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Congenit Heart Dis. 2017 Dec;12(6):768-776. doi: 10.1111/chd.12508. Epub 2017 Jun 28.

Impact of standardized clinical assessment and management plans on resource utilization and costs in children after the arterial switch operation.

Author information

1
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.
2
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
3
Institute of Relevant Clinical Data Analytics, Boston, Massachusetts, USA.
4
Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.

Abstract

BACKGROUND:

Standardized Clinical Assessment and Management Plans (SCAMPs) are a quality improvement initiative designed to reduce unnecessary utilization, decrease practice variation, and improve patient outcomes. We created a novel methodology, the SCAMP managed episode of care (SMEOC), which encompasses multiple encounters to assess the impact of the arterial switch operation (ASO) SCAMP on total costs.

METHODS:

All ASO SCAMP patients (dates March 2009 to July 2015) were compared to a control group of ASO patients (January 2001 to February 2009). Patients were divided into "younger" (<2 years) and "older" (2-18 years) subgroups. Utilization included all cardiology visits, tests, and procedures. Standardized costs were applied to each unit of utilization.

RESULTS:

There were 100 historical and 63 SCAMP patients in the younger subgroup, and 163 historical and 165 SCAMP patients in the older subgroup. In the younger subgroup, the SCAMP had a 28% reduction in outpatient clinic visits (P < .001), a 52% reduction in chest radiographs (P < .001), a 21% reduction in electrocardiograms (P < .001), and a 30% total reduction in costs. In the older subgroup, the SCAMP had a 21% reduction in outpatient clinic visits (P < .001), a 20% reduction in chest radiographs (P = .05), a 10% reduction in echocardiograms (P = .05), a 25% reduction in exercise stress tests (P = .01), and a 14% total reduction in costs. The total cost savings of the ASO SCAMP was $216 649 in the first 6 years of the SCAMP. There was no difference in clinical outcomes between the historical and SCAMP cohorts.

CONCLUSION:

SCAMPs can improve resource utilization and reduce costs after the ASO operation while maintaining quality of care.

KEYWORDS:

congenital heart disease; cost reduction; resource utilization; standardization

PMID:
28660735
DOI:
10.1111/chd.12508
[Indexed for MEDLINE]

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