Cancer Quality Performance Indicator Programme

In Aotearoa, people have differences in health outcomes that are not only avoidable but unfair and unjust. An equity approach recognises that people with different levels of advantage require different resources to get equitable health outcomes.

The QPI programme aims to highlight inequities and support the achievement of equity in the cancer system in a range of ways:

• Ensuring diversity on our expert working groups
• Selecting indicators that highlight inequities
• Undertaking data analysis that reports indicators by geographic region, age, gender, ethnicity
• Highlighting inequities in our reports
• Broad consultation with relevant parts of the cancer and health sector
• Providing data to enable prioritisation of quality improvement initiatives that aim to reduce inequities.

Te Tiriti o Waitangi provides an imperative for the Crown to protect and promote the health and wellbeing of Māori. This includes responding to and meeting Māori health needs, as well as allowing Māori self-determination of their treatment and/ or the approach to their treatment.

Given that Māori have the poorest overall health status in Aotearoa and are significantly disadvantaged in terms of health inequities, it is essential that we ensure the rights and meet the needs of Māori people.

The Waitangi Tribunal Health Services and Outcomes Inquiry (Wai 2575), initiated in November 2016, began hearing all claims concerning grievances relating to health services and outcomes of national significance for Māori. From the initial hearings related to primary health care. The Waitangi Tribunal made several recommendations in accordance with the principles of equity, active protection, options, and partnership. The QPI programme has and will prioritise these principles.

QPIs are developed to support quality improvement that will help to address and deliver improvements for Māori. This includes presenting data stratified by ethnicity, and in the future by age-standardisation. Quality improvement planning by services will require initiatives that improve both access and treatment for Māori.

• The QPI programme is aimed at clinicians and health professionals involved in cancer care, as well as those responsible for the delivery of cancer services and management within treatment providers.

• The intention is for clinicians and management to review the cancer specific QPI reports and identify areas where their service might be outside the norm compared with other districts for a specific indicator. This can highlight where further investigation into current practice might be needed and inform the development of cancer service quality improvement plans and initiatives.

• It is also hoped that the programme will provide useful information for patients and their whānau.

• Address an area of clinical importance that could impact on the quality and outcome of care delivered for people diagnosed with cancer.

• Support our goal of achieving Māori health gain and equity.

• Be able to be measured with data from the Ministry of Health’s national collections.

• Be evidence based and be appropriate for driving quality improvement.

• Districts can identify other districts which are performing well against a particular QPI and seek advice from them.

• Districts and clinicians can review the recommended actions and determine what to implement locally.

• Clinicians can review the data to identify practices for quality improvement.

• Providers can work with Te Aho o Te Kahu on service improvements, if suitable.

• Te Aho o Te Kahu can work with providers to undertake local, regional and national quality improvement projects, if suitable.

In addition to internal experts and consultation, the QPI programme is supported and advised by a range of clinical leadership and advisory groups including:

Clinical Assembly

The Clinical Assembly provides clinical advice to support the long-term strategic direction for reducing cancer incidence and improving cancer services across the cancer continuum. This includes driving equitable health outcomes for priority populations, specifically focusing on Māori, Pacific peoples, those who live in rural and highly deprived areas, those with poor mental health and disabled people.

QPI Advisory Group

The QPI Advisory Group provides strategic and operational advice for the QPI programme. The group provides high-level review of deliverables to ensure that Te Aho o Te Kahu provides intelligence that is high-quality and relevant for the cancer sector overall. In addition, to provide ongoing support for the QPI programme within the cancer sector.

Cancer-specific working groups

The cancer-specific working groups support Te Aho o Te Kahu to promote a nationally co-ordinated and consistent approach to the delivery of care for people with cancer. In addition, to promote equitable, timely and quality care for those with cancer and family/whānau.

Craft working groups

Radiation Oncology Working Group, Medical Oncology Working Group, Haematology Working Group

The craft working groups monitor system performance and providing advice on relevant clinical and service delivery issues including clinical effectiveness, service improvement, service development, treatment guidelines and service standards.

Te Aho o Te Kahu provides the opportunity for health professionals involved in cancer diagnosis and treatment services, and other key stakeholders including Hei Āhuru Mōwai (Māori Cancer Leadership Aotearoa) and He Ara Tangata (Te Aho o Te Kahu Consumer Reference Group), to provide feedback on the QPIs prior to finalisation.

Public consultation

Draft versions of QPI documentation, such as the potential QPI description reports, are published on our website and feedback is welcome from stakeholders.

For more information on Te Aho o Te Kahu governance and advisory structure, please click here.

The QPI programme develops a range of reports and documents for each cancer type. Below is a list of the reports with descriptions about their purpose.

Quality Performance Monitoring Reports

The monitoring report presents QPI results by district. This can help them to understand areas where they are not performing as well as their peers and therefore should apply quality improvement principles to plan and implement improvement projects.

Quality Performance Monitoring Report Updates

The monitoring reports are/ will be updated every three years with more recent data. It is generally the same indicators recalculated using the most up-to- date data available in national collections. Going forward, it is also an opportunity to identify new data available that may allow the aspirational indicators to be measured, evaluate changes over time, and identify contributing factors to any unwarranted variations observed.

Quality Performance Indicator Descriptions Reports

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 nationally available data to measure and report on them. The latter type of QPI remains ‘aspirational’ because we hope to be able to report on them in future when data improvement projects bring new data online.

