ECT breast & Re-accredited plan Dr. Somchai Thanasitthichai, M.D., FRCST National Cancer Institute

Innovative development provider NCI context Cancer policy advocacy NCI Center of excellence Innovative development provider TA & HE

Implementation of R&D Scheme Cancer informatics Health care outcome Health care system 1 prevention 2 prevention 3 prevention Palliation Capacity building Cancer incidence Survival rate Life expectancy Health care expense Innovation Prognostic factors Care model Risk factors Risk promoters Risk modifiers Social behavior HPH model Screening model Screening tools Gap analysis Cost benefit Cost effectiveness Cost utility Budget impacts Quality improvement Strategies development Epidemiology Registries PEST

Patient Characteristics new cancer (206) walk-in : refer (10 : 196) Indicator 2017 Oct-16 Nov Dec Jan-17 Feb Mar April May June July Aug Sep Screening clinic 11013 522 724 697 694 575 855 514 734 764 646 814 717 Cancer clinic 8307 731 1023 820 952 895 927 839 935 824 1021 1014 New case of breast cancer 465 33 46 38 45 44 30 35 40 Screening detected cancer 193 11 16 12 20 18 26 7 28 14 (1.75%)

New Case breast cancer Indicators 2014 2015 2016 2017 Surgery 518 361 352 465 Chemotherapy 905 792 670 289(ตค-มีค.) Radiation 382 396 353 365

MMG 2 wk 4/6/6 HPH & awareness Risk assessment Breast CA Dx Check in Screening Risk assessment Breast CA Dx Check in 2 wk Staging & Treatment planning Psychosocial support & counseling Psychosocial assessment Pre treatment preparation 4/6/6 Disease & complications Surveillance Rehabilitation & empower Treatment as planed

MMG 2 wk 4/6/6 HPH & awareness Risk assessment Breast CA Dx Check in cancer myths mis-diagnosis HPH & awareness MMG complications in-accessible Screening mixed up Risk assessment Breast CA Dx Check in 2 wk drop out depression Staging & Treatment planning Psychosocial support & counseling Psychosocial assessment depression Pre treatment preparation 4/6/6 late complications recurrence delayed treatment depression depression drop out Disease & complications Surveillance Rehabilitation & empower Treatment as planed complications

Patient Safety BMCT

Patient Outcome 5 y overall survival 80.9 % Indicators 2015 2016 (Oct-March) Re-admission (28 D) 0.33 Re-operation 0.56 0.99 Complication rate < 10 8.4 4.6 1.82 AE (error) 0.61 4.24:1000

Patient Outcome P.O. bleeding 0.28 1.32 Flap necrosis 0.99 Indicators 2015 2016 2017 P.O. bleeding 0.28 1.32 Flap necrosis 0.99 Wound infection SSI < 2 Shoulder Stiffness (1m.) < 10 4.14 0.31 Shoulder Stiffness (3 m.) < 5 Arm edema (12 m) 3.8 n.a. 0.98 Febrile neutropenia 1.68 2.0 1.8 Extravasation (need Rx) < 0.5 0.05 0.5 Infusion reaction 1.9 2.4* 2.75 Severe moist desquamation < 1 0.35 0.23 0.19

Treatment Efficiency < 5 2.0 2.7 0.64 0.17 0.32 0(ตค.-มีค.) 0.27 Indicators 2015 2016 (Oct-March) Initial drop out (sur) < 5 2.0 2.7 0.64 Initial drop out (cmt) 0.17 0.32 0(ตค.-มีค.) Initial drop out (RT) 0.27 Re-excision rate s/p BCS < 10 4 Postpone OR < 1 1.3 1.1 1.65 LOS (days) mastectomy <10 9.9 8.8 8.15 LOS (days) BCS <5 5.3 4.5 6.09 LOS (days) Reconstruction 9.1 8.09

Service plan Indicators 2015 2016 (Oct-Jan) MMG within 1 wk 80 100 Cyto within 2 wk 96.8 99.0 Patho within 2 wk 98.4 98.8 Surgery within 4 wk 50.6 54.7 46.55 Sur (nci) 63.4 68.3 53.67 Sur (ref) 33.7 32.1 25 Chemotherapy within 6 wk 49.7 46.2 49.04(ตค-มิย.) CMT (nci) 64.3 68.4 68.08 CMT (ref) 28.5 30.2 33.53 Radiation within 6 wk 59.0 65.9 58.65 RT (nci) 64.4 70.4 58.25 RT (ref) 51.7 61.4 59.43

Early stage 70 % NCI Breast cancer stage distribution National Cancer Institute breast cancer data base 1993-2014

Service plan breast cancer data base 2016 Stage I-II (12 regions) Service plan breast cancer data base 2016

Service plan breast cancer data base 2016 Stage I-II (Region 5) 817 cases 75.9 Service plan breast cancer data base 2016

Quality indicators of breast cancer care Thailand

Technolgy Assessment kappa 0.69 vs 0.31 Discordance of CBE results between NCI nurses & Regional hospitals nurses kappa 0.69 vs 0.31

Molecular profile

Research & Development Projects Status 1 prevention Thai breast cancer risk factors Progress Vitamin D in Thais Published 2015 2 prevention CBE model development Screening Biomarkers SBGI Start December 2016 3 prevention U.S guided BCS published 2016/ practice Oncothermia IORT Start March 2017 Hypo-fraction RT LOS project Standard practice 10 years Tamoxifen Policy advocacy TAN scale 4 palliative care Metastasis screening Home town pass away

Thank you

Service Plan Indicators 58 59 60 NCI Ref Sur 50.6 54.7 52.9 66.7 26.1 CMT 49.7 49.8 62.5 68.6 32.9 RT 59.0 65.9 69 68.1 69.8

Criteria for re-acc Hospital สามารถแสดงให้เห็นการบรรลุเป้าประสงค์ขององค์กร สามารถแสดงให้เห็นผลลัพธ์ที่ดีขึ้น โดยเฉพาะ clinical outcome (การดูแลรักษา / การสร้างเสริมสุขภาพ) benchmarking มีการประเมินประสิทธิภาพของระบบหลัก (RM, IC, ยา, เวชระเบียน, การดูแลผู้ป่วย และมาตรฐานวิชาชีพ) มีการใช้นวัตกรรมและความคิดสร้างสรรค์ มีวัฒนธรรมคุณภาพ ความปลอดภัย และ การเรียนรู้ มีบูรณาการของการพัฒนา มีการพัฒนาที่เป็นแบบอย่างให้กับ โรงพยาบาลอื่นๆ

Sur (68.3 : 32.1) CMT (75.0 : 35) RT (70.4 : 61.4)

Sur (68.3 : 32.1) CMT (68.6 : 32.9) RT (70.4 : 61.4)

Service plan breast cancer data base 2015 Stage I-II (12 regions) Service plan breast cancer data base 2015

Service plan breast cancer data base 2016 Stage I-II (12 regions) Service plan breast cancer data base 2016