Standardized Clinical Assessment And Management Plans (SCAMPs) provide a better alternative to clinical practice guidelines

Abstract

Variability in medical practice in the United States leads to higher costs without achieving better patient outcomes. Clinical practice guidelines, which are intended to reduce variation and improve care, have several drawbacks that limit the extent of buy-in by clinicians. In contrast, standardized clinical assessment and management plans (SCAMPs) offer a clinician-designed approach to promoting care standardization that accommodates patients' individual differences, respects providers' clinical acumen, and keeps pace with the rapid growth of medical knowledge. Since early 2009 more than 12,000 patients have been enrolled in forty-nine SCAMPs in nine states and Washington, D.C. In one example, a SCAMP was credited with increasing clinicians' rate of compliance with a recommended specialist referral for children from 19.6 percent to 75 percent. In another example, SCAMPs were associated with an 11-51 percent decrease in total medical expenses for six conditions when compared with a historical cohort. Innovative tools such as SCAMPs should be carefully examined by policy makers searching for methods to promote the delivery of high-quality, cost-effective care.

Keywords: Children’s Health; Evidence-Based Medicine; Health Reform; Organization And Delivery Of Care; Variations.

Exhibit 1

Providers’ Adherence To Testing Recommendations Of The First Six Standardized Clinical Assessment And Management Plans (SCAMPs), Twelve-Month Rolling Adherence Rate, March 2009–November 2011 SOURCE Authors’ analysis. NOTES The first six SCAMPs (for arterial switch operation, hypertrophic cardiomyopathy, dilated aorta, aortic regurgitation, aortic stenosis, and single ventricle) focus on pediatric cardiac disease and were the first SCAMPs designed and implemented by the Department of Cardiology at Boston Children's Hospital. This analysis excludes adherence to magnetic resonance imaging recommendations in arterial switch operation, hypertrophic cardiomyopathy, dilated aorta, and aortic stenosis because these recommendations were not universally relevant in early implementation of the SCAMPs.

Exhibit 3

Impact Of The Use Of A Standardized Clinical Assessment And Management Plan (SCAMP) On Catheterization Intervention On Aortic Stenosis In Children SOURCE Authors’ analysis. NOTES The percentages are for SCAMP patients (n = 23) and historical controls (n = 92). Outcomes were ideal (≤35 mmHg residual gradient across stenotic aortic valve and none to trivial residual aortic regurgitation), adequate (≤35 mmHg residual gradient and mild residual aortic regurgitation), or inadequate (>35 mmHg residual gradient, moderate to severe residual aortic regurgitation, or both).