Study: Continuously evolving care guidelines improve outcomes, lower costs

Hospitals should consider implementing standardized clinical assessment and management plans (SCAMP), rather than clinical practice guidelines, to reduce variation and improve care, according to a new study in this month's Health Affairs.

Providers develop SCAMPs, flexible and continuously evolving guidelines that can be modified after analyzing collected data and new medical literature. By doing so, hospitals allow for patients' differences, providers' clinical judgment and changes in medical knowledge in their care guidelines, the study notes.

"We're creating living guidelines in a way that we can gather information and learn from every encounter," Michael Farias, a pediatrics resident at Boston Children's Hospital and one of the program's developers, told Kaiser Health News.

The study points out problems with endorsing clinical practice guidelines as "best practices." Strict adherence to clinical practice guidelines often ignores patients' personal preferences and keeps providers from adjusting care pathways for individual patients' needs, it says.

SCAMPs, on the other hand, are based on "sound practice" that embraces evaluation and development, the study notes.

Such evolving care guidelines have already proven successful at Boston Children's Hospital, where SCAMPs were associated with an 11 percent to 51 percent decrease in total medical expenses for six conditions and almost $702,000 in savings for a group of about 1,000 patients when compared with historical controls, the Health Affairs study found.

Boston Children's Hospital also saw the rate of "ideal" outcomes grow from 40 percent to 69 percent while "inadequate" outcomes dropped from 30 percent to 9 percent thanks to using a SCAMP on catheterization intervention on aortic stenosis in children.

Moreover, evolving care guidelines can offer hospitals a financial benefit when future financial incentives based on SCAMPs will likely offset any revenue losses, the study notes.

For more:
- here's the Health Affairs study abstract
- read the KHN article