What is SCOAP?
The Surgical Care and Outcomes Assessment Program (SCOAP) is the future of surgical quality improvement. It is a physician-led, voluntary collaborative creating an aviation-like surveillance and response system for surgical quality. SCOAP’s goal is to improve quality by reducing variation in outcomes and process of care at every hospital in the region. Now at more than 50 hospitals in Washington State, SCOAP is an engaged community of clinicians working to build a safer, higher quality, and more cost effective surgical healthcare system.
SCOAP offers unique benefits to Washington hospitals and surgeons and to the public. Participation in SCOAP does not preclude participation in other programs, and may be complementary to them. SCOAP data should be useful to hospitals for multiple purposes (e.g., patient safety, process improvement, quality improvement projects, Joint Commission accreditation). Perhaps most importantly, SCOAP is an opportunity for Washington State payers and health care administrators to work jointly with surgeons to improve the quality of care without turning over that responsibility to a national organization.
How did SCOAP originate? What is the relationship between SCOAP and the State of Washington? Who runs SCOAP? What procedures are included in SCOAP? How does SCOAP compare to other programs whose goal is to improve processes and outcomes? How will SCOAP help improve surgical care and outcomes? Who is paying for this program? What happens if a hospital chooses not to participate?
How did SCOAP originate?
SCOAP is modeled on the cardiac Clinical Outcomes Assessment Program (COAP), a statewide QI program in which all Washington hospitals that perform cardiac procedures (coronary artery bypass grafts, percutaneous coronary interventions, and valve procedures) participate.
Based on the success of COAP in improving key cardiac process and outcomes measures, in 2003 the Washington State Health Care Authority (HCA) funded a study to assess the feasibility of expanding the COAP processes and principles to procedures performed by general surgeons. The study, carried out by the University of Washington Surgical Outcomes Resource Center and the Foundation for Health Care Quality, identified significant opportunities to decrease variation in processes and outcomes in Washington for many general surgical procedures.
SCOAP has been launched as a physician-led program, in partnership with other stakeholders, to promote data-driven quality improvement activities across Washington. The Washington State Chapter of the American College of Surgeons strongly supports SCOAP and urges its membership to facilitate SCOAP participation in the hospitals in which the members practice. In addition, SCOAP has the support of Washington’s surgical leadership, major state agencies, and major health plans.
What is the relationship between SCOAP and the State of Washington?
State agencies across the nation are increasingly requiring the collection of outcomes data and using the data to generate public report cards. Washington State has elected to pursue a different approach. The central premise of SCOAP is that quality of care can best be enhanced through collaborative, not punitive, mechanisms. No state agency will be authorized to review physician- or hospital-identified data without appropriate consent from the respective party. Instead, the SCOAP Management Committee will share with the State blinded data reports demonstrating general trends in surgical care, and will outline how it has responded to any concerns about quality of care. The Health Care Authority (HCA) contributes to program planning and development in an advisory role and strongly encourages hospitals to participate.
As a Coordinated Quality Improvement Program (CQIP) approved by the Washington State Department of Health, SCOAP quality improvement (QI) data are protected from disclosure.
Who runs SCOAP?
SCOAP is housed at and staffed by the Foundation for Health Care Quality, a private, not-for-profit organization that also facilitates Clinical Outcomes Assessment Program (COAP) and other QI programs and projects. The Foundation serves the health care community as a neutral, safe harbor for data-driven quality improvement activities. SCOAP policy and strategic decisions are formulated by its Advisory Board, comprised of leading surgeons from across the state in partnership with hospital administrators and representatives from other stakeholder organizations, including the HCA.
What procedures are included in general SCOAP?
The initial set of surgeries about which data has been collected includes appendectomies, colorectal procedures, and bariatric surgeries. These were included for initial focus because the feasibility work described earlier identified them as high-volume, high variation in process and/or outcome, and/or growing in volume. They are only a few procedures done by general surgeons that can be analyzed by hospital chart review and have significant opportunity for improvement in care and/or outcome. Additional procedures will be added over time as SCOAP matures.
How does SCOAP compare to other programs whose goal is to improve processes and outcomes?
SCOAP is not like other programs, such as the National Surgical Quality Improvement Program (NSQIP), the Surgical Care Improvement Project (SCIP), or the Institute for Healthcare Improvement’s 5 Million Lives Campaign.
SCOAP is a quality improvement program, not an accreditation mechanism or a data registry. It has been developed and is led by Washington State surgeon and hospital leadership, state agencies, and other stakeholders.
SCOAP’s key attributes are the following:
- Protection of data from disclosure via its CQIP status – and the ability of SCOAP to decide its own evolution on matters of disclosure and public accountability.
- Commitment to quality improvement, not punishment or exclusion.
- Leadership of hospitals and surgeons in guiding program development and strategy.
- Inclusion of both generic and disease- and procedure-specific measures in process and outcome variables.
- Use of many variables and definitions common to SCOAP, NSQIP, and SCIP.
- Quick turn-around on meaningful data: comparative reports returned to hospitals within two months of the quarter’s end; benchmarking facilitates quality improvement efforts.
- Flexibility to select surgical procedures of interest in response to public health needs and interests.
- Development of a community of providers who can learn from one another in a trusted, collaborative environment.
- Eventual universal participation by eligible hospitals.
- Ability to use the data for in-hospital QI projects.
How will SCOAP help improve surgical care and outcomes?
SCOAP participants receive regular reports of hospital-level data that provide the information they need to effectively make improvements in care by comparing and tracking their own processes and outcomes: surgeons and hospitals will identify opportunities to improve outcomes and identify unexpected outcomes and can benchmark themselves to their colleagues across the state.
Who is paying for this program?
Funding for this program is multifaceted. Support of the “start-up” phase was provided by several sources. The HCA contracted with the Foundation for Health Care Quality to organize and facilitate a secure and confidential statewide quality improvement program. The Foundation, under whose auspices SCOAP operates, has provided staffing for essential infrastructure and development. Several other entities, including health plans, have contributed grants to support this work. Additional funding sources include grants and fees from participating hospitals.
What happens if a hospital chooses not to participate?
Participation in SCOAP is voluntary. An important goal of SCOAP is to avoid coercive measures and create an atmosphere of collaboration and partnership in an effort to better serve patients in this state. The value that SCOAP provides—procedure- and disease-specific, clinically-pertinent, timely information for quality improvement—will help hospitals with their decisions to participate in SCOAP.