Development of Standardized Clinical Assessment and Management Plans (SCAMPs) in Plastic and Reconstructive Surgery

摘要: The healthcare budget has outpaced the economic growth for multiple decades.1,2 percentage of Gross Domestic Product allocated to been increasing at an alarming rate and is expected exceed 20% US by 2018.3 Medicine faced with challenge controlling costs while being able maintain safe high-quality standards care. To achieve this balance avoiding other alternatives such as reimbursement reduction, it becomes imperative ensure that care delivered appropriate unnecessary avoided. One way these goals have well-established practice guidelines, backed objective data, different clinical situations. Standardized guidelines (SPGs) may also help in effective communication between patient providers be key provide maintaining financial viability. However, clear data—the lynchpin most SPGs—is often lacking. In a study where 10 cardiologists Boston Children’s Hospital were shadowed, every decision was recorded classified team independent observers (Table ​(Table11).4 Surprisingly, 37.1% (441 1188) decisions made solely on experience or anecdotal evidence, whereas another 14.7% arbitrarily based instincts. Less than data from research studies. authors physicians studied academically accomplished very knowledgeable about evidence base pediatric cardiology. This lack makes establishing standardized difficult could result significant variability treatment protocols providers. Table 1. Analysis Clinical Decision Making among Pediatric Cardiologists (N = 1188) Most SPGs developed focus common medical conditions chronic wounds. It obtain strong uncommon situations due powered data.5–8 Furthermore, create even more procedures, lacking studies conflict. An example hypertension (cited JNC 8) which 5 9 recommendations recent guideline revision are expert consensus, not evidence. Specialities plastic surgery congenital heart include plethora rare diverse These characterized both institutional individual discrepancies.9–12 Similarly, though there American Society Plastic Surgeons (ASPS) broad topic breast reconstruction expanders implants, limited making produce recommendations.13,14 Based ASPS only level III available use acellular dermal matrix (ADM) during surgeons evaluate each case individually.13,14 Also, variable regarding association postoperative complications timing postmastectomy implant reconstruction. Absence society allows variation, but vulnerability poor quality Assessment Management Plan (SCAMP) model conclusive.15,16 Because SCAMP method relatively new concept implemented field reconstructive surgery, goal determine feasibility SCAMPs. manuscript, we investigate development implementation specifically immediate utilizing implants tissue expanders.