PERIOPERATIVE LEADERSHIP

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Name Author Abstract Publication/Date Link
The Perioperative Surgical Home- A Comprehensive Literature Review American Society of Anesthesiologists, Bita Kash, PhD, MBA, FACHE This new patient-centered model is designed to achieve the triple aim of improving health, improving the delivery of healthcare, and reducing the cost of care. These goals will be met through shared decision-making and seamless continuity of care for the surgical patient, from the decision for surgery through recovery, discharge, and beyond. Each patient will receive the right care, at the right place, and the right time. Submitted to the American Society of Anesthesiologists (ASA)June 12, 2014

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https://www.asahq.org/~/media/sites/psh/files/pshlitreview.pdf
AAOS What is a Perioperative Surgical Home? AAOS. Peggy L. Naas, MD, MBA The “medical home” is just one of the healthcare reform measures proposed to provide coordinated care and reduce healthcare costs. Best described as a philosophy of primary care, the medical home should be patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety. AAOS NowJune 2014 Issue

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http://tinyurl.com/q9qaadj
The Perioperative Surgical Home - An Introduction American Society of Anesthesiologists, A short descriptive Powerpoint slide deck intend for an audience that has no familiarity with the PSH Concept. A one-page Executive Summary document is intended to accompany the presentation American Society of Anesthesiologists, 15-09-10

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https://www.asahq.org/~/media/sites/psh/files/psh-an-introduction-final.pptx?la=en
American Society of Anesthesiologists: PSH Fact Sheet American Society of Anesthesiologists, Bita Kash, PhD, MBA, FACHE PSH Fact Sheet 2014 The American Society of Anesthesiologists.

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https://www.asahq.org/~/media/sites/psh/files/psh-fact-sheet-final.pdf?la=en
The Need for the Perioperative Surgical Home American Society of Anesthesiologists, The perioperative surgical home (PSH) is a system for organizing and coordinating carethat is patient-centered, physician-led and teambased. PSH care extends from the decision for surgery until completion of recovery. The main components of the PSH are engaged physician leadership, patient optimization for surgery, timely scheduling, evidence-informed care pathways, expert surgical and anesthetic care, facilitated rehabilitation, measurement of patient-centered outcomes, continuous performance improvement, and facilitated return to primary care. The benefits of the PSH are improved patient experience; improved safety and health outcomes; and reduced costs. Prepared September 2014 by the Department of Health Policy Research

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https://www.asahq.org/~/media/sites/psh/files/psh-white-paper.pdf?la=en
PSH Interviews from Selected Sites American Society of Anesthesiologists, Bita Kash, PhD, MBA, FACHE This study is a joint endeavor of the American Society of Anesthesiologists (ASA) and Center for Health Organization Transformation (CHOT) at Texas A&M University Health Science Center. The purpose of this study is to learn more about the perioperative surgical home (PSH), an anesthesiologist-led surgical care coordination model that is developing independently at several sites around the United States.The first phase of this study involved a comprehensive literature review that was completed in August of 2013 and subsequently updated in January and May of 2014. The findings from this review were used to develop the script for the interviews conducted with anesthesiologists and administrators at PSH sites around the nation. The findings from these interviews are discussed in the main text of this document. Submitted to the American Society of Anesthesiologists (ASA)June 12, 2014

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https://www.asahq.org/~/media/sites/psh/files/interviewresultsreportjune2014.pdf
You Can Do This: Here's HowThe Business Model for Perioperative Care American Society of Anesthesiologists, Thomas R. Miller, PhD, MBA Director of Health Policy Research Powerpoint presentation Submitted to the American Society of Anesthesiologists (ASA)January 24, 2014

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https://www.asahq.org/~/media/sites/psh/files/you_can_do_this_heres_how.pdf
Perioperative Medicine and the Future of Anesthesiology Training American Society of Anesthesiologists, Navid Alem, M.D., Kyle Ahn, M.D., Maxime Cannesson, M.D., Ph.D., Zeev N. Kain, M.D., M.B.A., Committee on Future Models of Anesthesia Practice how much of an emphasis do we place on training a physician anesthesiologist to readily diagnose a thromboembolic event on postoperative day two? Does our current training model place importance on a patient’s length of stay and educate on the intricacies of managing longitudinal care transitions after a surgical episode? A paradigm shift in training and ideology will position future physician anesthesiologists to take ownership for patients outside of the O.R. and act as consultants throughout the perioperative continuum ASA Newsletter, April 2015 n Volume 79 n Number 4

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https://www.asahq.org/~/media/sites/psh/files/alem_ahn_cannesson_kain.pdf?la=en
Payment Models for the Perioperative Surgical Home ASA: Marc L. Leib, M.D., J.D.Peter J. Dunbar, M.B., Ch.B., M.B.A. While there is general consensus on the structure of a Perioperative Surgical Home (PSH) model and the types of services it will provide, there is less agreement on who will pay for those services or how those payments will be structured. At the ASA’s PRACTICE MANAGEMENT 2015 conference in Atlanta, a number of presentations centered on payment models. Although these talks did not exclusively address the PSH, much of the information presented can be applied to this model of care. ASA Newsletter April 2015 n Volume 79 n Number 4

