Background
In 1993 the Washington State Health Care Authority (HCA), which purchases health services for state employees and low income individuals, proposed an initiative to identify "centers of excellence" for selective contracting of cardiac surgery services. However, after a thorough review of the written reports submitted by hospitals and physicians in response to the proposal and several statewide meetings to obtain feedback, the HCA agreed to suspend the selective contracting model while a collaborative approach to quality improvement was developed. A collaborative model would recognize the concerns raised by the medical community while moving forward with statewide efforts to promote quality improvement in the delivery of coronary bypass surgery.
In early 1994 the pilot phase of the Clinical Outcomes Assessment Program (COAP) was launched as the collaborative solution to selective contracting. With representation from all institutions in the state of Washington performing CABG surgery, COAP began a pilot study designed to examine quality of life outcomes after bypass surgery while demonstrating a method for collaboration in collecting, analyzing and disseminating outcomes data.
After completion of the pilot phase, the leadership of the Clinical Outcomes Assessment Program changed the scope of the quality improvement effort to include PTCA-based procedures as well as CABG surgeries. In addition, the focus of the data collection became strictly clinical, excluding the quality of life measures used in the pilot study. The COAP management committee intends to expand ongoing operations to include collection of quality of life outcomes on all cases in the future, when such expansion is financially and logistically possible.
In March 1997 COAP was presented to the State Interagency Quality Committee (IQC) and was endorsed as a Health Care Authority sponsored quality improvement activity. COAP was subsequently registered with the state Department of Health as a Certified Quality Improvement Program, achieving protection under Washington statute as a quality improvement program.
Today, COAP aims to provide a rigorous, evidence-based mechanism to promote internal quality improvement activities while meeting a variety of external quality improvement and accountability requirements increasingly common in today's health care market.
