meet regional needs for service, integration, co-ordination and quality improvement. 3. To facilitate patient and consumer involvement in planning and evaluating activities. 4. To implement provincial standards and report on the LHIN’s performance relative to these standards. 5. To monitor and report on the LHINs programs and services. 6. To respond to performance results for the LHIN, which may require assessment and re-alignment of where and how services are provided.

Development of Cancer Priorities for ICSP

• Cancer Incidence and Prevalence Data by Disease

Site within the LHIN

• Regional Modifiable Risk Factor Profile
• Understanding of Current Capacity Issues and

Challenges

• Direction of Ontario Cancer Plan (2005, 2008, 2011)
• Regional Priorities Established in Consultation with

CCO and in Alignment with OCP

• Cancer System Quality Index Data

Development of Cancer Priorities for ICSP

• RCPPC Review of Data, OCP III, Challenges,

Opportunities

• Alignment with LHIN Clinical Services Plan
• Agreement on Regional Priorities
• Agreement on Template & Domains
• MRPs for each Priority
• Interactive Process
• Milestones established over 4 years of the plan

Key Strategic Priorities

1. Development of the Walker Family Cancer Centre as an integrated partnership with JCC 2. Implementation of common Oncology-specific Information System across HNHB LHIN 3. Strengthen and Integrate Regional Programs

• 1. Radiation Therapy
• 2. Systemic Therapy
• 3. Cancer Surgery

Consolidate complex cancer surgery (Gyne, HPB, Thoracic, Sarcoma)

• 4. Palliative care
• 5. Integrated Screening Program

4. Strengthen Regional Networks

Strategic Priority 1

Development of Cancer Program at Walker Family Cancer Centre

• MOU to create an integrated partnership
• Establish medical and administrative leadership
• Establish Clinical Department of Oncology at NHS
• Build one radiation oncology program on 2 sites
• Expand screening services, systemic therapy
• Develop supportive and palliative care services
• Develop disease site subspecialization amongst
• ncologists, MCCs
• Implement common cancer information systems

Strategic Priority 2

Implement Regional Cancer Informatics Strategy

• Regional cancer informatics plan developed
• Director, Integrated Cancer Informatics recruited
• Agreement on common oncology-specific information

system obtained

• Implement Meditech registration/ADT interface to OPIS

2005, MOSAIQ

• Focus on integration of JCC/HHS and WFCC/NHS but

strategy to be extended to JBMH and BCHS

• Utilize Clinical Connect to link oncology specific information

across system

• Utilize the Dir to facilitate access to cancer images

Strategic Priority 3: Strengthen and Integrate Regional Cancer Programs

 Radiation Therapy Program

• Develop integrated administration and HR for single program

model

• Increase regional radiation therapy utilization: radiation
• ncologists in more community-based clinics,
• Engage radiation oncologists in more community-based

multidisciplinary case conferences (MCCs)

 Systemic Therapy Program:

• Implement Regional Systemic Therapy Plan
• Establish a Regional Systemic Therapy Committee; enhance

regional MO resources (AFP positions) to bring systemic therapy closer to home where possible (Brantford, St Catharines)

Model for the Full Integration of Systemic & Radiation Therapy Services Through the JCC, Walker Family Cancer Centre, Brantford General Hospital and Joseph Brant Memorial Hospital Affiliate Clinics*◊

Regional Systemic & Radiation Therapy Program

Brantford General Hospital Satellite Level 3 Facility

• Evolving to DST model
• Increase Systemic Therapy

clinics to 5 days per week

• Increase Radiation Oncology

Follow up Clinics

Walker Family Cancer Centre Level 2 Facility (2013)

Education and Research (Clinical Trials) Systemic Therapy Radiation Therapy Treatment

Joseph Brant Memorial Hospital Satellite Level 3 Facility

Evolving to DST Systemic Therapy Radiation Oncology Follow up Clinics

Juravinski Cancer Centre Level 1 Facility

Education & Research (Clinical Trials) Systemic Therapy (complex, tertiary cases) Radiation Therapy Treatment Brachytherapy IMRT Cyberknife

Welland Affiliate

Systemic Therapy Follow-up Clinics

Niagara Falls Affiliate

Systemic Therapy Follow-up Clinics

Haldimand Norfolk

Referrals to Brantford General Hospital & JCC Community Oncology Clinic as appropriate – for Systemic Therapy *Includes the implementation of the Disease Site Team (DST) Model across the LHIN, multidisciplinary case conferencing, plus a regional cancer informatics system to support care across

the continuum. ◊Definitions of Level 1, 2, 3 according to CCO definitions for Level of Care.

Strategic Priority 3:

 Surgical Oncology:

• Regional cancer surgery lead and representatives of 6 hospitals

doing the majority of cancer surgery make up SON

• Enhance the interaction between surgeons doing cancer surgery

across the LHIN

• Implement provincial guideline and standards developed through

CCO

• Consolidate tertiary activity; disperse common cancer surgeries

predominately to community

• Local surgical leads to encourage colleagues to engage in MCCs

and other quality initiatives

• Quarterly review of performance/quality metrics
• Regional Workshops: breast, colorectal, prostate

Strategic Priority 3:

 Consolidation of Complex Surgical Oncology

• Implementation of CCO Standards for high complexity

surgery:

• Thoracic
• Consolidated to St. Joseph’s Hospital; NHS and

JBMH have both agreed to stop thoracic oncology

• Lung DAP established at St. Joe’s and St.

