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.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: •Of importance •• Of major importance
Burwell SM. Setting value-based payment goals--HHS efforts to improve U.S. health care. N Engl J Med [Internet]. 2015;372(10):897–899. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25738663%5C http://www.ncbi.nlm.nih.gov/pubmed/25622024
Comprehensive care for joint replacement model. CMS.gov
Froimson MI, Rana A, White RE, Marshall A, Schutzer SF, Healy WL, et al. Bundled payments for care improvement initiative: the next evolution of payment formulations: AAHKS bundled payment task force. J Arthroplasty [Internet]. Elsevier Inc.; 2013;28(8 SUPPL):157–165. Available from: http://dx.doi.org/10.1016/j.arth.2013.07.012
What is MACRA—network for regional healthcare improvement. NRHI.org
Porter ME. What is value in health care? N Engl J Med [Internet]. 2010;363(1):1–3.
Porter ME. A strategy for health care reform—toward a value-based system. N Engl J Med. 2009;361(2):109–12.
Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Jt Surgery-American. 2007;89A(4):780–5.
Doman DM, Gerlinger TL. Total joint arthroplasty cost savings with a rapid recovery protocol in a military medical center. Mil Med. 2012;177(1):64–9.
Mertes SC, Raut S, Khanduja V. Integrated care pathways in lower-limb arthroplasty: are they effective in reducing length of hospital stay? Int Orthop. 2013;37(6):1157–63.
• Vetter TR, Goeddel LA, Boudreaux AM, Hunt TR, Jones KA, Pittet J-F. The perioperative surgical home: how can it make the case so everyone wins?. [Internet]. Vol. 13, BMC anesthesiology. 2013. p. 6 This is a description of an early PSH model that provides a widely accepted definition of what the PSH is.
• Kash BA, Zhang Y, Cline KM, Menser T, Miller TR. The perioperative surgical home (PSH): a comprehensive review of us and non-us studies shows predominantly positive quality and cost outcomes. Milbank Q. 2014;92(4):796–821. This is an excellent review that compared the PSH to other models.
Melnyk M, Casey RG, Black P, Koupparis AJ. Enhanced recovery after surgery (ERAS) protocols: Time to change practice? [Internet]. Vol., Can Urol Assoc J 2011 5. p. 342–348.
Cannesson M, Kain Z. The perioperative surgical home: an innovative clinical care delivery model. J Clin Anesth. 2015;27(3):185–7.
Duplantier N, Briski D, Luce L, Meyer M, Ochsner J, Chimento G. The effects of a hospitalist co-management model for joint replacement patients in a teaching facility. J Arthroplasty [Internet]. Elsevier Ltd; 2015;31(3):1–6.
•• Garson L, Schwarzkopf R, Vakharia S, Alexander B, Stead S, Cannesson M, et al. Implementation of a total joint replacement-focused. Anesth Analg. 2014;118(5):1081–9. To our knowledge this is the description of the first total joint PSH Model.
Yoon RS, Nellans KW, Geller JA, Kim AD, Jacobs MR, Macaulay W. Patient education before hip or knee arthroplasty lowers length of stay. J Arthroplasty [Internet]. Elsevier Inc.; 2010;25(4):547–551.
Ng VY, Lustenberger D, Hoang K, Urchek R, Beal M, Calhoun JH, et al. Preoperative risk stratification and risk reduction for Total joint reconstruction. J Bone Jt Surgery-American. 2013;19:1–15.
Duplantier N, Briski D, Ochsner JL, Meyer M, Stanga D, Chimento GF. The financial impact of a multidisciplinary preoperative risk stratification program for joint arthroplasty. J Arthroplasty [Internet]. Elsevier Inc.; 2015;30(9):1485–1491.
Boraiah S, Joo L, Inneh IA, Rathod P, Meftah M, Band P, et al. Management of modifiable risk factors prior to primary hip and knee arthroplasty: a readmission risk assessment tool. J Bone Jt Surg [Internet]. 2015;97(23):1921–8.
Iorio R. Strategies and tactics for successful implementation of bundled payments: bundled payment for care improvement at a large, urban, academic medical center. J Arthroplasty [Internet]. Elsevier Inc.; 2015;30(3):349–350.
Husted H. Fast-track hip and knee arthroplasty: clinical and organizational aspects. Acta Orthop Suppl [Internet]. 2012;83(346):1–39.
Ayalon O, Liu S, Flics S, Cahill J, Juliano K, Cornell CN. A multimodal clinical pathway can reduce length of stay after Total knee arthroplasty. HSS J. 2011;7(1):9–15.
Vetter TR, Barman J, Hunter JM, Jones KA, Pittet JF. The effect of implementation of preoperative and postoperative care elements of a perioperative surgical home model on outcomes in patients undergoing hip arthroplasty or knee arthroplasty. Anesth Analg.
Juliano K, Edwards D, Spinello D, Capizzano Y, Epelman E, Kalowitz J, et al. Initiating physical therapy on the day of surgery decreases length of stay without compromising functional outcomes following Total hip arthroplasty. HSS J. 2011;7(1):16–20.
Farias M, Jenkins K, Lock J, Rathod R, Newburger J, Bates DW, et al. Standardized clinical assessment and management plans (SCAMPs) provide a better alternative to clinical practice guidelines. [Internet]. Vol. 32, Health affairs (Project Hope). 2013. p. 911–920.
Bini SA, Fithian DC, Paxton LW, Khatod MX, Inacio MC, Namba RS. Does discharge disposition after primary total joint arthroplasty affect readmission rates? J Arthroplasty [Internet]. Elsevier Inc.; 2010;25(1):114–117.
Ashby E, Matejowsky C, Mythen MG, Haddad FS, Grocott MP. How efficient is patient discharge following lower limb arthroplasty? Perioper Med [Internet]. 2015;4(1):5.
Chaurasia A, Garson L, Kain ZL, Schwarzkopf R. Outcomes of a joint replacement surgical home model clinical pathway. Biomed Res Int. 2014;2014
Crawford DA, Scully W, McFadden L, Manoso M. Preoperative predictors of length of hospital stay and discharge disposition following primary total knee arthroplasty at a military medical center. Mil Med [Internet]. 2011;176(3):304–7.
Phan DL, Ahn K, Rinehart JB, Calderon M-D, Wu W-D, Schwarzkopf R. Joint arthroplasty perioperative surgical home: impact of patient characteristics on postoperative outcomes [Internet].
Cyriac J, Garson L, Schwarzkopf R, Ahn K, Rinehart J, Vakharia S, et al. Total Joint Replacement Perioperative Surgical Home Program: 2-Year Follow-Up. Anesth Analg. 2016;123:51–62.
Alem N, Rinehart J, Lee B, Merrill D, Sobhanie S, Ahn K, et al. A case management report: a collaborative perioperative surgical home paradigm and the reduction of total joint arthroplasty readmissions [Internet]. Vol. 5, Perioper Med. 2016. p. 1–10.
Raphael DR, Cannesson M, Schwarzkopf R, Garson LM, Vakharia SB, Gupta R, et al. Total joint perioperative surgical home: an observational financial review. Perioper Med (London, England) [Internet]. 2014;3(1):6.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Both authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
This article is part of the Topical Collection on Quality and Cost Control in TJA
Rights and permissions
About this article
Cite this article
Chimento, G.F., Thomas, L.C. The Perioperative Surgical Home: Improving the Value and Quality of Care in Total Joint Replacement. Curr Rev Musculoskelet Med 10, 365–369 (2017). https://doi.org/10.1007/s12178-017-9418-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12178-017-9418-3