Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Surgery

Supervisor

McGee, Jacob

2nd Supervisor

Nicholas Power

Joint Supervisor

3rd Supervisor

Terry Zwiep

Abstract

Ontario’s new health funding model, Quality-Based Procedures (QBP), designated certain performance outcomes that would determine future cancer care funding. We examined pre-specified outcomes for radical prostatectomy, one of the procedures integrated into QBP funding in 2015. We conducted two retrospective studies using provincial administratively-linked databases, including patients who underwent radical prostatectomy between April 2010 and March 2019. Our first study evaluated the 30-day complication rate and the trend in surgical approach. Our second study compared QBP outcomes before and after implementation of the funding model. The first study demonstrated that complication rate improved over the study period, possibly due to a transition to robotic approach for radical prostatectomy. The second study showed that complication rate and length of stay did improve after implementation of QBP, but not clearly because of the model. Unplanned visit rate and Wait 2 time worsened significantly, and there was no change in re-operation rate.

Summary for Lay Audience

In 2015, the Ministry of Health and Long-Term Care of Ontario and Cancer Care Ontario transitioned away from the old lump sum funding model to an outcomes-based funding model for the delivery of certain surgical oncology procedures. This was done to incentivize improvement in quality of care and outcomes delivered by cancer care groups. This new health funding model, called Quality-Based Procedures (QBP), designated certain Quality-Indicators (QIs) as performance outcomes that would be tracked by the province in order to determine future funding that cancer care groups would receive. As there is a need to evaluate whether the new model is improving outcomes, our project examined the QIs for radical prostatectomy, one of the procedures now integrated into QBP funding. We performed a brief review of the evidence behind funding model efficacy at improving outcomes. We reviewed the literature behind each QI outcome and expected rates. Prostate cancer as a disease, along with radical prostatectomy as a surgery were reviewed. We conducted two retrospective studies using provincial administratively-linked databases, including patients who underwent a radical prostatectomy between April 2010 and March 2019. Our first study evaluated the 30-day complication rate in depth, as well as the trend in surgical approach to radical prostatectomy. Our second study compared QI outcomes, which include 30-day mortality, 30-day complication rate, 30-day re-operation rate, 30-day unplanned visit rate, proportion meeting the Wait 2 target, and proportion meeting the length of stay (LOS) target before and after implementation of the QBP funding model. There was improvement in both 30-day complication rate and proportion meeting LOS target. However, more detailed analysis demonstrated both outcomes had already been improving, and did not get altered significantly upon implementation of the QBP model. However, this does align with greater utilization of robotic surgical approach, casting uncertainty as to whether conclusions can be drawn about the effect of the funding model in isolation. Other outcomes including 30-day unplanned visit rate and Wait 2 target time worsened significantly, while the 30-day re-operation rate remained unchanged. Overall, this study did not demonstrate that the QBP model improved outcomes, but further study is needed.

Additional Files
Worksheet in DCP_Radical prostatectomy_phase 1 (v2.9) for prelim submission.xlsx (16 kB)
CCI, ICD-10, OHIP codes used for data analysis plan
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