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

Rahul H. Rathod1,2, Brittney Jurgen1,2, Rose A. Hamershock3, Kevin G. Friedman1,2, Audrey C. Marshall1,2, Mihail Samnaliev4, Dionne A. Graham3, Kathy Jenkins1,2, James E. Lock1,2, Andrew J. Powell1,2
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
* Corresponding Author: Rahul H. Rathod, MD, Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115. Email:

Congenital Heart Disease 2017, 12(6), 768-776. https://doi.org/10.1111/chd.12508

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

Cite This Article

Rathod, R. H., Jurgen, B., Hamershock, R. A., Friedman, K. G., Marshall, A. C. et al. (2017). Impact of standardized clinical assessment and management plans on resource utilization and costs in children after the arterial switch operation. Congenital Heart Disease, 12(6), 768–776.



This work is licensed under a Creative Commons Attribution 4.0 International License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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