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https://www.asahq.org/~/media/sites/psh/files/leib_dunbar.pdf?la=en
The Perioperative Surgical Home: From Concept to Reality Michael P. Schweitzer, M.D., M.B.A., Chair, ASA Committee on Future Models of Anesthesia Practic The Perioperative Surgical Home (PSH) Learning Collaborative is implementing a proactive vision of redefining value propositions in new models of care delivery and payment to provide relevance in an evolving market. The PSH model is a patient-centered, physician-led, interdisciplinary and team-based system of coordinated care for the procedural and surgical patient ASA Newsletter April 2015 n Volume 79 n Number 4

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https://www.asahq.org/~/media/sites/psh/files/schweitzer_raman_steel.pdf?la=en
Implementing a Perioperative Surgical Home: Start With Why ... And Then Start Arthur Boudreaux, M.D. While the entire model still requires a proof-of-concept of its full implementation, each individual segment of the model has shown promise toward improvement in outcomes and reductions in cost. Implementation of preoperative clinics, procedure-specific standardized care pathways and enhanced recovery after surgery protocols have shown significant promise in this regard. But the implementation of this model involves fundamentally changing the way we practice. American Society of Anesthesiologists Article, June 1, 2014 Volume 78 Number 6

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https://www.asahq.org/resources/publications/newsletter-articles/2014/june-2014/implementing-a-perioperative-surgical-home-start-with-why-and-then-start
Outpatient/Short-Stay Vascular Surgery: A Model for the PSH Glenn Jacobowitz, M.D., FACS What is the Perioperative Surgical Home (PSH), and are both anesthesiologists and surgeons ready to accept this? The PSH is a concept of coordinated perioperative patient care that has been proposed by physician anesthesiologists. In a recent paper from Vetter et al. from the University of Alabama-Birmingham, the benefits and aspects of the surgical home were well described.1 It has been proposed by ASA and others as “an innovative, patient-centered, surgical continuity of care model that incorporates shared decision making.”1 The need for this is multifaceted. American Society of Anesthesiologists Article, June 1, 2014 Volume 78 Number 6

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https://www.asahq.org/resources/publications/newsletter-articles/2014/june-2014/pm-2014-outpatient-short-stay-vascular-surgery
Enhanced Patient Involvement Key to Improving Decision-Making Angela M. Bader, M.D. The following article will provide information from our group’s work regarding the current status of surgical decision-making, and hopefully will demonstrate the significant need for physician anesthesiologists who are developing and implementing the Perioperative Surgical Home (PSH) model to become involved in these issues. The point of preoperative assessment overseen by the physician anesthesiologist can be leveraged to review these issues and improve patient-centered care by ensuring high-value clinical appropriateness and alignment with patient values and goals. Effective preoperative processes developed within the PSH model can achieve these outcomes and improve the overall value of surgical care through increased and improved perioperative care coordination. American Society of Anesthesiologists Article, June 1, 2014 Volume 78 Number 6

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https://www.asahq.org/resources/publications/newsletter-articles/2014/june-2014/enhanced-patient-involvement-key-to-improving-decision-making
Administrative Update: Where Have You Gone Marcus Welby? Daniel J. Cole, M.D., ASA First Vice President “Marcus Welby, M.D.” was a top-rated television show during the 1970s. I recall Dr. Welby as a wise and caring physician whose clear mission in life was to help another human being in his or her hour of need. However, Dr. Welby was also a nonconformist who often went out on a limb – he was a “system” unto himself. The health care environment is much different today than it was four decades ago. Uncertainty and volatility are prevalent, and medicine is transforming at warp speed. Individualized care based on interpretation of the best evidence and intuitive decision-making is being replaced by disease-based protocols and standardization. Medical decisions are coerced by quality and cost metrics, and “shared decision-making” and “distributive leadership” are the new buzzwords. Has Marcus Welby become a remnant of the past? American Society of Anesthesiologists Article, April 1, 2014 Volume 78, Number 4

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https://www.asahq.org/resources/publications/newsletter-articles/2014/april-2014/administrative-update
Setting Up a Quality Program Shubjeet Kaur, M.D., M.S., HCM, Shubjeet Committee on Practice ManagementSpiro Spanakis, D.O. What is Quality? Why Now? Quality Assurance vs. Quality Improvement (Definitions and diagrams) American Society of Anesthesiologists Article, January 1, 2014 Volume 78, Number 1

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https://www.asahq.org/resources/publications/newsletter-articles/2014/january-2014/setting-up-a-quality-program
Administrative Update: Sailing Into Uncharted Waters With Confidence Jane C.K. Fitch, M.D., ASA President What a year 2014 is going to be! As I mentioned in my address to our House of Delegates (HOD) in October 2013 (see YouTube video at http://www.youtube.com/watch?v=Cm7bRE9m_sw), ASA will navigate this year based on our strategic plan, developed by your Administrative Council (AC) and additional Society thought leaders, and prioritized by your Board of Directors (BOD). We will navigate the uncharted waters of health care reform, including the Affordable Care Act (ACA). We will work tirelessly to repeal two of the most unfavorable aspects of this law: the Independent Payment Advisory Board (IPAB) and the non-discrimination clause. In fact, your ASA delegation to the American Medical Association (AMA) worked successfully this past year to have repeal of this non-discrimination clause placed as a priority advocacy item for the AMA. American Society of Anesthesiologists Article, January 1, 2014 Volume 78, Number 1

