Evaluation of a Health Care Policy Intervention to Change the Organization and Delivery of Lung Cancer Surgery in Ontario


Project Leader: David Urbach, MD, M.Sc., FRCSC

• Head of Prediction and Planning, Surgical Oncology Program, Cancer Care Ontario;
• Program Scientific Lead, Cancer Program, Institute for Clinical Evaluative Sciences;
• Adjunct Scientist, Institute for Clinical Evaluative Sciences;
• Associate Professor, Departments of Surgery and Health Policy, Management and Evaluation, University of Toronto;
• Staff Surgeon and Surgeon-Scientist, Division of General Surgery, University Health Network.

The Surgical Oncology Research Network came together within the preceding Patterns of Care Network to conduct research on the regional distribution of cancer surgery, access to surgical care, human resources for cancer surgery and regional population-based planning. The first project from this group was to create a descriptive practice atlas, Cancer Surgery in Ontario, published in 2008.

The atlas used administrative data linked to the Ontario Cancer Registry (OCR) to describe a comprehensive portrait of surgical care for cancers newly diagnosed in Ontario in 2003-2004, and serves as a baseline before introduction of several important changes in the health care system in Ontario, such as the creation of the Local Health Integration Networks (LHINs).

As a logical next project, the Surgical Oncology Research Network developed a plan to look at the effect of regionalization of thoracic surgery on the organization of lung cancer surgery, as well as complications and other outcomes of care. This study will be the first to go beyond simple description of volume-outcome relationships to actually evaluate the effects on outcomes, such as surgical morbidity and mortality, of a policy mandating that certain surgical procedures occur only in high-volume institutions by high-volume providers. The study will also qualitatively explore the lessons learned from implementation of this novel policy.