Dr. Philip Blazar (left) is one of the first BWH physicians to help develop a SCAMP.

Standardizing care is one of the keys to improving quality and reducing medical costs. By following guidelines based on today’s best medical evidence, we help deliver the best possible outcomes to our patients and help reduce waste.

But what do we do when reliable care guidelines don’t exist?

To help us improve quality when there’s uncertainty about the standard of care, Brigham and Women’s Hospital (BWH) launched the Standardized Clinical Assessment and Management Plan (SCAMP) program. Based on an initiative developed at Children’s Hospital Boston, a SCAMP offers a unique method for developing a guideline when no true guideline is available.

Unlike traditional evidence-based medicine, a SCAMP encourages thoughtful flexibility. “If a particular physician, for a particular patient, doesn’t want to follow a guideline, they can deviate from it,” says Dr. Jeff Greenberg, Medical Director of SCAMPs at Brigham and Women’s Hospital. “We’re just going to want to know why.” By analyzing these deviations to determine what does or doesn’t improve care, Dr. Greenberg explains, we can create improved guidelines that are based on reliable data.

Dr. Philip Blazar and Dr. Brandon Earp of the Department of Orthopedic Surgery were enthusiastic about developing a SCAMP to help standardize their practice’s treatment of distal radius fractures (at the end of the forearm, just above the wrist). Although distal radius fracture is the most common upper extremity fracture in the U.S., the way it’s treated varies greatly among physicians because there is no definitive national guideline.

“These fractures are only increasing with the aging population in the U.S.,” says Dr. Blazar. “We want to address practice variations and better understand which patients should have surgery, which patients need to be screened for osteoporosis, and, of those, which patients would benefit from an osteoporosis intervention.”

The distal radius SCAMP covers the entire spectrum of care, including decisions about whether to perform surgery, therapy protocols, imaging, osteoporosis evaluation, and pain management. It’s designed to ensure that every patient receives the best possible care at every step, helping reduce unnecessary tests, radiation, and surgery, and improving medical outcomes.

But the goal of a SCAMP isn’t simply to develop a guideline and then quit. It is designed to produce continuous improvement and learning.

“The whole process challenges you to be thoughtful about what you’re doing at every step along the way,” says Dr. Earp. “It’s a perpetual learning process for all of us.”

*To learn more about some of our other quality improvement initiatives, read Dr. Atul Gawande’s recent New Yorker article that features Dr. John Wright’s method for improving knee replacement surgery outcomes, or a recent HealthHub blog post about using technology to reduce medical errors.

– Chris P

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