CERTAIN developed in response to the growing need for healthcare system that is able to monitor the risks, benefits, and value of new healthcare treatments and technology to determine whether or not these developments actually improve quality of care and the health of patients. This type of system is called a learning healthcare system and is vital in this time of ever advancing healthcare technology and options available to healthcare stakeholders.
CERTAIN was built on the clinician and hospital relationship that created the Surgical Care and Outcomes Assessment Program (SCOAP). SCOAP is a unique performance data-sharing, benchmarking, and quality improvement (QI) platform for surgical and interventional procedures in Washington State. SCOAP is based in a grassroots, voluntary, clinician-led collaborative including doctors, statewide insurers, policymakers, professional organizations of nurses, physicians, nurse anesthetists and hospitals, and the state chapter of the American College of Surgeons. The program is administered by the non-profit Foundation for Health Care Quality (FHCQ), and the University of Washington Centers for Comparative and Health Systems Effectiveness (CHASE Alliance) parters with FHCQ in the development, deployment, and evaluation of SCOAP activities. Data linked from multiple sources, including medical records, payers, and a survey center are used to help SCOAP hospitals assess the longer-term impact of care and complications on patients and the healthcare system. The program includes a set of interventions for standardization (checklists, order sets, and training) to drive performance improvement and clinician education that has resulted in dramatic reductions in complications and significant savings to the healthcare system in general.
SCOAP has had remarkable success. However, a need exists to move beyond QI and to perform real world assessments of risks and benefits. QI alone, while important and worthwhile, cannot accomplish these assessments: QI registries are often limited and cannot capture long-term care and outcomes, don’t cross care delivery sites (inpatient vs. outpatient), don’t include patient perspectives, are extremely labor intensive, and are limited in dissemination and generalizability. CERTAIN is an innovative response to the limitations of pure QI by building an automated flow of electronic health information and creating a novel approach to incorporating patient perspectives into research through patient-reported outcomes surveys, a Patient Advisory Network, and integration of patients into research development and evidence dissemination.