Poster Presentation NSW State Cancer Conference 2023

Can we measure what matters? Feasibility of clinically prioritised colorectal cancer quality indicators with a New South Wales population-based linked dataset (#305)

Candice Donnelly 1 2 , Puma Sundaresan 3 4 , Gabriel Gabriel 2 5 , Shalini Vinod 5 6
  1. Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
  2. Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
  3. Radiation Oncology Network, Western Sydney Local Health District, Westmead, NSW, Australia
  4. Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
  5. South West Sydney Clinical Campuses, UNSW Medicine and Health, Liverpool Hospital, Liverpool, NSW, Australia
  6. Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, NSW, Australia

Background: In 2022, an Australian set of 26 multidisciplinary colorectal cancer (CRC) quality indicators (QIs) were identified to have utility in the measurement of quality of care in CRC (Donnelly 2023).

Aim: To test the feasibility of utilising the CRC QI set on a population-based linked dataset.

Methods: Data were obtained on adult patients diagnosed with CRC (ICD-10-AM codes C18-C20) between 01/07/05-31/12/2019 from the New South Wales (NSW) Cancer Registry. The NSW Cancer Registry data were linked to the NSW Clinical Cancer Registry, NSW Admitted Patient Data Collection, and NSW death records. The feasibility assessment was conducted in four stages; (1) data mapping to match variables required (2) review of publicly available state-wide and site-specific reports using these datasets for routine reporting of the 26 QIs, (3) assess completeness and coverage of data variables using proportional analyses, and (4) pilot calculation of feasible QIs where data exists.

Results: Data mapping found 14 of the 26 QIs were potentially feasible. Data relevant to imaging, pathology, specialist consultations, some surgical outcomes, and supportive care QIs were not available. Linked data of 38,430 CRC patients diagnosed between 2005-2019 were available to test eight surgical QIs. At review of existing state-wide reports, three of eight surgical QIs were routinely reported and deemed feasible. The remaining five surgical QIs were calculated with the linked dataset, of which a further three were feasible. Linked data of 8,439 CRC patients diagnosed between 2005-2014 were available to test six (neo)adjuvant therapy QIs. However, the data required to measure the these QIs had significant limitations in data coverage, completeness, and quality rendering the calculations unreliable, and some futile. The data completeness for staging ranged from 74-85% and almost one half of diagnosis dates were illogical. Overall, six of the 26 QIs were feasible and reliable to measure using the linked dataset. These were all surgical and included those that addressed unplanned re-operation/re-admission, colonoscopies, mortality and survival.

Conclusion: This study identified six clinically relevant QIs that were feasible to measure using available NSW population-based data. However, these QIs were restricted to surgical processes and outcomes. A large gap remains in the availability of adequate data to produce clinically meaningful quality measurements for a multidisciplinary CRC team, particularly in diagnostic work-up, (neo)adjuvant therapy and supportive care.

  1. Donnelly, C, Or, M, Toh, J, et al. Measurement that matters: A systematic review and modified Delphi of multidisciplinary colorectal cancer quality indicators. Asia-Pac J Clin Oncol. 2023; 1- 16. https://doi.org/10.1111/ajco.13917