Grant: Project Grant

Thoracic cancers (e.g. lung, esophagus) include the leading causes of cancer death in Canada; and surgery is the cornerstone of their cure. Roughly 125 surgeons in 30 centers perform all high-stakes lung cancer and all thoracic surgery in Canada, with a high chance of cure, yet a high risk of post-operative adverse events (AEs). Recent reports have demonstrated too much variation in Canadian cancer care and outcomes, as localized centers of excellence in different domains of thoracic surgical care have evolved. It is vital that this small number of practitioners better share best practice and experience. Recognizing the importance of a data-driven process, members of the Canadian Association of Thoracic Surgeons developed a national infrastructure to implement standardized data collection (currently 13 centers and expanding to 19). Data collected includes core surgical information including the occurrence and severity of all post-operative AEs. We have initiated a program of multicenter seminars to share best experience and evidence, and generate consensus recommendations to improve care. The overall aims of this research proposal are to perform a quantitative evaluation of clinical impact of this program, evaluate the feasibility of adding further patient-reported data collection and linkages, as well as a qualitative evaluation of the impact of this program on individual surgeons. This mixed-methods evaluation of the impact of this complex national quality improvement interventions offers the optimal means to rigorously evaluate impact, challenges and opportunities, and improve the effectiveness of this national learning network, relevant to innumerable surgical and intervention-based disciplines. A multidisciplinary group of researchers, clinicians, patients, and stakeholders are poised to evaluate and improve this national network with potential to transform thoracic surgery in Canada and provide a reproducible model for a Canadian learning health system.