School of Public Health and Preventive Medicine Gaining traction and propelling change: rubber on the road Adjunct Associate Professor Jeremy Millar Director, Radiation Oncology, Alfred Health, Monash University School of Public Health and Preventive Medicine Rap sheet Alfred Health RO Clinical Registry VCR - prostate cancer VCR - Rectal cancer VCR - Bladder cancer Victorian Prostate Cancer Registry School of Public Health and Preventive Medicine Australian Prostate Cancer Registry Victorian pilot Lung cancer registry Biogrid, esp colorectal, prostate Australian Plasma cell disorders Breast cancer Thyroid cancer registry Alfred Health oesophageal cancer registr Prostate seed brachytherapy registry School of Public Health and Preventive Medicine School of Public Health and Preventive Medicine School of Public Health and Preventive Medicine School of Public Health and Preventive Medicine Source: Porter ME. What is value in health care? N Engl J Med. 2010 23;363(26):2477–81. School of Public Health and Preventive Medicine Source: Porter & Lee. The Strategy That Will Fix Health Care. Harvard Business Review October 2013. School of Public Health and Preventive Medicine School of Public Health and Preventive Medicine Clinicians! School of Public Health and Preventive Medicine School of Public Health and Preventive Medicine The dogs bark, but the caravan moves on… -Arab proverb School of Public Health and Preventive Medicine Individual change Education Opinion Leaders Source: Ham C. Improving the performance of health services: the role of clinical leadership. Lancet. 2003 7;361(9373):1978–80 Peer-review processes Financial Ownership of idea and process Appeals to ethical professional principles NOT CONTROLS School of Public Health and Preventive Medicine Organisational change Education & training of clinical leaders Support of clinical leaders Allow time Organizational development Support teams Rapid iterations Source: Ham C. Lancet. 2003 Victorian Cancer Registry All Diagnoses 5311 cases 776 deaths State and National Death Registries Variation in death rate Cancer service regions Victorian Cancer Registry All Diagnoses 5311 cases 776 deaths State and National Death Registries Victorian Cancer Registry All Diagnoses Link to medical records & patients School of Public Health and Preventive Medicine VPCR – what worked well? Cumulative & Stacked Accrual by Hospital Cabrini Peter Mac Austin School of Public Health and Preventive Medicine What registries can achieve NCCN risk category at baseline and treatment provided Source: Prostate Cancer Registry 2012 School of Public Health and Preventive Medicine Treatment patterns * Frydenberg, Millar et al MJA 2000; 172:270-274 School of Public Health and Preventive Medicine What registries can achieve Sexual BOTHER according to primary treatment approach RP Big problem Moderate problem EBRT Very small/Small problem LDR 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Source: Prostate Cancer Registry 2012 School of Public Health and Preventive Medicine Victorian Prostate Cancer Registry School of Public Health and Preventive Medicine School of Public Health and Preventive Medicine School of Public Health and Preventive Medicine Confessions Concern about “data ownership” Pre-existing datasets / registries Clinical workload Minimal objective dataset Funding Rapid case-ascertainment Unbiased complete case-ascertainment Extending the registry School of Public Health and Preventive Medicine Accent-u-ate the positive… Elim-in-ate the negative… School of Public Health and Preventive Medicine Organisational influences on clinicians Establishment of higher goal Principles based Health service administrative champions e.g. Epworth Government champions School of Public Health and Preventive Medicine Individual clinicians Establish trust with clinicians – – – – – – – – – Communication & consultation Meet them face-to-face (hopefully with one or more of their own) Win intellectual argument Involvement Identification of influencers. Support them. Process-driven Respect Governance Group Awareness of clinical sensitivities Clinical Champions Relieve clinicians of workload School of Public Health and Preventive Medicine Change to clinicians’ environment Need to demonstrate the registry’s ability to improve patient care publish methodology/findings Where possible, integrate into clinical practice data collection as part of normal clinical process feedback of results timely and relevant Good governance structures credibility maintain independence from government and groups within specialist areas Incentives Funded forums to discuss outcomes/research stemming from registries/ability to be involved in publications School of Public Health and Preventive Medicine Thanks to Sue Evans John McNeil Joanne Dean Julie Wood Fanny Sampurno Catherine Pound Catherine Mulvany
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