使用标准化临床评估与管理计划（SCAMPs）降低资源利用

Decreasing Resource Utilization Using Standardized Clinical Assessment and Management Plans (SCAMPs).

作者信息

Luther Gaurav, Miller Patricia E, Mahan Susan T, Waters Peter M, Bae Donald S

机构信息

Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA.

出版信息

J Pediatr Orthop. 2019 Apr;39(4):169-174. doi: 10.1097/BPO.0000000000000873.

DOI:10.1097/BPO.0000000000000873

PMID:30839474

Abstract

BACKGROUND

Standardized clinical assessment and management plans (SCAMPs) are a novel quality improvement initiative shown to improve patient care, diminish practice variation, and reduce resource utilization. Unlike clinical practice guidelines, a SCAMP is a flexible algorithm that undergoes iterative updates based on periodic data collection and review. We recently implemented a SCAMP for the closed treatment of pediatric torus fractures. The purpose of this study is to analyze the effect of SCAMP implementation on resource utilization, practice variability, cost of care, and outcomes.

METHODS

This study was a retrospective review of prospectively collected data on 273 patients with pediatric torus fractures. The pre-SCAMP cohort included 116 subjects from 2008 to 2010. The SCAMP cohort included 157 subjects from 2011 to 2013. The pre-SCAMP cohort was treated according to the judgment of attending fellowship-trained pediatric orthopaedic surgeons. The SCAMP cohort was treated with a standardized algorithm including radiographs and splint application at initial presentation, with a single follow-up at 3 weeks. Patient demographics were analyzed to verify comparability between cohorts. Follow-up data including clinic visits, x-rays and practice variability was recorded. Costing analysis was conducted using time-derived activity-based costing methodology. Outcomes were compared using Poisson regression analysis. Incident rate ratios (IRR) with 95% confidence limits were estimated.

RESULTS

No differences in clinical results were observed between the pre-SCAMP and SCAMP cohorts, and all patients demonstrated return to baseline activity at final follow-up. Patient demographics were comparable across cohorts. The SCAMP cohort had a 48% reduction in clinic visits [IRR, 0.52; 95% confidence interval (CI), 0.44-0.60; P<0.001], 60% reduction in x-rays (IRR, 0.40; CI, 0.33-0.47; P<0.001), and a 23% reduction in x-rays per clinic visit (IRR, 0.77; 95% CI, 0.65-0.91; P<0.001). Furthermore, SCAMP implementation resulted in a 49% reduction in the overall cost of care.

CONCLUSIONS

SCAMPs provide a novel alternative to CPGs to implement cost effective changes in Orthopaedic practice. For pediatric torus fractures, SCAMP implementation resulted in decreased practice variability, resource utilization, and overall cost of care while maintaining clinical outcomes.

LEVEL OF EVIDENCE

Level 3.

摘要

背景

标准化临床评估与管理计划（SCAMPs）是一项新型质量改进举措，已被证明可改善患者护理、减少实践差异并降低资源利用。与临床实践指南不同，SCAMP是一种灵活的算法，会根据定期数据收集和审查进行迭代更新。我们最近实施了一项针对小儿青枝骨折闭合治疗的SCAMP。本研究的目的是分析实施SCAMP对资源利用、实践变异性、护理成本和结果的影响。

方法

本研究是对前瞻性收集的273例小儿青枝骨折患者数据的回顾性分析。SCAMP实施前队列包括2008年至2010年的116名受试者。SCAMP队列包括2011年至2013年的157名受试者。SCAMP实施前队列根据经过专科培训的小儿骨科主治医生的判断进行治疗。SCAMP队列采用标准化算法治疗，初始就诊时包括拍摄X线片和应用夹板，3周时进行一次随访。分析患者人口统计学特征以验证队列之间的可比性。记录随访数据，包括门诊就诊、X线检查和实践变异性。使用基于时间的作业成本法进行成本分析。使用泊松回归分析比较结果。估计了具有95%置信区间的发病率比（IRR）。

结果

SCAMP实施前队列和SCAMP队列之间未观察到临床结果的差异，所有患者在最终随访时均恢复至基线活动水平。各队列的患者人口统计学特征具有可比性。SCAMP队列的门诊就诊次数减少了48%[IRR，0.52；95%置信区间（CI），0.44 - 0.60；P < 0.001]，X线检查减少了60%（IRR，0.40；CI，0.33 - 0.47；P < 0.001），每次门诊就诊的X线检查减少了23%（IRR，0.77；95% CI，0.65 - 0.91；P < 0.001）。此外，实施SCAMP使护理总成本降低了49%。