ARCHIVED - Conference Presentation

The following is a text version of the presentation given at the Conference on Timely Access To Health Care, held February 8-9, 2007 in Toronto, Ontario.

Timely Access to Health Care Priority Area: Cancer: A British Columbia Perspective

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Presentation Outline

• Cancer as a process - access and wait times.
• Understanding access, waiting times and 'queues'
• BC as a cancer control system
• Access, quality and timeliness in relation to:
  • Radiation therapy
  • Screening mammography
  • Cervical cytology (PAP smears)
  • Colposcopy
• Other cancer control services - access and timeliness
• Going forward - sustaining and advancing BC's cancer control program.

Cancer as a process

Cancer - Understanding Access, Wait-Times and 'Queues

• Determining and balancing 'need' and capacity'
• Common definitions of wait-times
• Correlating wait-times with appropriate service limitation
• Standards, guidelines, quality and safety of services
• Correlating 'waiting times' with outcomes

Cancer - the BC Cancer Control System

BC - Access, Quality and Timeliness Radiation Services

• Integrated RT system:
  • Provincial policy and plans; regional implementation
  • All services within one program
  • Linked CAIS and RIS (paperless information systems)
  • Common IS, standards and portability (networks)
  • Continuous monitoring and reporting
  • In-house' maintenance
• Provincial determination of 'need' (demand):
  • Incidence (projected)
  • Utilization rate
  • Fractions per course
• Provincial determination of capacity (supply)
  • Number of fractions required
  • Operating assumptions applied
  • Equipment supply (replacement/life-span; new)

Cancer - Screening Mammography Program of BC

• The screening process:
  • Identification and invitation to the target group (50-69 years)
  • Provision of screening mammograms
  • Investigation of abnormalities
  • Re-screen reminders at appropriate interval
• Promotion, recruitment and recall - return rate by calendar year.
• Facilitated process to diagnostic investigation (Fast Track)
• Program QA and QC (personnel, process, equipment, reporting)
• Program evaluation and public reporting (Annual Report and web-site)

Cancer - Access, Wait-Times Screening Mammography Program of BC

• Key Issues:
  • Setting and achieving accrual targets
  • 'hard to reach' populations
  • Under 40's, and over 70's
  • Capital replacement, expansion, new technology
  • HR training and retention
• Key Enabling Factor:
  • Fund program by accrual target

Cancer - Cervical Cytology Screening Program of BC

• The screening process:
  • Receives smears from BC health professionals according to guidelines and standards
  • Provincial program; centralized lab (PHSA)
  • Program collaboration with Gynecologic Oncology Tumour Group
• Promotion recruitment and retention - rescreen rates by recommended interval
• Slide interpretation and recommendation to GP
• Program QA and QC
• Program evaluation and public reporting (Annual Report and web-site)

Cancer - Cervical Cytology Screening Program

Cancer - Access, Wait-Times Cervical Cytology Screening Program

• Key issues:
  • Slowly declining participation (new screens) - all age groups
  • Hard to reach populations
  • New technology (HPV testing); HPV vaccination
• Key enabling factors:
  • Coordinated, integrated disease management program
  • Centralization and coordination through:
    • Cervical Cytology Screening Program
    • Laboratories
    • Gynecologic Oncology Tumour Group
    • Colposcopy Program

BC - Access, Quality and Wait-Times Colposcopy

• Provincial program, complimentary to CCSP, aligned to Gynecologic Oncology Tumour Group
• Sessional payment for colposcopies through BCCA (total budget $690K pa)
• 24 funded, hospital-based colposcopy clinics across BC
• 47 registered colposcopists:
  • Formal education and training requirements
  • Mandatory 12 supervised clinics for new colposcopist
  • Annual CME encouraged
  • Annual program update attendance mandatory q2yrs
• Defined procedure and care protocols - individual quality reports to colposcopist annually
• Compliance monitoring with colposcopy recommendations
• 75% of all cervical cancer therapeutic procedures performed by GO's

BC Level of Compliance to Colposcopy Recommendations by Age Group

BC - Sustaining and Advancing Provincial Cancer Control

• Provincial population-based, cancer control planning and policy - regional implementation-based on evidence (multiple dimensions)
• Strategic framework for demand and supply projections with prioritization and funding commitment by target/benchmark
• Maintain access, quality and safety standards for all cancer control interventions according to 'targets/benchmarks'
• Investment in, and integration of, science (research) and medicine to foster knowledge translation into best practice.
• System integration through common policies, guidelines and standards for cancer control to overcome outcome disparities
• Introduce new interventions according to evidence for effectiveness, eg colo-rectal cancer screening and approved funding
• Funding according to performance and accountability for cancer control process and outcomes