Creating a learning healthcare system in surgery: Washington State's Surgical Care and Outcomes Assessment Program (SCOAP) at 5 years

Abstract

There are increasing efforts towards improving the quality and safety of surgical care while decreasing the costs. In Washington state, there has been a regional and unique approach to surgical quality improvement. The development of the Surgical Care and Outcomes Assessment Program (SCOAP) was first described 5 years ago. SCOAP is a peer-to-peer collaborative that engages surgeons to determine the many process of care metrics that go into a "perfect" operation, track on risk adjusted outcomes that are specific to a given operation, and create interventions to correct under performance in both the use of these process measures and outcomes. SCOAP is a thematic departure from report card oriented QI. SCOAP builds off the collaboration and trust of the surgical community and strives for quality improvement by having peers change behaviors of one another. We provide, here, the progress of the SCOAP initiative and highlight its achievements and challenges.

Fig. 1

Variability in reoperative complications in Washington State hospitals (based on administrative data) with gray points representing those hospitals that eventually joined SCOAP (A) from 2000 to 2003 before SCOAP started (B) from 2008 to 2009, after SCOAP.

Fig. 2

Rates of preoperative imaging (ultrasonography or computed tomography) to diagnose appendicitis among women of childbearing age, by quarters of a hospital’s SCOAP participation.

Fig. 3

Rates of anastomotic leak testing in elective colorectal operations, by quarters of a hospital’s SCOAP participation.

Fig. 4

Rates of blood glucose checks in diabetic patients undergoing elective colorectal operations, by quarters of a hospital’s SCOAP participation.

Fig. 5

Negative appendectomy rates, by calendar quarters.

Fig. 6

Rates of operative complication in elective colorectal operations in sites (n = 6) that eventually joined SCOAP and had >50 operations per year in 2003 and in 2009.

Fig. 7

Average cost per case for appendectomy, colorectal, and bariatric operations, by calendar year. Total cost savings in 2009 is noted.