Bowel Cancer Quality Performance Indicators

Bowel cancer quality performance indicators (QPIs) are used to improve the quality of cancer services and deliver better outcomes for people diagnosed with bowel cancer.

Bowel cancer is a leading cause of illness, disability, and death in Aotearoa. During 2017 and 2018 the Ministry of Health and the National Bowel Cancer Working Group (NBCWG) worked together to develop a set of proposed QPIs for bowel cancer. This work transferred from the Ministry to Te Aho o Te Kahu in December 2019.

During 2017 and 2018, the Ministry of Health’s Cancer Services team and NBCWG worked together to develop a set of QPIs for bowel cancer. The first Bowel Cancer Quality Improvement Monitoring Report using 2013 – 2016 was published in 2019. In 2022, the first Bowel Cancer Quality Improvement Monitoring Report Update, using 2017 – 2019, data was released.

Quality Improvement Monitoring Reports

The original Bowel Cancer Quality Improvement Report was published in 2019, covering the years 2013 to 2016.

In 2022, the Bowel Cancer Quality Improvement Monitoring Report Update was published. This report update presents data for seven QPIs. Six of these were originally calculated and reported on in the first bowel cancer QPI monitoring report in 2019. The QPI that differs from the 2019 report (abdominoperineal resection) has been chosen to replace one of the original QPIs (stoma-free survival) due to data challenges preventing recalculation of the original QPI.

Te Aho o Te Kahu expects districts (previously District Health Boards prior to 1 July Health and Disability Reforms) will review their performance and, where unwarranted variation is identified, take action to improve their performance and patient outcomes. The differences noted in our findings and discussed in this report will also help guide national quality improvement programmes.

The reported QPIs in the Bowel Cancer Quality Improvement Monitoring Report Update 2021:

Route to diagnosis: Proportion of people with bowel cancer who are diagnosed following a referral to a clinic, screening or presentation to an emergency department (ED) (with or without surgery).
90-day post-operative mortality: Proportion of people with bowel cancer who died within 90 days of surgery (all surgery and elective surgery).
Emergency surgery: Proportion of people with bowel cancer undergoing major resection who have emergency surgery.
Length of stay after surgery: Median length of stay following surgery for bowel cancer.
Lymph node yield: Proportion of people with colon cancer who undergo surgical resection where 12 or more lymph nodes are pathologically examined.
Rectal cancer treatment: Proportion of people having major surgery for rectal cancer who receive a) no radiotherapy (that is, surgery alone), b) pre-operative short-course radiotherapy (SCRT) or c) pre-operative long-course radiotherapy (LCRT).
Abdominoperineal resection: Proportion of people with rectal cancer who had major surgery and an abdominoperineal resection (APR).

Reports:

Quality Performance Indicator Descriptions

The QPI descriptions report outlines the detailed evidence-based descriptions for each indicator including the numerator and denominator. This report should be read in conjunction with the monitoring reports. This document includes indicators that can be measured and those we term ‘aspirational’ that are important for clinical care quality improvement but currently there is no data available to measure and report on them.

Quality Performance Technical Specifications

The QPI technical specifications report outlines method for calculating each QPI that is reported in the associated monitoring report. This method should provide enough detail to replicate our calculations every two year. We have provided information on data sources, numerator criteria, denominator criteria, relevant data codes and descriptions and data flow diagrams.

Improvement Plan (Action Plan)

This action plan should be read in conjunction with the monitoring report. Districts can review the monitoring report to identify where their performance is significantly different to that of other districts. This can then lead to quality improvement principles to plan for and implement improvement projects in those areas.

The ‘recommended actions’ set out in this plan are intended as a guide to the types of actions districts or hospitals could take to improve their performance. Districts and hospitals can develop and implement local quality improvement plans with actions appropriate to their local context and priorities.

We note that some districts and hospitals are already undertaking quality improvement work. The recommendations in this action plan do not prevent additional actions or the Districts and hospitals continuing to follow existing effective quality improvement activities.

National Bowel Cancer Working Group

Role

The National Bowel Cancer Working Group (NBCWG) was established by the Ministry of Health in 2012. The NBCWG has provided expertise and advice to a number of bowel cancer service improvement projects.

In late 2019 the management of the NBCWG was transferred to Te Aho o Te Kahu, the Cancer Control Agency.

From 2022 the management of the NBCWG has been jointly held by Te Aho o Te Kahu and the National Bowel Screening Programme.

Terms of reference

Membership

Chair

Ralph Van Dalen, general surgeon, Te Whatu Ora - Waikato

Members

Ben Lawrence, medical oncologist, Health New ZealandTe Whatu Ora - Te Toka Tumai Auckland
Bernard Mcentee, regional chair, Hawkes Bay District
Chris Hemmings, anatomic pathologist, Canterbury Health Laboratories, Health New Zealand Te Whatu Ora Waitaha Canterbury, and Clinical Associate Professor of Pathology, Ahorangi pāhono o te ara, University of Otago and RCPA Vice President (NZ)
Clarence Kerrison, gastroenterologist / Māori and equity expert, Health New Zealand Te Whatu Ora - Waikato
David Vernon, consultant general and colorectal surgeon, Health New Zealand Te Whatu Ora - Lakes
Denise Robbins, consumer representative
Iain Ward, radiation oncologist, Health New Zealand Te Whatu Ora ‐ Waitaha Canterbury
Janet Hayward, general practitioners college representative, Nelson Private Practise
John McMenamin, general practitioner representative, Wicklow Avenue Medical Centre; Whanganui General Practice
Justin Hegarty, radiologist, Pacific Radiology
Marianne Lill, regional chair, general surgeon, Whanganui
Rozzie Tuitama, consumer representative
Siraj Rajaratnam, regional chair, general and colorectal surgeon, Health New Zealand Te Whatu Ora ‐ Waitematā
Susan Parry, clinical lead, national bowel cancer screening programme (NBSP), national screening unit (NSU)
Teresa Chalmers-Watson, gastroenterologist, Health New Zealand Te Whatu Ora ‐ Waitaha Canterbury.

Minutes

Cancer Care Data Explorer

The Cancer Care Data Explorer (the explorer) is a tool for service providers and clinicians to explore their QPI results by region and district (previously District Health Boards prior to 1 July 2022 Health and Disability Reforms), gender, age group, ethnic group, and neighbourhood deprivation.

The results are presented from the published quality improvement monitoring reports in an interactive dashboard. The dashboard will be updated with further cancer types as each monitoring report is published.

View the Cancer Care Data Explorer.