Boston Children’s Hospital: SCAMPS

Our mission is to deliver a novel and systematic approach to informing and improving healthcare delivery, which goes beyond the current tools – retrospective studies, prospective trials, and clinical practice guidelines – while accomplishing three goals:

Reduce practice variation
Improve patient care
Decrease ineffective or unnecessary resource utilization

Standardized Clinical Assessment and Management Plans (SCAMPs) serve to take a relatively heterogeneous patient population and through a process of iterative analysis and modification of standardized assessment and management algorithms, SCAMPs allow the intrinsic biologic variability in a patient population to emerge and be understood. SCAMPs can be used to complement our currently available tools in order to result in incremental and sustained improvement in health-care delivery.

We recognized the need, both in our field and in healthcare in general, for a robust, practical, and effective system to standardize care and to gather, analyze, and act on relevant clinical data in a flexible and continuous way. We hypothesized that a new kind of tool was required for this purpose, as no existing tool was well suited for these needs. In designing this tool, we made the following assumptions:

There is a need to reduce practice variability, optimize resource utilization, and enhance patient care
The assertion that “best practice” can be defined is misleading, as it ignores the continual changes in medical knowledge, therapeutic options, and patient populations, and discourages both clinical acumen and innovation
Any standardization of care must therefore be based on principles of “sound practice,” which represent a synthesis of current medical knowledge and best clinical judgment, and are imperfect in ways yet to be determined
Guidelines to standardize care cannot be static or stand-alone, as many CPGs have been designed to be; rather, guidelines must be flexible and must be used to create a medical learning system that can collect, analyze, and learn from relevant data to allow continuous revision and improvement
Data gathering must be selective and, based on prior medical understanding, be targeted towards relevant clinical findings in order to optimize the data burden and signal-to-noise ratio. It must readily accommodate economic analyses for cost-effectiveness studies as well
Any solution is more likely to succeed if it is designed and implemented by caregivers themselves, such that they are owners of the process rather than passive recipients
Finally, certain cherished characteristics of medical practice – the ability to discover and innovate, to train the next generation to the highest standards, and to provide truly outstanding healthcare – must be maintained

With these considerations in mind, Standardized Clinical Assessment and Management Plans (SCAMPs) were created.

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