1. Surgical Clinical Outcomes Assessment Program (SCOAP)

2. Presenters Claudia Sanders Miriam Marcus-Smith Nancy Fisher, MD
Vice President, Policy Development
WSHA
Miriam Marcus-Smith
Quality Improvement Program Director, Foundation for Health Care Quality
Nancy Fisher, MD
Medical Director
Washington State Health Care Authority
David Flum, MD
SCOAP Medical Director
Surgeon, University of Washington Medical Center
Leigh Cooley
Quality Improvement Director, Skagit Valley Hospital

3. Goals of Web Cast
To make sure hospitals are informed about SCOAP, currently under development at the Foundation for Health Care Quality
To make sure hospitals are preparing for the program
To provide an opportunity for hospitals to ask questions

4. Presentation Overview
Background and components
Rationale for SCOAP: surgical variability
SCOAP recommendations
SCOAP current status
Hospital concerns
Questions and discussion

5. Background and Components

6. COAP Physician-led with all stakeholders included
CQIP status (Coordinated Quality Improvement Program)
Participation directed by HCA contracts with plans
Regular descriptive and risk-adjusted data reports

7. COAP (cont.)
Currently includes all coronary artery bypass grafts (CABG) and percutaneous heart procedures and programs
Will add valves in 2006

8. COAP (cont.)
Tracking of outlier status and coordinating QI activity has led to:
Improvements in use of best practices (arterial grafts)
Reduction in rate of adverse outcomes (prolonged time on ventilators)

9. SCOAP Background HCA engaged Foundation for Health Care Quality (FHCQ)
HCA support of COAP, interest in SCOAP
Decision to proceed with SCOAP
Future contract requirements
Expansion to Medicare, Medicaid, private insurance
Methods
FHCQ partnership with UW
Literature review, analyses, stakeholder discussions

10. Rationale for SCOAP: Surgical Variability

11. Variability in Surgical Practices
There is significant variability in general surgery
Process
Outcome
Cost
Best Practices
There are “best practices”
“Best practices” can be encouraged

12. Variability in Other Industries

13. Variability in Other Industries
Risk falls below threshold
Variability is being addressed

14. Appendectomy Most commonly performed emergency abdominal procedure
~5800/yr
15 percent misdiagnosed
1 in 4 women of reproductive age

15. Variability in Outcome % Negative Appendectomy (NA), by Hospital

16. Gastric Bypass for Obesity
Operations per Year in Washington

17. Variability in Adverse Outcome
Gastric bypass for obesity
by hospital

18. Colorectal Surgery 5000/year
Adverse outcomes result in significant morbidity, mortality, and cost
Increasing use of laparoscopic colon resection has not been well studied

19. Colorectal Surgery Outcomes

20. Is SCOAP Worth It?
Colorectal Surgery Outcomes

21. Is SCOAP Worth It? (cont.)
2-5 years old−no clinical detail
“Apples and apples?”

22. Is SCOAP Worth It? (cont.)
Process Measures: Coloectomy & Procectomy
Length of operation (hours)
Procedure priority: elective
Procedure method (Open vs. Laparoscopic)
ASA class IV
Lowest intra-op temperature
Insulin administered in OR
Highest periop BG
Part removed:
Ostomy:
Anastomosis
Anastomosis tested
Pathology results confirm diagnosis
Perioperative interventions:
Heparin/LMWH within 2 hrs
Intermittent pneumatic compression
Beta blocker within 12 hrs
Antibiotics within 60 min.
Pain management within 24 hrs
NGT RBC transfusion
Mechanical ventilation post RR

23. SCOAP Recommendations

24. SCOAP Goals Create a system to evaluate and improve surgical quality
Define practice patterns
Risk adjusted outcomes
Track and reduce variability

25. Initial Focus on Three Procedures
Appendectomy
Colectomy/proctectomy
Bariatric

26. Procedure Selection Rationale
Performed widely
High cost, high volume and/or growing fast
High variability in process and outcomes
Complications in the inpatient setting

27. Program Features Similar to COAP
Physician leadership
Confidentiality
CQIP status and protection
Universal participation (eventual)
Existing infrastructure/ administration
Requirements to participate

28. Program Features Different from COAP
Funding sources
Initial
Ongoing
Coordinated QI activities

29. SCOAP Current Status

30. SCOAP Progress to Date
Secured funding from HCA to develop infrastructure
Data variables, forms, and definitions developed and tested
Report formats developed
Initial set of participating hospitals
Contracted with data management firm

31. SCOAP Management Committee
Fred Bowers, MD Kadlec Med. Center
Leigh Cooley, RN, MN Skagit Valley Hospital
Patch Dellinger, MD University of Washington Med. Center
Denise Dominik, RN Sacred Heart Med. Center
Michael Florence, MD Swedish Med. Center
David Flum, MD University of Washington Med. Center
Eric Froines, MD Group Health Cooperative
Jerry Jurkovich, MD Harborview Med. Center
Ben Knecht, MD Wenatchee Valley Med. Center
David Lauter, MD Evergreen Hospital Med. Center
Paul Lin, MD Sacred Heart Med. Center
David Simonowitz, MD Overlake Hospital Med. Center
Richard Thirlby, MD Virginia Mason Med. Center

32. SCOAP Timeline and Next Steps
Hospitals begin to collect and submit data
Secure program funding support effective January 2006
Expand to additional hospitals this summer
Initial reports early 2006
Bring in rural and critical access hospitals

33. SCOAP Hospital Roles Early (2005) participants help shape SCOAP
Sign contract for data submission with Foundation
Work with SCOAP staff for training re variables, definitions, etc.
Submit data
Engage surgical and QI staff and leadership

34. SCOAP Costs
No fee in 2005
Effective 2006, assume $15-$20 per case for budgeting
Staff time: minutes per case for abstraction

35. Clinical FAQs What are the alternatives?
SCIP/SIP
NSQIP
Centers of Excellence
Why are we focusing on process rather than outcome?
Balanced appraisal needed
Process is more actionable than outcome data

36. Administrative FAQs Who will know a hospital’s results?
Hospitals and surgeons

37. Hospital Concerns

38. Hospital Concerns with SCOAP
Increased hospital reporting
Meetings regarding SCOAP
Costs/employee time
Extension of program to rurals
Hospital interest in not just reporting information, but desire for focus on quality improvement

39. Where We All Agree
Surgical COAP is consistent with increasing trend toward quality reporting
It will affect any hospital that performs the procedures and wishes to contract with insurers of state employees and will extend as other payers come on board
Information is available to help with planning and budgeting

40. POLL How will SCOAP affect your hospital?
SCOAP will be very beneficial to improving surgical care.
SCOAP will be somewhat beneficial.
SCOAP is okay – an equal combination of benefit and burden.
SCOAP will be a reporting burden with little benefit.
SCOAP will be very burdensome with no benefit.

41. Questions
Contact Information
Leigh Cooley
Claudia Sanders
Miriam Marcus-Smith

42. Thank you for participating!
Please fill out the evaluation.