Technical Specifications Reports

The QPI technical specifications report outlines method for calculating each QPI that is reported in the associated monitoring report. These reports provide enough detail for the reader to replicate our calculations using their own data. We have provided information on data sources, numerator criteria, denominator criteria, relevant data codes and descriptions and data flow diagrams.

Action Plans

The action plan (previously named ‘improvement plans’) outlines selected QPIs and provides recommended actions to cancer care providers and clinicians. The action plan should be read in conjunction with the monitoring report. The ‘recommended actions’ are intended as a guide to the types of actions providers could take to improve their performance, although providers should develop and implement local quality improvement with actions appropriate to their local context and priorities. The regional hubs can offer support to develop and implement local quality improvement plans, setting out actions appropriate to the local context and priorities.

To see all reports click here.

All patient data that is used in the QPI programme comes from datasets in the Ministry of Health’s National Collections. These only include publicly funded treatments provided in Aotearoa. Some public provision is contracted to private providers and this information is included in the QPI data set.

New Zealand Cancer Registry

The New Zealand Cancer Registry (NZCR) is a population-based registry. It is the most comprehensive source of information on people who have been diagnosed with malignant cancer in Aotearoa. It is primarily based on pathology reporting but includes information from other sources, including death certificates and reviews of the diagnosis coding for people admitted to public hospitals.

National Minimum Dataset

The National Minimum Dataset (NMDS) is a national collection of public and private hospital discharge information, including coded clinical data for inpatients and day patients. Linking NZCR data to NMDS data gave us a view of the procedures each patient underwent as treatments in public hospitals leading up to and following their lung cancer diagnosis.

Radiation Oncology Collection

The Radiation Oncology Collection (ROC) is a national collection of private and public courses of radiation therapy delivered. Treatment centres have submitted data electronically in an agreed format since 2018, although most providers have supplied historic data back to 2012. Data collected for each course of radiation therapy delivered includes treatment centre, diagnosis code (according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), 8th edition), treatment site, intent of the treatment, dose, fractions, and number of treatment sessions. Only publicly funded radiation therapy treatments were extracted from this collection for linking with the NZCR data.

Pharmaceutical Collection

The Pharmaceutical Collection (PHARMS) is a national data warehouse that supports the management of pharmaceutical subsidies and contains claim and payment information from pharmacists for subsidised dispensing. The PHARMS collection includes names of drugs dispensed and date of dispensing.

National Non-Admitted Patients Collection

The National Non-Admitted Patients Collection (NNPAC) information includes event-based purchase units that relate to medical and surgical outpatient events and emergency department (ED) events. This includes information on the type of service provided and the health specialty involved. The NNPAC allows the Ministry of Health and districts to monitor outpatient activity and ensure that districts are appropriately remunerated for the services they provide. The NNPAC provides national consistent data on non-admitted patient (outpatient and ED) activity.

The Ministry of Health started work on the QPI programme in 2018. When Te Aho o Te Kahu was formed in December 2019, the programme was transferred to the agency.

To date, we have completed QPI projects for bowel, lung, and prostate cancer. For bowel cancer, the first three-yearly update was published in April 2022. Breast and pancreatic cancer QPI projects are currently underway.

Bowel Cancer

Bowel cancer QPIs were the first to be developed in 2019. The action plan, technical specifications, and monitoring report were completed in 2019/2020. Bowel cancer QPIs were recalculated in 2022.

Key findings:

• Māori are more likely than European/Other to be diagnosed following presentation to an emergency department, undergo emergency surgery, and undergo an abdominoperineal resection for rectal cancer.
• 90-day post-operative mortality showed a downward annual trend.
• Between 2017 and 2019, there was an increase in diagnosis following screening from 2.8 percent to 10.1 percent, which aligns with the roll out of the National Bowel Screening Programme.
• Compared with the previous report, a higher proportion of people undergoing surgery had 12 or more lymph nodes pathologically examined.
  
  

Lung Cancer

Lung cancer QPIs were developed in 2021. The action plan, technical specifications, and monitoring report was completed in 2021. Lung cancer QPIs recalculations will be published in 2023 or 2024.

Key findings:

• Lung cancer contributes to ethnic inequities in health outcomes in Aotearoa, with rates of lung care nearly four times higher for Māori compared with non-Māori (83 per 100,000 for Māori, 22.6 per 100,000 for non-Māori).
• A high proportion of people (45 percent) were diagnosed with lung cancer following a presentation to an emergency department.
• Overall, one-year survival in Aotearoa has improved over time. At 41.6 percent, our one-year survival rate is higher than that of the United Kingdom (36.7 percent) but lower than Australia’s survival rate (54.3 percent)
  
  

Prostate Cancer

Prostate cancer QPIs were developed in 2021. The action plan, technical specifications, monitoring report were completed late 2021. Prostate cancer QPIs recalculations will be published in 2023 or 2024.

Key findings:

• Māori men were more likely than men in the European/Other ethnic group to be diagnosed in association with presentation at an emergency department (ED) (8.4 percent vs 5.8 percent).
• Overall, a relatively low proportion of patients (6.1 percent) were diagnosed with prostate cancer in association with a presentation to ED.
• Overall, 28.9 percent of men had some form of public hospital curative treatment, with wide variation between DHBs (ranging from 16.7 to 44.5 percent).