Team approach to surgery improves quality of care while reducing cost

By merely reducing unnecessary preoperative tests, the cost of surgery could be reduced by $112 per case according to a new study published by Bita Kash, Ph.D., M.B.A., FACHE, associate professor at the Texas A&M Health Science Center School of Public Health and Director of the National Science Foundation Center for Health Organization Transformation (CHOT).

The study, published in the top-ranked health policy journal Milbank Quarterly, was the first large-scale literature review of an approach to surgical care known as the Perioperative Surgical Home (PSH).

A PSH is a patient-centered, team-based model of coordinated care in which a patient’s entire surgical experience from preoperative to post-discharge is fully coordinated and treated as one continuum of care. The physician-led, multi-specialty team model uses resources in a cost-efficient manner and strives to increase quality of care by key activities such as reducing unnecessary preoperative tests, increasing preoperative patient education, and ensuring safe and effective transitions post-operation to home or rehabilitation.

Kash led a team of researchers in a review of more than 150 peer-reviewed studies published between 1980 and 2013, and compared PSH models in the United States and other countries in regards to clinical outcomes, efficiencies and costs of surgery.

The analysis revealed that the majority of studies (82 percent in both preoperative and intraoperative studies and 90 percent in postoperative studies) showed a significant positive impact on clinical outcomes and reduced costs. This was typically accomplished through preoperative patient education, reduction of unnecessary testing, real-time patient-routing systems, and enhanced recovery programs that encourage quicker recovery and earlier discharges.

“Whether in the United States or overseas, the review found that the PSH model of care is highly effective at reducing cancellations and surgical delays, lowering complication rates and readmissions and shortening hospital stays,” said Thomas Miller, Ph.D., M.B.A., coauthor of the review and director of health policy research at the American Society of Anesthesiologists.

Kash emphasizes that this study substantiates just how effective the PSH is at reducing cost and increasing quality of surgical procedures and 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,” Kash said. “Accordingly, the PSH may represent the beginning of a long, collaborative journey for many physicians and health systems.”

Additional researchers from the Texas A&M School of Public Health were Yichen Zhang, Kayla Cline and Terri Menser.