Resource utilization after introduction of a standardized clinical assessment and management plan.
BACKGROUND
A Standardized Clinical Assessment and Management Plan (SCAMP) is a novel quality improvement initiative that standardizes the assessment and management of all patients who carry a predefined diagnosis. Based on periodic review of systemically collected data the SCAMP is designed to be modified to improve its own algorithm. One of the objectives of a SCAMP is to identify and reduce resource utilization and patient care costs.


METHODS
We retrospectively reviewed resource utilization in the first 93 arterial switch operation (ASO) SCAMP patients and 186 age-matched control ASO patients. We compared diagnostic and laboratory testing obtained at the initial SCAMP clinic visit and control patient visits. To evaluate the effect of the SCAMP over time, the number of clinic visits per patient year and echocardiograms per patient year in historical control ASO patients were compared to the projected rates for ASO SCAMP participants.


RESULTS
Cardiac magnetic resonance imaging (MRI), stress echocardiogram, and lipid profile utilization were higher in the initial SCAMP clinic visit group than in age-matched control patients. Total echocardiogram and lung scan usage were similar. Chest X-ray and exercise stress testing were obtained less in SCAMP patients. ASO SCAMP patients are projected to have 0.5 clinic visits and 0.5 echocardiograms per year. Historical control patients had more clinic visits (1.2 vs. 0.5 visits/patient year, P<.01) and a higher echocardiogram rate (0.92 vs. 0.5 echocardiograms/patient year, P<.01)


CONCLUSIONS
Implementation of a SCAMP may initially lead to increased resource utilization, but over time resource utilization is projected to decrease.
Friedman
Kevin G
KG
Department of Cardiology, Children's Hospital Boston and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA. kevin.friedman@cardio.chboston.org
Rathod
Rahul H
RH
Farias
Michael
M
Graham
Dionne
D
Powell
Andrew J
AJ
Fulton
David R
DR
Newburger
Jane W
JW
Colan
Steven D
SD
Jenkins
Kathy J
KJ
Lock
James E
JE
D000293:Adolescent; D001774:Blood Chemical Analysis / Q000706:statistics & numerical data; D001900:Boston; D006348:Cardiac Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data*; D016507:Cardiology Service, Hospital; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D019091:Critical Pathways / Q000191:economics / Q000706:statistics & numerical data*; D025401:Echocardiography, Stress / Q000706:statistics & numerical data; D005080:Exercise Test / Q000706:statistics & numerical data; D006295:Health Resources / Q000706:statistics & numerical data*; D006302:Health Services Research; D017721:Hospital Costs; D006776:Hospitals, Pediatric; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D055414:Myocardial Perfusion Imaging / Q000706:statistics & numerical data; D009819:Office Visits / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care / Q000191:economics; D010346:Patient Care Management / Q000191:economics / Q000706:statistics & numerical data*; D016730:Program Development; D015397:Program Evaluation; D013902:Radiography, Thoracic / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014188:Transposition of Great Vessels / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D016896:Treatment Outcome