The Surgical Care and Outcomes Assessment Program (SCOAP) is a clinician-led, performance benchmarking and quality improvement (QI) registry for surgical and interventional procedures.
SCOAP was established in 2005 through a grassroots effort of WA State’s surgical community led by David Flum, MD, MPH, and the state chapter of the American College of Surgeons. SCOAP is administered by the Foundation for Health Care Quality (FHCQ), a non-profit organization serving as ‘‘safe-harbor’’ for the multiple groups involved in healthcare improvement projects in Washington State.
In 2009, SCOAP rolled out its most visible initiative—the Surgical Checklist. Modeled after the checklist used by pilots on commercial airlines, this checklist is now in every Washington State hospital. This list assures the entire surgical team reviews each step in the upcoming surgery at the same time and prior to the surgery itself. The checklist initiative was widely implemented and received support from Washington State governor, Christine Gregoire.
SCOAP data exchange is protected by the WA State Continuous Quality Improvement Program statute. As a Washington State approved Coordinated Quality Improvement Program, SCOAP's participating hospitals are allowed to disclose protected healthcare information specifically for program purposes. Hospitals hire and train staff to review medical records and abstract clinical data using SCOAP data collection forms and data dictionaries. The clinical data are entered to the SCOAP registry using a web-based form. Participant hospitals receive quarterly QI performance reports that show their data alongside benchmarks and peer performance. The SCOAP continuous data collection and feedback loop is proven to improve the quality and safety of surgical and interventional care while decreasing costs.
There are currently five SCOAP registries: gastrointestinal/general surgical procedures, oncologic surgical procedures, pediatric surgical procedures, spine surgical procedures, and vascular surgical and interventional healthcare procedures.
Growth and Development
SCOAP’s growth and development was supported through grants from the Life Sciences Discovery Fund, the Agency for Healthcare Research and Quality (AHRQ) and the National Cancer Institute (NCI) to investigators in the Department of Surgery at the University of Washington (UW) under principal investigator David Flum, MD, MPH. Current research and development using SCOAP data is supported by the UW’s Comparative Effectiveness Research Translation Network (CERTAIN) within the Surgical Outcomes Research Center (SORCE). CERTAIN aims to answer patient centered comparative effectiveness research questions across a range of clinical topic areas, most recently including; the use of interventional care for claudication, the role of antibiotics in appendicitis, the value of elective surgery for diverticulitis, the impact of non-steroidal pain medication on outcomes and the effect of hyperglycemia on surgical infections. Led by implementation research teams at the UW, SCOAP was the first to bring advanced operating room checklists to every hospital in the state in 2010. In 2012 this group helped move checklisting from the OR to the surgeon’s office by creating Strong for Surgery, an initiative now run in partnership with the American College of Surgeons.
SCOAP has similarities to the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), but is more focused on directing improvements in process of care metrics along with benchmarking on risk-adjusted outcome measures. SCOAP was also the first statewide performance surveillance to incorporate patient reported outcomes (pain and function in spine surgery) into its benchmarking.
Medical Director:
Richard C. Thirlby, MD, FACS (2015 - current)
Ellen Thomason, MD, MPH, FACS (2012-2014)
David R. Flum, MD, MPH, FACS (founding Medical Director, served 2005-2012)
Advisory Board:
Michael Florence, MD (Chair)
Program Director:
Vickie A. Kolios-Morris, MSHSA, CPHQ (2012-current)
Rosa Johnson (2007-2012)
Miriam Marcus-Smith (2005-2007)
The SCOAP-CERTAIN Collaborative. Thromboembolic Complications and Prophylaxis Patterns in Colorectal Surgery. JAMA Surg. Published online June 10, 2015.
