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

• Published in: The Milbank quarterly Vol. 92; no. 4; pp. 796 - 821
• Main Authors: KASH, BITA A., ZHANG, YICHEN, CLINE, KAYLA M., MENSER, TERRI, MILLER, THOMAS R.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.12.2014; THE MILBANK MEMORIAL FUND; BlackWell Publishing Ltd
• Subjects: 20th century; 21st century; Anesthesiology; care coordination; Continuity of Patient Care; Cost Control - economics; Cost Control - methods; Cost efficiency; Cross-national analysis; Decision Making; early patient engagement; enhanced recovery after surgery; Health care costs; Health care payments; Health care policy; Health economics; Health outcomes; Health policy; Health services; Hospital costs; Hospitals; Humans; Operating rooms; Patient-Centered Care - economics; Patient-Centered Care - standards; Patients; Payment models; Perioperative Care - economics; Perioperative Care - standards; perioperative management; Public health; Quality of care; Quality of Health Care - economics; Quality of Health Care - standards; Review; Review Article; Review articles; Subacute care; Surgery; Surgical outcomes; Surgical Procedures, Operative - economics; Surgical Procedures, Operative - standards; Surgical specialties; Unit costs; United States; United States; enhanced recovery after surgery; care coordination; early patient engagement; perioperative management
• ISSN: 0887-378X; 1468-0009
• DOI: 10.1111/1468-0009.12093

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. Methods: This comprehensive review of peer-reviewed literature investigates the history and evolution of PSH and PSH-like models and summarizes the 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.