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Perioperative Surgical Home (PSH) Study

Researcher and trial participant. 

Credit: National Center for Complementary and Integrative Health, National Institutes of Health

This work of researchers at Texas A & M’s Center for Healthcare Organization Transformation (CHOT) is a first-of-its-kind, large-scale national survey and systematic literature review focusing exclusively on perioperative safety and quality. The resulting Perioperative Surgical Home (PSH) Model is a physician-led care delivery model that includes multi-specialty care teams and cost-efficient use of resources. Simply put, PHS is a patient-centered continuity of care delivery model that incorporates shared decision-making. The twoyear study focused on how the PSH reduces surgical care costs while improving clinical outcomes. It included: 1) a systematic literature review of PSH activities focused on clinical outcomes and cost savings; 2) an in-depth survey of 15 leading PSH programs in the U.S. designed to identify and better understand key PSH activities, and; 3) a gap analysis of residency training requirements for anesthesiology, internal medicine, surgery, and family medicine. The work has demonstrated that the model is capable of serving as a guide for future curriculum development.

Results have demonstrated that successful evolution of the PSH requires the concomitant expansion of the perioperative clinicians’ roles suggested by the PSH Model. Results have provided support for the CHOT sponsor ASA’s framework and approach to alternative payment models by identifying the economic benefits of the PSH. They also suggest that anesthesiologists, hospitalists, surgeons, and nurses need to be actively involved in organization-wide strategy development and initiatives to improve care quality and reduce cost.

Subsequent follow-up studies by CHOT have identified gaps in medical education related to competencies for successful PSH development, helping to initiate conversations within ASA and with the American Board of Anesthesiology regarding medical education.

This breakthrough study has the potential for policy-relevant cost savings for policymakers, payers, administrators, clinicians, and patients across the perioperative continuum of care. This is due to the demonstrable substantial improvement its use provides in both safety and quality outcomes. This study also identifies specific areas of improvement for residency training programs that are necessary to address key PSH activities.

Economic Impact:

Surgical care is too often not standardized or coordinated. This can result in duplicated and/or unnecessary care that costs an estimated $18 billion annually in the United States. Many Western countries have developed preoperative testing and assessment guidelines to improve surgical outcomes and the reduce costs of surgical care.



Based on results of this study, the PSH has potential for dramatic cost savings due to: 1) Better coordinated preoperative testing, potentially resulting in patient cost savings; 2) Improved rehabilitation programs; Improved preoperative patient education; 3) More effective operating room (OR) scheduling initiatives that have demonstrated 22.5% decreases in OR turnaround time; 4) More effective blood use programs that have the potential to save over $100 per patient after implementation of group-and-save policies; 5) Improved nausea and vomiting protocols with 16% more patients achieving response standards with standardized protocol; 6) Improved early mobilization programs that demonstrated $756/patient cost savings due to 1.8 day reductions in overall length of stay; 7) Better coordinated discharge planning initiatives that demonstrate $412/patient reductions in total costs), and;8) Overall, surgical cost savings estimated to be estimated to be $112 per surgical patient when using evidence-based pre-operative test ordering practice guidelines.

For more information, contact Bita Kash at Texas A & M University, bakash@tamhsc.edu, Bio http://sph.tamhsc.edu/hpm/faculty/kash.html, 979.436.9462.

 

PDF icon CHOT-2016.pdf