The ACE Programme - ACE Wave 2 - Multidisciplinary Diagnostic Centres Northern Cancer Alliance - 23rd March 2018 - Northern England Clinical Networks
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The ACE Programme
ACE Wave 2 - Multidisciplinary Diagnostic Centres
Northern Cancer Alliance – 23rd March 2018
Title
ACE Programme overview
A joint early diagnosis initiative to Accelerate, Co-
ordinate, and Evaluate (ACE) learning, and to spread
good practice and improvement
ACE Wave 1:
• 60 projects across England, organised into 8 work
clusters
• Evaluating variety of initiatives to improve earlier
diagnosis of cancer & develop the evidence-base
ACE Objectives:
ACE Wave 2:
• 5 projects across England developing & trialling Faster diagnosis (cancer or other)
Multidisciplinary Diagnostic Centre (MDC) based Shift from late > early stage diagnosis
pathways
Reduce diagnoses via emergency
• Focused on patients with non-specific but
presentation
concerning symptoms
Improved patient experience
Title ACE Programme Wave 2 What is the ACE Wave 2 Programme? Activity to date What happens next?
Title
ACE Programme pilot sites
Airedale, Wharfedale & Leeds
Craven MDC site: St James University Hospital (Specialist Cancer
MDC site: Airedale General Centre)
Hospital
London
Greater Manchester
MDC sites: North Middlesex University Hospital,
MDC sites: University University College London Hospital (Specialist
Hospital South Manchester Cancer Centre), Southend University Hospital,
& Pennine Acute Hospitals Queens (UCLH Partners) & the Royal Free Hospital
Trust (Royal Oldham Hospital
site)
ACE Wave 2 headlines:
Oxford o 9 MDC sites now operational
MDC site: Oxford University Hospitals Trust o Over 1000 patients seen in MDC to date (Nov 17)
(Specialist Cancer Centre) o Common dataset agreed & being populated
o 3 varying approaches identifiedTitle The theory behind MDCs
Title
Activity to date – data analysis
Developing our understanding…..
National Cancer Diagnosis Audit (NCDA) data
NCDA 2014 data analysed with a focus on patients presenting with non-specific but
concerning symptoms:
o 17,042 cancer diagnoses included within overall sample
o 2,526 cancer diagnoses presenting with non-specific but concerning symptoms
(14.8% of total) (NSCS cohort)
o Late stage diagnosis more common for o Longer diagnostic interval more likely for
patients presenting with non-specific patients presenting with non-specific
symptoms symptoms (median)
Stage NCDA (-NSCS cohort) NSCS Interval NCDA (-NSCS cohort) NSCS
1 27.5% 10.3% Presentation 3 days 12 days
to referral
2 17.5% 13.1%
Presentation 37 days 48.5 days
3 13.7% 16.5%
to diagnosis
4 18.7% 31.5%
First seen to 11 days 14 days
Unknown 22.5% 28.3% diagnosisActivity to date – summary as at 30th Nov 17
Title
MDC No. Patients Female (%) Median age No. cancer cases Conversion (%)
Airedale 143 52% 72 16 11.2%
Greater Pennine 77 60% 71 9 11.7%
Manc.
Wythenshawe 143 59% 71 7 4.9%
Leeds 217 49% 69 16 7.4%
London BHRUT 81 52% 66 10 12.3%
North Mid 48 54% 60.5 2 4.2%
UCLH 175 52% 64 3 1.7%
Oxford 151 60% 70 19 12.6%
Total 1035 54% 69 years 82 7.9%Title Activity to date – emerging models Different approaches being trialled in each of the 5 MDC project areas. However, 3 varying approaches have been identified across the ACE Programme: o Cancer Diagnostic Service o Yes / No Cancer Diagnostic Service o Broad Diagnostic Service A set of overarching MDC design principles has been developed and is available at www.cruk.org/ACE The approaches may develop further as programme learning continues Programme evaluation will seek to provide a comparative analysis of the differing approaches .
Title Activity to date – distinguishing MDC features A set of overarching features of a MDC pathway has also been developed that are common across all 5 projects:
Title
Activity to date – early learning from MDCs
Early project reflections………….
Subject Observation
Time On average, it took 16 months to set up MDC pathway
Planning Building MDC plans around people who believed in the model was seen as more
important than clinical specialisation
People Primary care colleagues were seen as key stakeholders to engage from the outset,
as they are critical to the success of the MDC approach
Data The development of appropriate data management and information governance
arrangements is complex and needs to be started as soon as possible
Estimating referral volumes and setting comparator baselines is likely to be
challenging, but projects have identified a range of solutions to address issues
Resources Projects have reported limited resources for MDC pathways, but have implemented
effective solutions, including diagnostic reporting and workforce capacity
Further information on early project learning will be included in the ACE Wave 2
interim report.Title
What happens next?
o Continuing to support & evaluate MDC-based pathways across England
o Evaluating the impact of MDCs on patient experience & outcomes
o Developing the evidence-base, sharing learning & developing
resources:
o Design principles information
o Early learning on practical issues – challenges & solutions
o Support materials planned, including effective primary care engagement, MDC
pathway integration and MDC sustainability
• Interim report on work to date – April 2018
• Final programme evaluation report – December 2018Title Thank you! Any questions? Dave Chapman ACE Programme Lead (Wave 2) dave.chapman@cancer.org.uk www.cruk.org/ACE
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