International Journal for Quality in Health Care Advance Access originally published online on January 21, 2005
International Journal for Quality in Health Care 2005 17(2):107-114; doi:10.1093/intqhc/mzi007
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Development of a set of strategy-based system-level cancer care performance indicators in Ontario, Canada
1 Cancer Quality Council of Ontario, Toronto, Ontario, Canada, 2 Cancer Care Ontario, Toronto, Ontario, Canada, 3 Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Objectives. To develop a set of scientifically sound and managerially useful system-level cancer care performance indicators for public reporting in Ontario, Canada.
Implementation. Using a modified Delphi panel method, comprising a systematic literature review and multiple rounds of structured feedback from 34 experts, the Cancer Quality Council of Ontario developed a set of quality indicators spanning cancer prevention through to end-of-life care. To be useful to decision-makers and providers, indicator selection criteria included a clear focus on the cancer system, relevance to a diversity of cancer providers, a strong link to the mission and strategic objectives of the cancer system, clear directionality of indicator results, presence of targets and/or benchmarks, feasibility of populating the indicator, and credibility of the measure as an indicator of quality. To ensure that the selected indicators would measure progress over time against specific and widely accepted goals, we created a strategy map based on the five strategic objectives of the Ontario cancer system: (i) to improve the measurement and reporting of cancer quality, (ii) to increase the use of evidence and innovation in decision-making, (iii) to improve access to cancer services and reduce waiting times, (iv) to increase efficiency across the system, (v) to reduce the burden of cancer. An analysis of the mean indicator ratings by experts, and the strategy mapping exercise resulted in the identification of 36 indicators deemed suitable for routine performance measurement of the Ontario cancer system.
Lessons learned. The resulting instrument incorporates a credible evidence basis for performance measurement aligned to the five strategic goals for the Ontario cancer system. It represents the integrating of a management culture, focused on the implementation of a new strategic direction for the cancer system, with the underlying evidence-based culture of clinicians.
Keywords: neoplasms, performance measurement, quality indicators of health care, quality of health care
Address reprint requests to Adalsteinn D. Brown, Assistant Professor, Associate SGS Member, Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, McMurrich Building, 2nd Floor, 12 Queen’s Park Crescent, West Toronto, Ontario, M5S 1A8416-978-1484. E-mail: adalsteinn.brown{at}utoronto.ca
Accepted for publication October 8, 2004.