The Spine SCOAP-CERTAIN Collaborative, Lee MJ, Shonnard N, Farrokhi F, Martz D, Chapman J, Baker R, Hsiang J, Lee C, Gholish R, Flum D. The Spine Surgical Care and Outcomes Assessment Program (Spine SCOAP): A Surgeon – Led Approach to Quality and Safety. Spine (Phila Pa 1976) 2015 March 1;40(5):332-341. doi:10.1097/BRS.0000000000000750 PMID 25901980
Colorectal Writing Group for the SCOAP-CERTAIN Collaborative. The impact of delaying elective resection of diverticulitis on laparoscopic conversion rate. Am J Surg 2015 Feb 25; doi: 10.1016/j.amjsurg.2014.12.027. PMID 25773308
The SCOAP-CERTAIN Collaborative. Perioperative Hyperglycemia and Risk of Adverse Events Among Patients With and Without Diabetes. Ann Surg. 2015 Jan; 261(1):97–103. PMCID: PMC4208939
The SCOAP-CERTAIN Collaborative. Addressing the Appropriateness of Elective Colon Resection for Diverticulitis: A Report From the SCOAP CERTAIN Collaborative. Ann Surg. 2014 Sep; 260(3):533–539. PMCID: PMC4160115
The SCOAP-CERTAIN Collaborative. Enteral contrast in the computer tomography diagnosis of appendicitis: Comparative effectiveness in a prospective surgical cohort. Ann Surg. Aug 2014; 260(2): 311–316. PMCID: PMC4208938
The CERTAIN Collaborative. Implementation of a "real-world" learning health care system: Washington state's Comparative Effectiveness Research Translation Network (CERTAIN). Surgery. 2014 May;155(5):860-6. PMID 24787113
The SCOAP Collaborative. Comparative effectiveness of skin antiseptic agents in reducing surgical site infections: a report from the Washington State Surgical Care and Outcomes Assessment Program. J Am Coll Surg. 2014 Mar;218(3):336-44. PMID 25034999
The CERTAIN Collaborative. Preparing Electronic Clinical Data for Quality Improvement and Comparative Effectiveness Research: The SCOAP CERTAIN Automation and Validation Project. eGEMs. 2013 Oct; 1(1):[16].
The CERTAIN Collaborative. A model for incorporating patient and stakeholder voices in a learning health care network: Washington State’s Comparative Effectiveness Research Translation Network. J Clin Epidemiol. 2013 Aug;66(8):122-9. PMCID: PMC4097950 doi:10.1016/j.jclinepi.2013.04.007 PMID 23849146
The SCOAP Collaborative. Progress in the diagnosis of appendicitis: a report from Washington State's Surgical Care and Outcomes Assessment Program. Ann Surg. 2012 Oct;256(4):586-94. PMCID: PMC3475492
The SCOAP Collaborative. Adoption of laparoscopy for elective colorectal resection: a report from the Surgical Care and Outcomes Assessment Program" J Am Coll Surg 2012 Jun;214(6):909-18. PMCID: PMC3397823 doi:10.1016/j.jamcollsurg.2012.03.010 PMID 22533998
The SCOAP Collaborative. β-blocker continuation after noncardiac surgery: a report from the surgical care and outcomes assessment program. Arch Surg. 2012 May;147(5):467-73. PMCID: PMC4211634 doi:10.1001/archsurg.2011.1698 PMID 22249847
The SCOAP Collaborative. Routine leak testing in colorectal surgery in the Surgical Care and Outcomes Assessment Program. Arch Surg. 2012 Apr;147(4):345-51. PMCID: PMC4209849 doi:10.1001/archsurg.2012.12 PMID 22508778
The SCOAP Collaborative. Creating a learning healthcare system in surgery: Washington State's Surgical Care and Outcomes Assessment Program (SCOAP) at 5 years" Surgery 2012 Feb;151(2):146-52. PMCID: PMC4208432 doi:10.1016/j.surg.2011.08.015 PMID 22129638
The SCOAP Collaborative. Perioperative pharmacologic prophylaxis for venous thromboembolism in colorectal surgery" J Am Coll Surg 2011 Nov;213(5):596-603. 3205259 doi:10.1016/j.jamcollsurg.2011.07.015 PMID 21871823
