Medical innovation/quality improvement platform featured in Health Affairs

May 6, 2013

A quality improvement platform developed at Boston Children's Hospital could help health care provider groups continuously improve their medical practice, curbing costs and improving patient outcomes. Successful outcomes associated with the platform, called Standardized Clinical Assessment and Management Plans (SCAMPs) and supported by a consortium of Massachusetts payers, are featured in the May issue of Health Affairs.

SCAMPs start with existing practice recommendations, but are continuously revised as clinicians learn from everyday patient encounters. Recognizing that many clinicians find constraining and not applicable to all situations, SCAMPs permit clinicians to diverge from recommendations as they manage individual patients, provided they document their rationale. The results of this decision-making are then tracked and used to update the guidelines themselves.

"If clinicians want to do something different than what a SCAMP calls for, they have to explain why they're doing it differently," says Boston Children's Hospital -in-Chief James Lock, MD, a co-author on the paper. "The reasons that doctors choose not to follow a SCAMP are extremely important information, and fuel improvement at a rapid clip."

"The SCAMPs platform, which can be applied at any institution for nearly any type of medical problem, could provide the infrastructure needed by health care payers to ensure the success of care and payment reform," Lock adds. The substantial cost savings, reduced practice variation and improved outcomes after implementation.

The SCAMPs program, started by the cardiovascular program at Boston Children's Hospital in 2009, provides a structured, eight-step approach to innovation that can be applied to nearly any type of medical problem or encounter (see appendix). To date, 49 different SCAMPs have been initiated at Boston Children's and other hospitals, and have involved more than 12,000 patients and more than 25,000 patient encounters, ranging from common outpatient presentations to advanced surgical procedures. Peter Waters, MD, clinical chief of the Orthopedics Center at Boston Children's, is co-chairing a committee to facilitate the spread of SCAMPs institution-wide.

"As clinicians and institutions learn about SCAMPs and what we have accomplished here at Boston Children's, interest in joining our initiative is growing at a remarkable pace," says Michael Farias, MD, MBA, first author on the paper. "Providers of medical care are motivated to do what is best for their patients and, in this environment of healthcare reform, they appreciate that SCAMPs help reduce over-utilization while allowing others to learn from an individual provider's clinical acumen."

Twenty-four new SCAMPs are in development for conditions ranging from management of gastroesophageal reflux to postoperative neurosurgery. Brigham and Women's Hospital has taken the SCAMP model and applied it within its orthopedic surgery department for distal radius fractures, among other conditions. Nearly 20 other health care institutions now collect SCAMPs data (see appendix).

"Tools like SCAMPs are going to be especially important in accountable care, as they let us reduce costs and improve quality at the same time for less frequent conditions, which have been much harder to address with more traditional approaches," says David Bates, MD, MSc, Chief Quality Officer at Brigham and Women's Hospital and a coauthor on the paper. "We have implemented a number of SCAMPs, and it has been a great way to get specialists in particular engaged in care improvement."

SCAMPs results

The SCAMPs team has documented lowered costs, reductions in practice variation, and improvements in care for several pediatric conditions after implementing the plans. For example:

  • Cost reduction

    In the Boston Children's Cardiovascular Program, SCAMPs have reduced the average cost of an episode of care by 20 percent for chest pain, 11 percent for patients after the arterial switch operation, 20 percent for hypertrophic cardiomyopathy, 30 percent for aortic regurgitation and 51 percent for aortic stenosis in clinic. In addition, SCAMPs are projected to reduce the average cost of caring for aortic stenosis in the catheterization lab by 33 percent over a 10-year episode of care. Overall, for these six conditions, costs were reduced by an estimated 27 percent, at an estimated $702,000 savings, when compared to pre-SCAMPs patients with the same conditions.

  • Reduced practice variation

    When a recommended practice was refined through a SCAMP, clinicians were more likely to follow it. For example, a SCAMP for patients with a dilated aortic root examined the recommended practice of referring patients to a geneticist, and found that many referral visits weren't yielding significant new information. When the criteria for referral were tightened, adherence to the recommendation went from 19.6 percent to 75 percent.  

