The Perioperative Surgical Home: Improving the Value and Quality of Care in Total Joint Replacement

Abstract

Purpose of Review The perioperative surgical home (PSH) is a patient-centered, physician-led, multidisciplinary care pathway developed to deliver value-based care based on shared decision-making. Physician and hospital reimbursement will be tied to providing quality care at lower cost, and the PSH model has been used in providing care to patients undergoing lower extremity arthroplasty. The purpose of this review is to discuss the rationale, definition, development, current state, and future direction of the PSH. Recent Findings The PSH model guides the patient throughout the pre and perioperative process and into the postoperative phase. It has been shown in multiple studies to decrease length of stay, improve functional outcomes, allow more home discharges, and lower costs. There is no increase in complications or readmission rates. Summary The PSH pathway is a safe and effective method of providing value-based care to patients undergoing hip and knee arthroplasty.

Centering Racial and Ethnic Equity in Health Care Throughout Spatial Data Analysis

“…Akin to other patient-based practice structures, such as Ontario's (Canada) Family Health Team Model, [28] medical homes are largely based on physician-led continuity of care delivery that includes multispecialty care teams that utilize shared decision-making. [29] In the broadest sense, medical homes represent a transformative approach to improving patient care, reducing avoidable utilization, and increasing satisfaction among patients and providers. [30] At the time of this study, Medicaid bene ciaries were able to attend 297 of the state's 367 medical homes that participated in its managed care network.…”

Team Approach: A Multidisciplinary Approach to the Management of Hip and Knee Osteoarthritis

“…The perioperative surgical home is defined by the American Society of Anesthesiologists as 23 : "a patient-centered and physicianled multidisciplinary and team-based system of coordinated care that guides the patient throughout the entire surgical experience." This model has been associated with decreased length of stay, improved functional outcomes, earlier discharge, and increased likelihood of discharge directly to the home without concurrent increase in complication or readmission rates 23,24 . Integrated care systems have also promoted novel initiatives including cross-training and shared working between team members from different disciplines 25 .…”

“…Care redesign covering most components of an integrated care system has traditionally focused on the surgical episode and guiding patients from the decision to undergo arthroplasty through the perioperative period to the postoperative phase 23 . The perioperative surgical home is defined by the American Society of Anesthesiologists as 23 : "a patient-centered and physicianled multidisciplinary and team-based system of coordinated care that guides the patient throughout the entire surgical experience." This model has been associated with decreased length of stay, improved functional outcomes, earlier discharge, and increased likelihood of discharge directly to the home without concurrent increase in complication or readmission rates 23,24 .…”

Post-acute Transitional Journey: Caring for Orthopedic Surgery Patients in the United States

“…The PSH model was created in direct response to Centers for Medicare & Medicaid Services implementing a Comprehensive Care for Joint Replacement (CJR) bundled payment model, which held hospitals financially accountable for quality and cost of an entire joint replacement episode of care. By implementing the PSH model, hospitals have been able to reduce the length of stay without an increase in complications or readmissions, leading to greater reimbursements under the CJR payment plan (52). Enhanced Recover After Surgery pathway has been implemented with proven clinical benefits of reducing length of stay, cost, and perioperative complications (53).…”