caa a22 4500 445335289 CHVBK 20180317142752.0 cr unu---uuuuu 170323e20110301xx s 000 0 eng 10.1245/s10434-010-1337-0 doi (NATIONALLICENCE)springer-10.1245/s10434-010-1337-0 A Qualitative Assessment of a Provincial Quality Improvement Strategy for Pancreatic Cancer Surgery [Elektronische Daten] [Frances Wright, Margaret Fitch, Angela Coates, Marko Simunovic] Purpose: A study released in Ontario, Canada (1999) found a positive relationship between surgical volume and patient outcomes after pancreatic resection for cancer. In response, a province-level quality improvement (QI) strategy was initiated, which included the development and dissemination of a standards document and an audit and feedback exercise with surgeons. We assessed perceptions and actions of Ontario surgeons to this QI strategy. Methods: We conducted semistructured interviews with surgeons and chiefs of surgery at three types of hospitals providing pancreatic cancer surgery, including hospitals that provided high volumes of surgery after 2001, hospitals that provided low volumes of surgery after 2001, and hospitals that provided low volumes of surgery before 2001 and stopped after year 2001. High-volume hospitals performed ten or more surgeries annually. The interview guide was based on Pathman's model of physician practice change (i.e., awareness, agreement, adoption, and adherence). Grounded theory guided data collection and analysis. Results: Twenty-four interviews were completed. All groups were aware of the 1999 province-level QI strategy and agreed in principle with the standards document recommendations. Many surgeons had concerns regarding the number of cases necessary to be considered high-volume. Decisions to cease pancreas cancer surgery were occurring before 1999 and made at the surgeon level, often with input from the chief of surgery, but rarely with input from hospital administration. Conclusions: Surgeons were aware of and agreed in principle with the province-level QI strategy for pancreas cancer surgery. Decisions to continue or cease performing surgery were made by individual surgeons. Society of Surgical Oncology, 2010 Wright Frances Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada aut Fitch Margaret Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada aut Coates Angela Department of Surgery, McMaster University, Hamilton, ON, Canada aut Simunovic Marko Department of Surgery, McMaster University, Hamilton, ON, Canada aut Annals of Surgical Oncology Springer-Verlag 18/3(2011-03-01), 629-635 1068-9265 18:3<629 2011 18 10434 https://doi.org/10.1245/s10434-010-1337-0 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1245/s10434-010-1337-0 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Wright Frances Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Fitch Margaret Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Coates Angela Department of Surgery, McMaster University, Hamilton, ON, Canada aut NATIONALLICENCE 700 1- Simunovic Marko Department of Surgery, McMaster University, Hamilton, ON, Canada aut NATIONALLICENCE 773 0- Annals of Surgical Oncology Springer-Verlag 18/3(2011-03-01), 629-635 1068-9265 18:3<629 2011 18 10434 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer