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Quality Dimensions

The Cancer System Quality Index uses quality dimensions as a framework for cancer system performance reporting. The indicators selected ensure comprehensive representation across the 6 quality dimensions that reflect a high performing cancer system: Effective, Efficient, Equitable, Timely, Safe and Person-Centred. These dimensions aligned with the 6 system goals of the Ontario Cancer Plan and the quality domains from the National Academy of Medicine.

Quality Dimension
Quality Dimension Definition How This Measures Performance
Effectiveness Providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit (avoiding underuse and misuse, respectively). The cancer system in Ontario aims to provide effective cancer care based on best evidence. Effective cancer care means that patients receive evidence-based care that facilitates the best possible outcome for their health.
Efficient Avoiding waste, including waste of equipment, supplies, ideas and energy. Ontarians want healthcare resources to be used optimally, with minimal duplication and waste. To continue providing high quality cancer services into the future, it is important for our cancer system to be sustainable so that demand for care is met.
Equitable Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location and socioeconomic status. Everyone in Ontario should be their healthiest. Better health equity across the cancer system helps ensure that people are not disadvantaged by who they are, where they live or what resources they have.
Timely Reducing waits and sometimes harmful delays for both those who receive and those who give care. Many patients say that waiting for care is one of the most stressful parts of having or suspecting cancer. Reduced wait times are important for quality of life and decision-making, and can be important for clinical outcomes.
Safe Avoiding harm to patients from the care that is intended to help them. Patients, caregivers and healthcare professionals expect their health system to deliver safe care. There is a need to be proactive in reducing avoidable harm in all care settings.
Person-Centred Providing care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring patient values guide all clinical decisions. The patient’s view of the care experience is an important factor that defines excellence of care. The delivery of responsive and respectful person-centred care is important for optimizing quality of life across the cancer care continuum.

The focus on quality as measure of performance is crucial for the continuous drive towards better cancer care in Ontario. The following table shows which quality domains relate to each indicator reported in the Cancer System Quality Index. Indicators may fall under multiple domains.

Indicators by quality dimension
Indicator Safe Effective Equitable Person-Centred Timely Efficient
Modifiable Risk Factors - Alcohol Consumption Exceeding Cancer Prevention Recommendations N/A Yes Yes N/A N/A N/A-
Modifiable Risk Factors - Overweight/Obesity N/A Yes Yes N/A N/A N/A
Modifiable Risk Factors – Tobacco Smoking N/A Yes Yes N/A N/A N/A
Modifiable Risk Factors – Physical Inactivity N/A Yes Yes N/A N/A N/A
Modifiable Risk Factors – Inadequate Vegetable and Fruit Consumption N/A Yes Yes N/A N/A N/A
First Nations Cancer Burden N/A Yes Yes N/A N/A N/A
Modifiable Risk Factors for Cancer in First Nations N/A Yes Yes N/A N/A N/A
Modifiable Risk Factors for Cancer among Inuit in Ontario and Other Regions in Canada N/A Yes Yes N/A N/A N/A
Modifiable Risk Factors for Cancer in the Métis Peoples of Ontario N/A Yes Yes  N/A N/A N/A
Engagement with First Nations, Inuit, Métis and Urban Indigenous Communities: Developing and Sustaining Relationships Within the Cancer System N/A Yes Yes N/A N/A N/A
Smoking Cessation in Regional Cancer Programs N/A Yes N/A N/A N/A N/A
Breast Cancer Screening Follow-up N/A Yes N/A N/A Yes N/A
Breast Cancer Screening Participation N/A Yes N/A N/A Yes N/A
Breast Cancer Screening Quality N/A Yes N/A N/A N/A N/A
Colorectal Cancer Screening Follow-up N/A Yes N/A N/A Yes N/A
Colorectal Cancer Screening Participation N/A Yes N/A N/A Yes N/A
Colorectal Cancer Screening Quality Yes N/A N/A N/A N/A N/A
Quality and Efficiency of Staging Tests in Breast Cancer Patients N/A Yes N/A N/A N/A Yes
Reporting of Cancer Stage at Diagnosis N/A Yes N/A N/A N/A N/A
Access to PET/CT Scans N/A Yes N/A N/A Yes N/A
Time from Diagnosis to Start of Treatment N/A N/A N/A N/A Yes Yes
Access to Hematopoietic Cell Transplant N/A N/A N/A N/A Yes Yes
Lung Resection for Stage 1 Patients N/A Yes Yes N/A N/A N/A
Lymph Node Sampling in Colon Cancer Surgery N/A N/A N/A N/A N/A N/A
Margins in Prostate Cancer Surgery Yes Yes N/A N/A N/A N/A
Margins in Rectal Cancer Surgery Yes Yes N/A N/A N/A N/A
Post-Surgery Mortality – Lung Cancer Yes Yes N/A N/A N/A N/A
Low-Risk Prostate Cancer Patients with No Record of Treatment Yes Yes N/A N/A N/A N/A
Symptom Burden N/A N/A N/A Yes N/A N/A
Unplanned Hospital Visits and Readmission After Surgery Yes N/A N/A N/A N/A Yes
Survivorship Care: Breast Cancer Survivors N/A Yes N/A N/A N/A N/A
Survivorship Care: Colorectal Cancer Survivors N/A Yes N/A N/A N/A N/A
Emergency Department Visits in the Last 30 Days of Life N/A Yes N/A Yes N/A Yes
Intensive Care Unit Admissions and Transfusions in the Last 2 Weeks of Life N/A Yes N/A Yes N/A Yes

There are several domains and disease sites for which indicators are still under development; future editions of the Cancer System Quality Index will provide a more comprehensive view of performance along the quality domains and will include additional indicators representative of a high performing cancer system. See Indicators Under Development for more information.