Can concordance between actual care received and a pathway map be measured on a population level in Ontario? A pilot study

  • K. Forster Ontario Health (Cancer Care Ontario)
  • K. Tsang Ontario Health (Cancer Care Ontario)
  • S. Li Ontario Health (Cancer Care Ontario)
  • L. Ieraci Ontario Health (Cancer Care Ontario)
  • P. Murray Ontario Health (Cancer Care Ontario)
  • K. J. Woltman Ontario Health (Cancer Care Ontario)
  • D. Chmelnitsky Ontario Health (Cancer Care Ontario)
  • C. M.B. Holloway Ontario Health (Cancer Care Ontario), Sunnybrook Health Sciences Centre
  • E. D. Kennedy Ontario Health (Cancer Care Ontario) Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto
Keywords: Clinical pathways, concordance, quality improvement, system performance, colon cancer

Abstract

Background Clinical pathways are associated with improved adherence to clinical guidelines; however, most studies have evaluated pathways for a single intervention at a single institution. The objective of the present study was to develop and evaluate a method of measuring concordance with a population-based clinical pathway map to determine if that method could be feasible for assessing overall health system performance.

Methods Patients with stage ii or iii colon cancer diagnosed in 2010 were identified, and clinical data were obtained through linkages to administrative databases. Pathway concordance was defined a priori based on receipt of key elements of the Ontario Health (Cancer Care Ontario) colorectal pathway maps. For stages ii and iii colon cancer alike, concordance was reported as the proportion of patients receiving care that followed the predefined key elements of the pathway map. Regression analysis was used to identify predictors of concordant care.

Results Our study identified 816 patients with stage ii and 800 patients with stage iii colon cancer. Of the patients with stage ii disease, 70% (n = 571) received concordant care. Of the patients with stage iii disease, results showed high concordance for all key elements except receipt of chemotherapy, leading to an overall concordance rate of 39% for that cohort.

Conclusions Our method of measuring concordance was feasible on a population-based level, but future studies to validate it and to develop more sophisticated methods to measure concordance in larger cohorts and various disease sites are necessary. Measurement of clinical pathway concordance on a population-based level has the potential to be a useful tool for assessing system performance.


Author Biographies

C. M.B. Holloway, Ontario Health (Cancer Care Ontario), Sunnybrook Health Sciences Centre
Department of Surgery
E. D. Kennedy, Ontario Health (Cancer Care Ontario) Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto
Institute of Health Policy, Management and Evaluation, Department of Surgery
Published
2020-03-06
How to Cite
Forster, K., Tsang, K., Li, S., Ieraci, L., Murray, P., Woltman, K. J., Chmelnitsky, D., Holloway, C. M., & Kennedy, E. D. (2020). Can concordance between actual care received and a pathway map be measured on a population level in Ontario? A pilot study. Current Oncology, 27(1). https://doi.org/10.3747/co.27.5349
Section
Surgical Oncology