Using Standardized Electronic Pathology and Surgery Data to Inform Clinical Quality Improvement and Health System Planning
Authors: Sone S. , Kitchen J. , Mukhi S. , Argent-Katwala M. , Srigley J. 
Published: September 2018

Background: Practice variation in diagnosis and treatment exists between clinicians and jurisdictions across Canada. This variation can impact the quality of care that patients receive and patient outcomes. Knowledge of the scale and type of variation is the first step to developing action plans to improve consistency and enhance patient care. Aim: We aimed to establish a method by which to examine the magnitude of practice variation between clinicians and interjurisdictionally within the cancer system. We leveraged and derived evidence from discrete pathology data collected by five Canadian jurisdictions at the point of care to identify areas to improve quality of cancer care services and to direct patient care. Methods: Fifty pathologists, surgeons, and medical oncologists from 10 jurisdictions conferred to leverage literature and data standards (developed by the College of American Pathologists (CAP)) to create 48 descriptive and outcome indicators related to five cancers: breast, lung, colorectal, endometrial, and prostate cancer. Five jurisdictions collected and used data to generate the indicators. This baseline data were reviewed by 65 clinicians. Results: Interjurisdictional comparative baseline data analyses on 48 indicators showed clinical validity and relevance for use to direct downstream patient care. Data characterizing cancer type, stage, and grade distribution were consistently reported across geography and aligned with the evidence noted in the literature. The data also noted practice and performance variation across multiple cancer sites. For example, although the recommended guideline is to examine at least 12 lymph nodes in 90% of colorectal cancer patients, only one province met this target. Another example is Lynch syndrome testing, which may be important for patients with a diagnosis of colorectal or endometrial cancer depending on the age at diagnosis and family history. The data showed that 0%–70% of patients diagnosed with colorectal cancer prior to age 70 received testing for Lynch syndrome, and only 10%–40% of endometrial cancer cases were tested for markers of Lynch syndrome across the country. The value of these indicators is enormous to inform potential training opportunities and set standards of care at the local or broader clinical governance level so that consistent, high-quality care is delivered in accordance with evidence-based guidelines. Conclusion: Practice variation exists between clinicians and jurisdictions, and comparative pathology data can be used to create a cancer learning system. Four jurisdictions are now embarking on leveraging indicator data analysis to generate physician-level feedback reports and convening communities of practice with the goal of facilitating peer-to-peer conversations, and establishing benchmarks and targets to improve the quality of care, refine or develop clinical guidelines, and inform health system planning in Canada. These lessons can be applied in other cancer systems.