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Reddeman L, Foxcroft S, Gutierrez E, Hart M, Lockhart E, Mendelsohn M, Ang M, Sharpe M, Warde P, Brundage M, Reddeman L, Foxcroft S, Gutierrez E, Hart M, Lockhart E, Mendelsohn M, Ang M, Sharpe M, Warde P, Brundage M. ReCAP: Improving the Quality of Radiation Treatment for Patients in Ontario: Increasing Peer Review Activities on a Jurisdictional Level Using a Change Management Approach. J Oncol Pract 2016; 12:81-2, e61-70. [DOI: 10.1200/jop.2015.006882] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
QUESTION ASKED: What is the impact of the Cancer Care Ontario (CCO) strategy (designed with guidance from a change management framework) to accelerate the use of peer-review processes in radiation oncology (ie, review of a radiation oncologist’s proposed treatment plan by a second radiation oncologist with or without additional multidisciplinary input) across all of its 14 cancer treatment centers? SUMMARY ANSWER: By following a number of key change management principles for organizational transformation, the proportion of radical-intent radiation therapy courses peer reviewed province-wide increased from 43.5% (April 2013) to 68.0% (March 2015), with some centers reaching over 95%. METHODS: The initiative design was guided by the Kotter eight-step process for organizational transformation, including the creation of a multidisciplinary leadership team, site visits to individual centers, the development of education and implementation processes (done in collaboration with each center), and the creation of new performance metrics for central reporting. Monitoring of these metrics enabled the leadership team to track the percentage of radiation therapy courses peer reviewed and the timing of peer review (before 25% treatment visits complete, after 25% treatment visits complete). Performance targets for the quality measures were arrived at by consensus that included engagement of all center radiation treatment program leaders. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: Peer review has been shown to increase quality of care. However, it requires that resources be invested, including the time and effort of radiation oncologists, and the programmatic work required to organize, execute, and document peer-review activities. There is currently no way of confirming the quality of peer-review activities. REAL-LIFE IMPLICATIONS: A change management framework can be useful for planning and achieving substantial increases in peer-review activities on a jurisdictional basis. Ongoing work will capitalize on facilitators of peer review and on addressing barriers to its application that were identified as part of the initiative. Guidance for peer-review activities specific to common clinical cases is required and is under development. The principles of peer review could be extended to other oncological disciplines with the goal of improving individual patient care and overall program quality. [Figure: see text]
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Affiliation(s)
- Lindsay Reddeman
- Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen’s University, Kingston, Ontario, Canada
| | - Sophie Foxcroft
- Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen’s University, Kingston, Ontario, Canada
| | - Eric Gutierrez
- Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen’s University, Kingston, Ontario, Canada
| | - Margaret Hart
- Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen’s University, Kingston, Ontario, Canada
| | - Elizabeth Lockhart
- Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen’s University, Kingston, Ontario, Canada
| | - Marissa Mendelsohn
- Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen’s University, Kingston, Ontario, Canada
| | - Michelle Ang
- Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen’s University, Kingston, Ontario, Canada
| | - Michael Sharpe
- Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen’s University, Kingston, Ontario, Canada
| | - Padraig Warde
- Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen’s University, Kingston, Ontario, Canada
| | - Michael Brundage
- Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen’s University, Kingston, Ontario, Canada
| | - Lindsay Reddeman
- Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen’s University, Kingston, Ontario, Canada
| | - Sophie Foxcroft
- Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen’s University, Kingston, Ontario, Canada
| | - Eric Gutierrez
- Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen’s University, Kingston, Ontario, Canada
| | - Margaret Hart
- Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen’s University, Kingston, Ontario, Canada
| | - Elizabeth Lockhart
- Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen’s University, Kingston, Ontario, Canada
| | - Marissa Mendelsohn
- Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen’s University, Kingston, Ontario, Canada
| | - Michelle Ang
- Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen’s University, Kingston, Ontario, Canada
| | - Michael Sharpe
- Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen’s University, Kingston, Ontario, Canada
| | - Padraig Warde
- Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen’s University, Kingston, Ontario, Canada
| | - Michael Brundage
- Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen’s University, Kingston, Ontario, Canada
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