Building a learning network to accelerate improvement in pancreas cancer care and outcomes: Canopy Cancer Collective.

Abstract

368 Background: Pancreas cancer (PC) survival is among the lowest of all malignancies. While limited advances in treatment are a major driver of this reality, ample opportunity exists to improve outcomes by reducing care variation, providingcoordinated, comprehensive care, and accelerating research. Learning health networks (LHNs) improve outcomes in pediatric diseases through such mechanisms, yet are not widely implemented in adult care. We aimed to develop, implement, and collect initial outcomes of the first oncology LHN, the Canopy Cancer Collective (CCC). Methods: In 2019, we established CCC to apply to PC the LHN model, including core tenets of continuous quality improvement (QI), data-sharing, empowered interdisciplinary teams and a stakeholder community including individuals with PC, and focus on community-defined improvable “outcomes that matter”. Six care centers were selected to join the LHN, and engaged in a collaborative design process to co-create a set of improvement aims and change ideas. Center team members received training in basic QI methods/tools guided by the IHI Model for Improvement and were coached to apply these to local improvement efforts. LHN infrastructure and technology enabled sharing of new ideas, best practices, and results amongst centers. Eight more centers joined in 2021, and an outcomes database built and implemented. Results generated by this database will inform center-specific and Network-wide improvement efforts and allow the LHN to undertake research. Results: Currently, 14 care centers are active participants in the CCC LHN. Five key outcomes have been defined as key targets, and centers have co-created and tested change ideas organized around key drivers of excellent PC care including proactive, timely care, aligned/prepared multidisciplinary teams, informed, activated patients, and accurate diagnosis and disease classification. 100% of care centers are trained in QI methods and actively testing change ideas. For example, in May 2022, 11 centers reporting on monthly QI activities met on average 4 times to advance QI projects, deploying a mean of 2.9 plan-do-study-act (PDSA) cycles (range, 0-5) focused on key drivers and outcomes, including reduced time to treatment, increased trial enrollment, assessment of patient experience, and improved data capture. Conclusions: Building a sustainable LHN for PC centers is feasible and has set the stage for improving patient and provider outcomes through iterative community-building, continuous improvement, and sharing of data and multidisciplinary best practices. Results lay the foundation for expansion not only in PC, but translation to other complex malignancies that will benefit from transformative, system-based approaches to outcome improvement.

Variation in outcomes and practice patterns among patients with localized pancreatic cancer: the impact of the pancreatic cancer multidisciplinary clinic

“…Given these benefits that MDC care can provide, efforts to more broadly reorganize cancer care to deliver inter-disciplinary coordinated care to pancreatic cancer patients should be incentivized and pursued ( 26 ). Given the resources required to support MDCs, additional efforts to characterize the cost-effectiveness of providing such inter-disciplinary care will be important ( 11 , 27 ).…”

Development of a Neoadjuvant Treatment Pathway to Standardize Pancreatic Cancer Care and Improve Outcomes Across a Large Diverse Health System

“…Recently, a number of high-volume centers, including Northwell Health, established a partnership with the goal of setting quality metrics to improve care 14 . Our group saw an opportunity to establish a set of standards for the management of PDAC patients with disease amenable to resection, under a standardized process we call a neoadjuvant therapy pathway (NATP).…”