Background


In 2006, concerned by a trend in healthcare where the increase in medical expenditures seemed to be outstripping both the health benefits and the nation’s financial underpinning to pay, clinicians in the Cardiology Department at Boston Children’s Hospital began investigating ways to reduce the cost of care delivered to their patients. The group’s focus turned to standardization of care, working toward improved efficiency and, ultimately, cost savings through reduction of unnecessary utilization.

 

Traditional tools to study and standardize care had been somewhat ineffective in many ways including a lack of accounting for the fact that healthcare standards are constantly changing. To compensate for the deficiencies of the traditional tools, the group decided to develop a new methodology to accomplish their goals. In developing this new tool, the following assumptions were used:

 
  • There is a need to reduce practice variability, optimize resource utilization, and enhance patient care
  • The assertion that "best practice" can be defined is misleading, as it ignores the continual changes in medical knowledge, therapeutic options, and patient populations, and discourages both clinical acumen and innovation
  • Any standardization of care must therefore be based on principles of "sound practice," which represent a synthesis of current medical knowledge and best clinical judgement, and are imperfect in ways yet to be determined
  • Guidelines to standardize care cannot be static or stand-alone, as many CPGs have been designed to be; rather, guidelines must be flexible and must be used to create a medical learning system that can collect, analyze, and learn from relevant data to allow continuous revision and improvement
  • Data gathering must be selective and, based on prior medical understanding, be targeted towards relevant clinical findings in order to optimize the data burden and signal-to-noise ratio. It must readily accommodate economic analyses for cost-effectiveness studies as well
  • Any solution is more likely to succeed if it is designed and implemented by caregivers themselves, such that they are leaders of the process rather than passive recipients
  • Finally, certain cherished characteristics of medical practice - the ability to discover and innovate, to train the next generation to the highest standards, and to provide truly outstanding healthcare - must be maintained
 

With these considerations in mind, Standardized Clinical Assessment and Management Plans (SCAMPs) were created. SCAMPs outline a data-backed, consensus-based, care pathway for a diverse patient population with a particular diagnosis or condition. Data is collected on the treatment and outcomes of that population, analyzed, and then used to improve upon the care pathway. The three main goals of SCAMPs are to:

 
  • Improve patient outcomes
  • Reduce practice variation
  • Reduce unnecessary resource utilization
 

With their proven success in meeting these goals in many different clinical settings (adult, pediatric, multiple disciplines, inpatient, outpatient, etc.), SCAMPs garnered interest from institutions across the world. The Institute for Relevant Clinical Data Analytics (IRCDA) was started in 2010 to spread and promote SCAMPs to interested institutions. IRCDA is a 501(c)(3) organization focused on informing and improving healthcare delivery through the use of SCAMPs at its 11 member institutions.