Surgical Clinical Outcomes Assessment Program (SCOAP)

1
Surgical Clinical Outcomes Assessment Program
(SCOAP)
2
Presenters
Claudia Sanders Vice President, Policy
Development WSHA
Miriam Marcus-Smith Quality Improvement Program
Director, Foundation for Health Care Quality
David Flum, MD SCOAP Medical Director Surgeon,
University of Washington Medical Center
Nancy Fisher, MD Medical Director Washington
State Health Care Authority
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
Appendectomy
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?
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, MDKadlec Med. Center
• Leigh Cooley, RN, MNSkagit Valley Hospital
• Patch Dellinger, MDUniversity of Washington Med.
  Center
• Denise Dominik, RN Sacred Heart Med. Center
• Michael Florence, MDSwedish Med. Center
• David Flum, MDUniversity of Washington Med.
  Center
• Eric Froines, MDGroup Health Cooperative

• Jerry Jurkovich, MDHarborview Med. Center
• Ben Knecht, MDWenatchee Valley Med. Center
• David Lauter, MDEvergreen Hospital Med. Center
• Paul Lin, MDSacred Heart Med. Center
• David Simonowitz, MDOverlake 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 15-20 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 hospitals 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 lcooley_at_skagitvalleyhospital.org
Claudia Sanders claudias_at_wsha.org
Miriam Marcus-Smith Mmarcus-smith_at_qualityhealth.or
g
42
Thank you for participating!

• Please fill out the evaluation.