Boston Children's Hospital set out to reduce clinical variation in treatments for pediatric chest pain through a "standardized clinical assessment and management plan," which has been found to reduce the cost per episode of care by 20 percent and has also earned positive reviews from physicians, according to a report from Health Affairs.
In the article, researchers say SCAMPs represent a promising alternative to clinical practice guidelines, which rely on best practices. The researchers said clinical practice guidelines can be "misleading and paralyzing because it implies a value judgment" that can override a range of variables, including changes in medical knowledge, therapeutic options or patient populations.
The first SCAMPs were conceived, designed, and implemented by physician and nursing leaders of the cardiovascular program at Boston Children's in 2009. A SCAMP involves an eight-step approach that is implemented by a multidisciplinary team of physicians.
1. Analyze the current practice, and form a background position on a particular disorder.
2. Identify which patients to include in the SCAMP, which clinical assessments to use and how to structure a treatment algorithm.
3. Form "plausible findings" that highlight knowledge gaps, and identify what data is required for collection in the SCAMP. At Boston Children's, providers began recording data on patients' body mass indices to explore the relationship between high BMIs and chest pain.
4. Develop data forms and electronic tools to implement the SCAMP, and collect targeted clinical data.
5. Pilot the SCAMP at a few sites before deploying on a larger scale throughout a network of practices or institutions.
6. A data coordinator gathers clinical data from the forms the clinicians have filled out on patients and extracts additional relevant information from their electronic health records. This data is stored in a database.
7. After a set time period, typically six to 12 months, has passed or a minimum number of patients, usually 200, have been enrolled, SCAMP data are analyzed by a statistician. The statistician's report is reviewed by the clinical group and also shared with the larger group of clinicians participating in the SCAMP to ensure transparency.
8. Persuasive data from the above analysis and from new medical literature are used by the clinical group to modify the SCAMP.
At Boston Children's, the average cost per episode of care for pediatric chest pain was $1,506 in the control group compared with $1,200 for the SCAMP group. Also, a survey of hospital physicians in 2010 found the approval ratings for SCAMPs exceeded those of other tools used to standardize and improve care, such as practice guidelines and care pathways.
Furthermore, preliminary results from a 2011-12 survey of 400 patients and parents of patients showed that SCAMPs do not interfere with patient satisfaction with their providers or the care they receive, according to the Health Affairs article.
Nineteen healthcare institutions currently collect SCAMP data.
10 Hospitals Join Program to Test Link Between Costs, Clinical Variation
6 Requirements of Hospital Leaders to Drive Value in Healthcare
In the article, researchers say SCAMPs represent a promising alternative to clinical practice guidelines, which rely on best practices. The researchers said clinical practice guidelines can be "misleading and paralyzing because it implies a value judgment" that can override a range of variables, including changes in medical knowledge, therapeutic options or patient populations.
The first SCAMPs were conceived, designed, and implemented by physician and nursing leaders of the cardiovascular program at Boston Children's in 2009. A SCAMP involves an eight-step approach that is implemented by a multidisciplinary team of physicians.
1. Analyze the current practice, and form a background position on a particular disorder.
2. Identify which patients to include in the SCAMP, which clinical assessments to use and how to structure a treatment algorithm.
3. Form "plausible findings" that highlight knowledge gaps, and identify what data is required for collection in the SCAMP. At Boston Children's, providers began recording data on patients' body mass indices to explore the relationship between high BMIs and chest pain.
4. Develop data forms and electronic tools to implement the SCAMP, and collect targeted clinical data.
5. Pilot the SCAMP at a few sites before deploying on a larger scale throughout a network of practices or institutions.
6. A data coordinator gathers clinical data from the forms the clinicians have filled out on patients and extracts additional relevant information from their electronic health records. This data is stored in a database.
7. After a set time period, typically six to 12 months, has passed or a minimum number of patients, usually 200, have been enrolled, SCAMP data are analyzed by a statistician. The statistician's report is reviewed by the clinical group and also shared with the larger group of clinicians participating in the SCAMP to ensure transparency.
8. Persuasive data from the above analysis and from new medical literature are used by the clinical group to modify the SCAMP.
At Boston Children's, the average cost per episode of care for pediatric chest pain was $1,506 in the control group compared with $1,200 for the SCAMP group. Also, a survey of hospital physicians in 2010 found the approval ratings for SCAMPs exceeded those of other tools used to standardize and improve care, such as practice guidelines and care pathways.
Furthermore, preliminary results from a 2011-12 survey of 400 patients and parents of patients showed that SCAMPs do not interfere with patient satisfaction with their providers or the care they receive, according to the Health Affairs article.
Nineteen healthcare institutions currently collect SCAMP data.
More Articles on Clinical Variation:
Driving Unwarranted Clinical Variation Out of a Hospital: Key Strategies10 Hospitals Join Program to Test Link Between Costs, Clinical Variation
6 Requirements of Hospital Leaders to Drive Value in Healthcare