Catharines General

• Hepatobiliary
• HPB from MUMC and St. Joe’s consolidated to

Juravinski Hospital as part of HHS Access to Best Care

Model for the Delivery of Cancer Surgery*

Regional Cancer Surgery Model

• St. Joseph’s Hospital
• Thoracic

Prostate Head & Neck Endocrine Sarcoma Ophthalmology Hamilton Health Sciences Gyne-Juravinski CNS-General HPB Juravinski Sarcoma

Brantford General Hospital Joseph Brant Memorial Hospital Norfolk General Hospital West Haldimand General Hospital Haldimand War Memorial Hospital West Lincoln Memorial Hospital

• St. Catharines

General Hospital Greater Niagara General Hospital Welland General Hospital HPB * Consolidation of specific sites to HHS and St. Joseph’s Hospital, with general surgery for breast, colorectal and GU delivered across the LHIN at all hospitals

Niagara Health System

Thoracic

Strategic Priority 3:

 Palliative Care

• Develop a regional palliative care network
• Implement 9 CCO recommendations within region
• Establish a TAPCU at JHCC
• Implement standard symptom management

assessment tools (ESAS) across LHIN

• Collaborate with HNHB Hospice Palliative Care Network to

increase use of standardized assessment tools across LHIN (ESAS, PPS)

17

Strategic Priority 3:

 Integrate Cancer Screening Programs

• Participate in CCO plan to integrate breast, cervix and colon

cancer screening programs

• Implement recruitment strategies using geospatial mapping

support to recruit underserviced populations

• Focus on quality improvement in CCC (reduce rejected kits,

evaluate FIT) and efforts to engage family physicians

• Convert hospital and IHFs to OBSP centres
• Expand cancer genetics program at JCC

Strategic Priority 4: Implement Regional Networks

Prevention Network

• Build support for implementation of the Ottawa Smoking Cessation Program

in all regional hospitals

• Collaborate with partners in regional prevention network on educational

initiatives on cancer risk factors – obesity, smoking, exercise, alcohol, consumption

 Primary Care Network

• Collaborate in development of integrated cancer screening program
• Develop electronic tool to aid primary care physicians diagnose and refer

patients with suspicion of cancer

Strategic Priority 4

 Pathology Network

• Through regional network, implement synoptic reporting

across all hospitals and all tumour types

• Develop SOPs for specimen handling, molecular markers
• Undertake teaching workshops (Gyne oncology pathology

focus: fall 2010)

Strategic Priority 4

 Cancer Imaging Network (new)

• Conduct environmental scan; develop regional action plan
• Knowledge transfer, stakeholder education re: standardizing

access to high quality oncology interventions

• Implement guidelines on role of breast MRI in screening and pre-
• p staging; optimization of radiological assessment of patients

with rectal cancer

• Work with CCO on provincial guidelines for vascular access and

image guided biopsies

Strategic Priority 4

 Psychosocial Oncology

• Establish a regional psychosocial oncology network with reps from

cancer clinics, CCAC, CCS, Wellwood and WellSpring Niagara

• Undertake environmental scan of resources; post resources
• nline

 Cancer Education

• Standardize regional cancer patient education materials
• Improve linkages to other cancer information providers (shared

library processes with Wellwood; website link to community resources in collaboration with Canadian Cancer Society

• Conduct 3 patient forums per year in collaboration with disease

sites (e.g. Lymphoma Conference, Kidney Conference)

Alignment with Clinical Services Plan

• Community based – care closer to home; enhanced primary

care engagement (diagnosis, referral, follow-up)

• Collaboration between institutions and professionals and

enhanced inter-professional engagement

• Consolidation of complex care to tertiary facilities

Next Steps to Achieve ICSP

• Establish Partnership Agreements between CCO/RCP and regional

institutions that speak to the delivery of integrated cancer services

• Strengthen regional and local leadership
• VP level Designated Cancer Leads for hospitals (RCP Priorities

and Planning Committee)

• Ensure each hospital has a designated lead for each

program/network as appropriate

• Establish individual hospital Cancer Committees/Councils to:
• Review CCO Contractual Agreements
• Monitor Quality & Performance Metrics and direct quality

improvement

• Ensure network participation and collaboration

Next Steps to Achieve ICSP

• Direct Regional Program and Network physician and

administrative leads to develop work plans that address ICSP priorities

• Implement common oncology-specific information systems to

support cancer care integrated with the hospital information systems

• Put in place infrastructure support to enable integration of

cancer services across LHIN

• Patient Navigators/Diagnostic Assessment Programs
• Interim support to enable cancer care expansion
• Obtain support for the integration of the regional networks and

programs and their quality improvement initiatives

Regional Cancer Integration Coordinator

• Coordinate the process to create regional integration

agreements

• Coordinate the review and signoff of CCO funding

agreements (CSA, colonoscopy,etc.)

• Coordinate regional network/program meetings and

reports

• Support the organization of regional workshops
• Coordinate the process for annual work plans
• Produce an annual report on program and network

activities

– Estimated annual cost $65K

Regional Cancer Quality Specialist

• Support the development and implementation of quality

metrics and local quality dashboards at regional hospitals with cancer committees

• Maintain the dashboard for the regional cancer

program and support initiatives by programs/networks to improve metrics

• Support quality improvement initiatives between

partner sites and the RCP

• Serve as a resource to support regional collaboratives

(systemic therapy, colorectal, etc.)

– Estimated annual cost $130K

Comments and Questions