  • Improved outcomes

    When a SCAMP was initiated for balloon valvuloplasty for congenital aortic stenosis, the frequency of "ideal" outcomes rose from 40 percent to 69 percent, while the frequency of "inadequate" results fell from 30 percent to 9 percent.

The SCAMPs initiative is supported by Blue Cross Blue Shield of Massachusetts, Tufts Health Plan, Harvard Pilgrim Health Care and MassHealth through the Payer-Provider Quality Initiative at Boston Children's Hospital. It has been well received by clinicians: in a survey of clinicians from six different institutions, 72 percent favored SCAMPs over clinical practice guidelines, the second most popular tool (preferred by 12 percent).

"The SCAMPs program has been able to build clinically informed treatment paradigms for both complex and routine conditions," says Joel Rubinstein, MD, Medical Director for Network Medical Management and Behavioral Health at Harvard Pilgrim Health Care, a health plan that has provided support to SCAMPs. "Variation and unnecessary interventions have been reduced with improvements in efficiency and quality. Health plans such as Harvard Pilgrim welcome the SCAMPS program for these reasons, and expect it will lead to better care for our members and the community."

Explore further: Michigan's collaborative quality improvement program cuts costs, improves patient care

Related Stories

Michigan's collaborative quality improvement program cuts costs, improves patient care

April 7, 2011
In a paper published today in the professional health care journal, Health Affairs, Blue Cross Blue Shield of Michigan and the University of Michigan Health System report that their model for collaborative health care quality ...

Home visits for asthma: A win for both patients and payers

February 20, 2012
Nearly 1 in 10 children have asthma, according to government statistics, and in low-income parts of Boston, nearly 16 percent of children are affected. A program called the Community Asthma Initiative (CAI), developed and ...

Collaborative care teams improve mental health outcomes

October 17, 2012
Collaborative care, a model that involves multiple clinicians working with a patient, significantly improves depression and anxiety outcomes compared to standard primary care treatment for up to two years, finds a new review ...

The patient satisfaction chasm

March 1, 2013
Quality is a central component of any discussion around health care and one of the key dimensions and measurements of quality care is the patient experience. However, many healthcare organizations struggle to become 'patient ...

Neurologically impaired children dependent on children's hospitals

January 17, 2012
Because of care advances, more infants and children with previously lethal health problems are surviving. Many, however, are left with lifelong neurologic impairment. A Children's Hospital Boston study of more than 25 million ...

Large hospital successfully implements CPOE system with clinical decision support for radiology

February 1, 2012
In an effort to reduce the inappropriate use of medical imaging and improve quality of care, a large, tertiary-care hospital has successfully implemented a computerized physician order entry (CPOE) system with clinical decision ...

Recommended for you

Brain disease seen in most football players in large report

July 25, 2017
Research on 202 former football players found evidence of a brain disease linked to repeated head blows in nearly all of them, from athletes in the National Football League, college and even high school.

Safety of medical devices not often evaluated by sex, age, or race

July 25, 2017
Researchers at Yale and the University of California-San Francisco have found that few medical devices are analyzed to consider the influence of their users' sex, age, or race on safety and effectiveness.

Why you should consider more than looks when choosing a fitness tracker

July 25, 2017
A UNSW study of five popular physical activity monitors, including Fitbit and Jawbone models, has found their accuracy differs with the speed of activity, and where they are worn.

Dog walking could be key to ensuring activity in later life

July 24, 2017
A new study has shown that regularly walking a dog boosts levels of physical activity in older people, especially during the winter.

Alcohol to claim 63,000 lives over next five years, experts warn

July 24, 2017
Alcohol consumption will cause 63,000 deaths in England over the next five years – the equivalent of 35 deaths a day – according to a new report from the University of Sheffield Alcohol Research Group.

Alcohol boosts recall of earlier learning

July 24, 2017
Drinking alcohol improves memory for information learned before the drinking episode began, new research suggests.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.