Surgical Care and Outcomes Assessment Program

Surgical Care and Outcomes Assessment Program
Name	Surgical Care and Outcomes Assessment Program
Abbreviation	SCOAP
Formation	2006
Type	Nonprofit quality improvement collaborative
Headquarters	Washington (state)
Region served	United States
Parent organization	Surgical Care and Outcomes Assessment Program Foundation

Surgical Care and Outcomes Assessment Program is a clinician-led, peer-to-peer quality improvement collaborative focused on perioperative care and surgical outcomes. The program connects hospitals, surgeons, and multidisciplinary teams to standardize data collection, implement evidence-based practices, and reduce complications for procedures ranging from colorectal resection to bariatric surgery. SCOAP operates through data-driven benchmarking, continuous feedback, and collaborative learning networks.

Overview

SCOAP was established as a regional quality improvement network linking hospitals such as Harborview Medical Center, Swedish Medical Center (Seattle), Providence Health & Services, University of Washington Medical Center, Virginia Mason Medical Center, and community hospitals across Washington (state), with engagement from clinicians affiliated with institutions like Mayo Clinic, Massachusetts General Hospital, Johns Hopkins Hospital, Cleveland Clinic, UCLA Medical Center, UCSF Medical Center, Mount Sinai Hospital (New York City), Stanford Health Care, Northwestern Memorial Hospital, Brigham and Women's Hospital, Duke University Hospital, University of Michigan Health, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, Penn Medicine, Bellevue Hospital Center, Rush University Medical Center, Hennepin County Medical Center, UT Southwestern Medical Center, Baylor University Medical Center, Hospital of the University of Pennsylvania, Children's Hospital of Philadelphia, Texas Medical Center, Kaiser Permanente affiliates, and other centers of surgical care. SCOAP interfaces with professional societies and stakeholders including American College of Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons, American Society of Anesthesiologists, Obesity Society, American Board of Surgery, Association of periOperative Registered Nurses, and payers such as Centers for Medicare and Medicaid Services and private insurers. The program emphasizes metrics that align with guidelines from bodies like National Quality Forum, Agency for Healthcare Research and Quality, and Institute of Medicine.

History and Development

SCOAP was launched through collaboration among clinicians, hospital executives, and policy leaders influenced by reform efforts associated with entities such as Bill & Melinda Gates Foundation-funded initiatives, state health agencies, and academic centers including University of Washington. Early champions included surgical leaders with ties to American Surgical Association, Association of American Medical Colleges, and the Robert Wood Johnson Foundation. The model drew on principles used by international benchmarking programs seen in National Health Service (England), Scandinavian Surgical Registries, and registries like Society of Thoracic Surgeons’ database and Vascular Quality Initiative. Funding and technical support arrived from philanthropic and public sources similar to grants awarded by Kaiser Family Foundation and collaborations reminiscent of projects with Centers for Disease Control and Prevention.

Program Structure and Methodology

SCOAP functions as a collaborative consortium with a governance structure echoing practices found in organizations such as Institute for Healthcare Improvement, National Quality Forum, and regional collaboratives patterned after Surgical Care Improvement Project. Leadership includes multidisciplinary committees composed of surgeons, anesthesiologists, nurses, informaticians, and quality officers drawn from partner hospitals like Seattle Children’s Hospital and academic centers including Harvard Medical School, Yale School of Medicine, Perelman School of Medicine at the University of Pennsylvania, Vanderbilt University School of Medicine, and University of Chicago Medicine. Methodology integrates prospective clinical data abstraction, risk adjustment models influenced by constructs used at American College of Surgeons National Surgical Quality Improvement Program, and Plan-Do-Study-Act cycles described by W. Edwards Deming and adopted by Institute for Healthcare Improvement. SCOAP develops procedure-specific modules (e.g., colorectal, bariatric, vascular) using definitions and performance measures aligned with standards from World Health Organization, Joint Commission, and specialty societies.

Data Collection and Quality Metrics

Data collection in SCOAP relies on standardized clinical data elements captured by trained abstractors and electronic health record interfaces; concepts mirror systems used by National Surgical Quality Improvement Program, National Cardiovascular Data Registry, and registries like Society of Thoracic Surgeons Adult Cardiac Surgery Database. Core metrics include surgical site infection, anastomotic leak, readmission, mortality, length of stay, and process measures such as appropriate prophylactic antibiotics and venous thromboembolism prophylaxis; these echo measures endorsed by National Quality Forum, Centers for Disease Control and Prevention, World Health Organization, American College of Surgeons, and specialty groups. SCOAP applies risk-adjustment and statistical benchmarking drawing on methodologies used by Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Johns Hopkins ACG System, and predictive models employed at institutions such as Mayo Clinic and Cleveland Clinic.

Participation and Governance

Participation is voluntary and includes academic medical centers, community hospitals, and critical access hospitals similar to networks involving Kaiser Permanente, Intermountain Healthcare, Geisinger Health System, and regional collaboratives across states like California, Texas, New York (state), Massachusetts, and Florida (state). Governance incorporates clinical steering committees, data management teams, and legal and compliance advisors with structures comparable to those at American Board of Surgery collaboratives and nonprofit foundations such as Robert Wood Johnson Foundation. Contracting, data use agreements, and confidentiality protections align with practices seen in collaborations with Health Information Trust Alliance standards and institutional review processes at institutions like Stanford University School of Medicine and Yale School of Medicine.

Impact on Clinical Outcomes and Research

SCOAP has reported reductions in complications and variation for targeted procedures through iterative quality interventions, publishing findings in journals and presenting at meetings hosted by organizations including American College of Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons, Association for Surgical Education, AcademyHealth, American Medical Association, American Public Health Association, and specialty congresses. The program’s dataset has supported comparative effectiveness research and quality science akin to studies from National Institutes of Health, Agency for Healthcare Research and Quality, Patient-Centered Outcomes Research Institute, The Cochrane Collaboration, and academic investigators at Harvard School of Public Health, Johns Hopkins Bloomberg School of Public Health, University of Michigan School of Public Health, and Columbia University Mailman School of Public Health.

Criticisms and Limitations

Critiques of SCOAP mirror concerns raised for other registries and include data completeness and abstraction burden similar to challenges reported by National Surgical Quality Improvement Program, potential selection bias affecting comparisons as seen in voluntary registries such as Society of Thoracic Surgeons datasets, and resource constraints analogous to those encountered by rural hospitals and safety-net institutions like Bellevue Hospital Center and Hennepin County Medical Center. Additional limitations cited include variability in electronic health record interoperability familiar to Epic Systems Corporation and Cerner Corporation users, and the difficulty of attributing outcomes to specific interventions as debated in forums including Institute of Medicine panels and publications from The New England Journal of Medicine and JAMA.

Category:Healthcare quality improvement