Comprehensive Cancer Care Networking (CCCN) As Effective Cancer Management Model: Pilot Project of the Czech Republic (2014 -> 2017)
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Comprehensive Cancer Care Networking (CCCN) as effective cancer management model: pilot project of the Czech Republic (2014 -> 2017) Institute of Biostatistics and Analyses Masaryk University, Brno, Czech Republic www.iba.muni.cz Czech cancer care in 2013: many challenges Opportunistic Population-based cancer screening ?interventions 2013 High and growing Management of cancer incidence ? growing burden Regional set of cancer centers Equal access to ? high quality care Pilot model of the CCCN -> Main PRINCIPLES adopted Common information system Organized structure (multi-tier model) Implemented cancer management protocols Multidisciplinary assessment of patients (CCs boards) Common governance including control (QA/QC indicators) Quantified and mapped collaboration with neighboring regions Emphasis on complexity of the system: controlled patient pathways CC(s) CCCN(s) ? Evolutionary – step by step – transformation ! Pilot CCCN -> Main BARRIERS to overcome Legislation allowing data E FUNCTIONAL centralization Representative cancer care model Support of - stakeholders HEALTH and payers LEGAL BACKGROUND LEGAL Functional reimbursement mechanisms Pilot CCCN -> IT infrastructure for cancer care networking Epidemiology Equity of health Population-based care registries Structure of health care Population and treatment burden National Cancer Registry Results of health care Hospitals Quality of Specialized health care registries REPORTS Hospital information systems Local and national registries Distribution of Monitoring of health care health care EHR Volume of health care Primary care (GPs, gynaecologists) Hospital care Data validation Specialized care and cancer centres Complexity of the CCCN = complexity of its ICT background SEGMENT VIEW Diagnostics & therapy Prevention Palliative Primary Follow-up screening care care Supportive care INDIVIDUAL VIEW Diagnostics Therapy Supportive care Palliative care Established Pilot CCCN - written agreement - CCCN structure - CCCN territory Spatially closed, geographically interconnected regions Fully representative demographic, social and epidemiologic attributes Sufficient demographic mass of people (patients) Target area of the CCCN Together, South Moravian Region and the Vysočina Region (target area for CCCN) account for 18% of the total area of the Czech Republic. Although these two regions are geographically next to each other, their remote parts are very different and provide thus representative sample for piloting of CCCN. SW Moravia South Moravian Region Vysočina Region Both regions Population (as of 31/12/2015) 1 175 025 509 475 1 684 500 Area (km2) 7 195 6 796 13 991 Population density (per km2) 163 75 120 Number of districts 7 5 12 Number of municipalities 673 704 1 377 Total length of roads and motorways (km, estimation) 4 500 5 000 9 500 Total length of railway network (km, estimation) 800 650 1 450 Demography in the CCCN area (2015) – benchmarking The distribution of age groups in the population Men Women South Moravian and Czech Republic South Moravian and Czech republic ] ] Vysocina Regions Vysocina Regions % % 10 [ [ 10 9 9 8 8 7 7 population population 6 6 the the in in 5 5 4 4 3 3 groups groups 2 2 age age 1 1 0 0 Various Various 0 - 4 5 - 9 85 + 0 - 4 5 - 9 85 + 10 - 1415 - 1920 - 2425 - 2930 - 3435 - 3940 - 4445 - 4950 - 5455 - 5960 - 6465 - 6970 - 7475 - 7980 - 84 10 - 1415 - 1920 - 2425 - 2930 - 3435 - 3940 - 4445 - 4950 - 5455 - 5960 - 6465 - 6970 - 7475 - 7980 - 84 Age groups Age groups Source: The Czech Statistical Office Cancer incidence (2013–2015) – benchmarking MEN CCCN area Number of reported cancers WOMEN CCCN area Number of reported cancers CR annually per 100,000 men CR annually per 100,000 women 0 100 200 300 0 100 200 300 other malignant neoplasms of skin (C44) 262 other malignant neoplasms of skin (C44) 229 prostate (C61) 133 breast –women (C50) 125 62 colon and rectum (C18–C20) 92 colon and rectum (C18–C20) uterus (C54, C55) 38 trachea, bronchus and lung (C33, C34) 77 trachea, bronchus and lung (C33, C34) 28 kidney (C64) 37 kidney (C64) 21 bladder (C67) 28 ovary (C56) 20 oral cavity and pharynx (C00–C14) 20 pancreas (C25) 18 19 pancreas (C25) cervix uteri (C53) 16 19 malignant melanoma of skin (C43) malignant melanoma of skin (C43) 16 17 stomach (C16) thyroid gland (C73) 14 leukaemias (C91–C95) 16 non-Hodgkin lymphoma (C82–C85, C96) 13 12 non-Hodgkin lymphoma (C82–C85, C96) 15 leukaemias (C91–C95) 11 liver and intrahepatic bile ducts (C22) 11 stomach (C16) 10 9 testis (C62) gallbladder and biliary tract (C23, C24) 8 9 bladder (C67) oesophagus (C15) 7 8 brain and spinal cord (C70–C72) brain and spinal cord (C70–C72) 7 8 oral cavity and pharynx (C00–C14) larynx (C32) 5 6 liver and intrahepatic bile ducts (C22) multiple myeloma (C90) 4 multiple myeloma (C90) 5 3 gallbladder and biliary tract (C23, C24) Hodgkin lymphoma (C81) 4 thyroid gland (C73) connective and soft tissue (C47, C49) 2 3 1 Hodgkin lymphoma (C81) oesophagus (C15) 3 1 connective and soft tissue (C47, C49) larynx (C32) 32 other malignant neoplasms 33 other malignant neoplasms Source: Czech National Cancer Registry (IHIS CR) Pilot CCCN: South Moravian Region and Vysocina Region – cancer care infrastructure – Type of health care facility www.onconet.cz Comprehensive Cancer Centre [n=1] Cancer Centres [n=3] CCCN Children’s cancer centres [n=1] Haemato-oncology centres [n=1] Constituent parts of CCCN [n=4] HCF cooperating with CCs [n=20] Mammography screening centres [n=13] Colonoscopy screening centres [n=29] LCTHs and hospices [n=20] All [n=92] Pilot CCCN in institutional view CCC Masaryk Memorial Cancer Institute www.mou.cz CC FN Brno CC FNuSA www.fnbrno.cz www.fnusa.cz Institute of Biostatistics Masaryk University and Analyses Faculty of Medicine www.iba.muni.cz www.med.muni.cz CCCN information system Education – Training ICT background CC Jihlava Certification Data analyses www.nemji.cz Research Region Vysocina - coordinating cancer centre - CCCN collaboration Practical implementation: written agreement Common governance – given structure – – multidisciplinary assessment Common protocols – – QA/QC standards – common information system Practical implementation: common governance Management coordination and leadership Network managerial board Network governance, financial management Involvement of stakeholders, patients Managerial leadership Coordination Independent evaluation team Clinical QA/QC control leadership Quality and performance evaluation Standards of care Management of ICT background QA/QC, reporting, predictions Cancer care standards and pathways Standardization of protocols and procedures Multidisciplinary tumor assessment Quality control with clinical feedback Research activities Examples of outcomes I. ICT background and e-communication tools www.onconet.cz Comprehensive cancer centers Hospital facilities in general Supportive and palliative centers Screening centers Primary care specialists www.onconet.cz Diagrams of cancer care available for each region PDF download Regional models of cancer care, presenting professionals and navigating patients Interactive maps Access points www.onconet.cz Comprehensive cancer care Regional models of cancer care Map of facilities involved in comprehensive cancer care Types and numbers of facilities Diagram of cancer care Link to a regional Cancer Centre Regional news Detail of a health care facility www.onconet.cz Comprehensive cancer care Cancer Centres On-line Equipment characteristics Clinical research Information systems …and more Examples of outcomes II. Data processing and reporting - performance – patients’ flow – equity – QA/QC system Population level: epidemiology Hospital-based information systems Predictions of cancer burden Indicators of CCCN functionality CCCN pilot: performance, quality and outcome assessment Specialized Epidemiological Hospital data registries registries /EHR/ (surveys) CCCN coverage in Access to CCCN Social & Equity catchment area entry points demographic Performance Volume of care Consumption typology of rates treated patients (Re)distribution of Pathways: Pathways: specific Patient care primary and therapeutic pathways Inter-regional follow-up care procedures / drugs migration for care Performance of Time aspects of Standardized No. of patients enrolled tumor diagnostics, protocols Patient flow management staging, follow-up teams Population-based Hospitalization- Clinical trials Safety, efficacy reference: related safety Adverse events, Outcomes mortality and and outcome Patient’s survival measures satisfaction Examples of reporting generated by the Czech National Cancer Control System: I. Population level Model diagnosis: colorectal cancer – CCCN area Main trends: Main trends: Clinical stages: primary diagnosis incidence & mortality prevalence TNM 2. TNM 3. TNM 4. TNM 5. TNM 6. TNM 7. 90 600 100% +3,2 % +54,2 % 80 incidence 500 70 mortality 80% 60 400 50 60% 300 40 40% 30 200 -12,0 % 20 100 20% 10 %: trend change 2003–2013 %: trend change 2003–2013 0 Counts per 100 per 100 000 inhabitants Counts Counts per 100 per 100 000 inhabitants Counts 0 0% 1977 1980 1983 1986 1989 1992 1995 1998 2001 2004 2007 2010 2013 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 1977197919811983198519871989199119931995199719992001200320052007200920112013 Incidence Mortality Prevalence (31.12.2013) Absolute counts in 2013 1 213 528 Absolute counts 9 176 Stage of the disease Counts per 100 000 in 2013 72,2 31,4 Counts per 100 000 546,5 1 2 3 4 unknown not recorded Survival of patients in time trends Stochastic