The Perioperative Surgical Home (PSH): A Comprehensive Review of US and Non‐US Studies Shows Predominantly Positive Quality and Cost Outcomes

Abstract

Policy Points:r The perioperative surgical home (PSH) is complementary to the patient-centered medical home (PCMH) and defines methods for improving the patient experience and clinical outcomes, and controlling costs for the care of surgical patients.r The PSH is a physician-led care delivery model that includes multispecialty care teams and cost-efficient use of resources at all levels through a patient-centered, continuity of care delivery model with shared decision making.r The PSH emphasizes "prehabilitation" of the patient before surgery, intraoperative optimization, improved return to function through follow-up, and effective transitions to home or post-acute care to reduce complications and readmissions. Context:The evolving concept of more rigorously coordinated and integrated perioperative management, often referred to as the perioperative surgical home (PSH), parallels the well-known concept of a patient-centered medical home (PCMH), as they share a vision of improved clinical outcomes and reductions in cost of care through patient engagement and care coordination. Elements of the PSH and similar surgical care coordination models have been studied in the United States and other countries. 796The Perioperative Surgical Home 797 results of studies of PSH elements in the United States and in other countries. We reviewed more than 250 potentially relevant studies. At the conclusion of the selection process, our search had yielded a total of 152 peer-reviewed articles published between 1980 and 2013. Findings:The literature reports consistent and significant positive findings related to PSH initiatives. Both US and non-US studies stress the role of anesthesiologists in perioperative patient management. The PSH may have the greatest impact on preparing patients for surgery and ensuring their safe and effective transition to home or other postoperative rehabilitation. There appear to be some subtle differences between US and non-US research on the PSH. The literature in non-US settings seems to focus strictly on the comparison of outcomes from changing policies or practices, whereas US research seems to be more focused on the discovery of innovative practice models and other less direct changes, for example, information technology, that may be contributing to the evolution toward the PSH model. Conclusions:The PSH model may have significant implications for policymakers, payers, administrators, clinicians, and patients. The potential for policy-relevant cost savings and quality improvement is apparent across the perioperative continuum of care, especially for integrated care organizations, bundled payment, and value-based purchasing.

Joint arthroplasty Perioperative Surgical Home: Impact of patient characteristics on postoperative outcomes

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Comorbidities and Complications of Spinal Fusion for Scoliosis

“…To help achieve the triple aim of increased patient satisfaction, improved quality of care, and decreased cost, 9 pediatricians are integrating 10 with surgeons, anesthesiologists, specialists, and other providers to help assess and manage the children's comorbid conditions before, during, and after surgery. 11 -15 Despite the promise of involving pediatricians in the perioperative management of comorbid conditions for CMC, little is known about which comorbidities have the strongest associations with health outcomes and use of expensive hospital resources after major surgical interventions.…”

From programme theory to logic models for multispecialty community providers: a realist evidence synthesis

“…77 One US variant was a 'physician-led' team such as the 'perioperative surgical home' (PSH) in which activities included patient 'rehabilitation' before surgery and transitions to home or post-acute care designed to reduce complications and readmissions. 51 l Mental health services. Lewis et al 56 describe the addition of mental health-workers (e.g.…”

“…The six components of Wagner's CCM are (1) community resources and policies, (2) health care organisation, (3) self-management support, (4) delivery system design, (5) decision support and (6) clinical information systems. Five studies 28,30,31,49,51 reported in a SR of integrated care models for patients with chronic diseases found that projects that incorporated at least two of the six components had significantly fewer admissions and fewer inpatients days than other integrated care projects. 126 Huber et al 128 attributed reductions in the likelihood of hospital admission for cardiovascular and COPD, but not respiratory disease, patients to the introduction of care co-ordination and care guidelines in Swiss primary care networks.…”