Using a disease pathway management (DPM) approach to improve the quality of lung cancer care in Ontario.
Bibliographic record
Abstract
93 Background: Cancer Care Ontario (CCO) is mandated to oversee quality of cancer care in Ontario and began its Lung Cancer (LC) DPM initiative in 2009. DPM has 4 objectives: align provincial quality improvement (QI) initiatives by disease site; map the patient journey and identify gaps in evidence/quality in clinical practice that impact care or the patient experience; set and manage regional quality indicators across the pathway; and leverage tools to model the impact of policy decisions. Methods: The LC DPM drafted a disease pathway map and established 5 multidisciplinary working groups (WGs) each focussed on a phase of the LC patient journey: prevention, screening, and early diagnosis; diagnosis; treatment; palliative care; the patient experience. WGs held 25 two-hour meetings and developed ideas for 17 QI projects. 8 were selected for discussion at a provincial consensus conference and yielded a Priorities for Action Report. Regional “roadshows” were held in all 14 regions of the province at which region-specific data on incidence, stage at diagnosis, compliance of treatment with guidelines and wait times, amongst other metrics relevant to LC, were shared with the regional care providers. Funding was provided by CCO for regional QI based on the data and identified priorities. Results: Completed diagnostic and treatment pathways are posted on CCO’s website as are educational materials on dyspnea management, including a patient video and a document prepared by patients for patients “Understanding Lung Cancer.” Lung diagnostic assessment units/programs have been initiated in 14 regions. An audit is underway to better understand the barriers to the uniform uptake of evidence-based practices across the province. The percent of LC patients whose symptoms are assessed at least once a month using a standardized symptom assessment instrument (ESAS) has improved. Conclusions: Regional cancer programs are now aware of their performance on a range of LC specific quality metrics. Standardized diagnostic and treatment pathways have been developed and assessment units have been implemented across the province.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.008 | 0.002 |
| Scholarly communication | 0.005 | 0.002 |
| Open science | 0.002 | 0.008 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".