Background
Optimal Care Pathways (OCPs) guide comprehensive cancer care across the care continuum. Monitoring adherence requires robust clinical indicators reflecting care quality and outcomes. Victorian Integrated Cancer Services (VICS) lacked a standardised set of indicators and relied on an annual, resource-intensive Cancer Services Performance Indicators (CSPI) medical record audit to monitor quality for a limited range of elements of care. VICS developed and are implementing a standardised suite of clinical indicators aligned with OCPs to improve monitoring and reporting.
Methods
A longlist of 168 potential indicators was generated from 24 adult cancer-type OCPs, guidelines, literature, and expert input. After a data collection feasibility assessment, and synthesis across cancer types, a multidisciplinary clinical reference group used a modified-Delphi survey process to score and refine indicators based on utility, validity, feasibility, and data availability. Indicators were prioritised using a matrix considering collection burden and system interoperability. Existing datasets in the Statewide Cancer Indicator Platform (SCIP) and CSPI audits informed feasibility. Pilot testing across VICS health services provided feedback for final refinements before statewide rollout.
Impact on Practice
From 168 candidates, 21 indicators were selected to capture key OCP steps: diagnosis, staging, treatment initiation, and post-treatment care. The process ensured alignment with clinical priorities and reliable data sources, facilitating benchmarking across services. Challenges included data variability, reporting resistance, and technical extraction barriers, addressed through collaboration, iterative refinement, and stakeholder engagement. Integration into SCIP supports standardised data access for the VICS to monitor unwarranted care variation.
Discussion
This standardised, evidence-based methodology enhances Victorian cancer services’ capacity to monitor OCP adherence and drive quality improvements. Planned automation of reporting indicators will enable consistent and timely reporting to services to inform data-driven quality improvement initiatives. Future work should evaluate the long-term impact of these indicators on patient outcomes and healthcare efficiency.