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https://www.asahq.org/resources/publications/newsletter-articles/2014/january-2014/administrative-update
The Perioperative Surgical Home: How to make the case so everyone wins Biomed Central - DebateThomas R Vetter, Lee A Goeddel, Arthur M Boudreaux, Thomas R Hunt, Keith A Jones, Jean-Francois Pittet Varied and fragmented care plans undertaken by different practitioners currently expose surgical patients to lapses in expected care, increase the chance for operational mistakes and accidents, and often result in unnecessary care. The Perioperative Surgical Home has thus been proposed by the American Society of Anesthesiologists and other stakeholders as an innovative, patient-centered, surgical continuity of care model that incorporates shared decision making. Topics central to the debate about an anesthesiology-based Perioperative Surgical Home include: holding the gains made in anesthesia-related patient safety; impacting surgical morbidity and mortality, including failure-to-rescue; achieving healthcare outcome metrics; assimilating comparative effectiveness research into the model; establishing necessary audit and data collection; a comparison with the hospitalist model of perioperative care; the perspective of the surgeon; the benefits of the Perioperative Surgical Home to the specialty of anesthesiology; and its associated healthcare economic advantages. © 2013 Vetter et al.; licensee BioMed Central Ltd.

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http://www.biomedcentral.com/1471-2253/13/6
Anesthesia & Analgesia’s Collection on the Perioperative Surgical Home Shafer, Steven L.; Donovan, John F. The American Society of Anesthesiologists, our primary professional organization in the United States, put a great deal of thought into the concept of the “Perioperative Surgical Home” (PSH). Their Web site articulates a clear and worthy vision for the PSH:a “This new patient-centered model is designed to achieve the triple aim of improving health, improving the delivery of healthcare, and reducing the cost of care. These goals will be met through shared decision-making and seamless continuity of care for the surgical patient, from the decision for surgery through recovery, discharge, and beyond. Each patient will receive the right care, at the right place, and the right time.” To move this initiative forward, the American Society of Anesthesiologists has committed resources to create a learning collaborative of up to 50 health care institutions to create an “evidence-based road map” for the PSH.b Anesthesia & Analgesia. 118(5):893-895, May 2014

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http://journals.lww.com/anesthesia-analgesia/Fulltext/2014/05000/Anesthesia___Analgesia_s_Collection_on_the.1.aspx
The Anesthesiologist-Directed Perioperative Surgical Home: A Great Idea That Will Succeed Only if It Is Embraced by Hospital Administrators and Surgeons Butterworth, John F. IV; Green, Jeffrey A. the United States has fewer licensed physicians and fewer licensed hospital beds per person than other Western democracies. This leads to the most fundamental problem: health care in the United States delivers inadequate value for its cost, relative to our competition. The problem is not unique to surgical and perioperative care. However, the “Perioperative Surgical Home (PSH)” is the focus of this issue of Anesthesia & Analgesia. Three articles identify defects in our current system4–6 and conclude that the anesthesiologist-led PSH offers a means by which to improve patient experiences and patient outcomes, thereby increasing value. Anesthesia & Analgesia. 118(5):896-897, May 2014.

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http://journals.lww.com/anesthesia-analgesia/Fulltext/2014/05000/The_Anesthesiologist_Directed_Perioperative.2.aspx
Implementation of a Total Joint Replacement-Focused Perioperative Surgical Home: A Management Case Report Garson, Leslie; Schwarzkopf, Ran; Vakharia, Shermeen; More The perioperative setting in the United States is noted for variable and fragmented care that increases the chance for errors and adverse outcomes as well as the overall cost of perioperative care. Recently, the American Society of Anesthesiologists put forward the Perioperative Surgical Home (PSH) concept as a potential solution to this problem. Although the PSH concept has been described previously, “real-life” implementation of this new model has not been reported. Anesthesia & Analgesia:May 2014 - Volume 118 - Issue 5 - p 1081–1089

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http://journals.lww.com/anesthesia-analgesia/Fulltext/2014/05000/Implementation_of_a_Total_Joint.29.aspx
Enhanced Recovery after Surgery Versus Perioperative Surgical Home: Is It All in the Name? Cannesson, Maxime; Kain, Zeev In this issue of Anesthesia & Analgesia, investigators from the Department of Anesthesiology at Duke University present 2 articles focusing on the topic of enhanced recovery after surgery (ERAS). The first article by Miller et al. shows that implementation of an ERAS protocol in patients undergoing colorectal surgery leads to a decreased length of stay (LOS) in the hospital. The second article by Waldron et al. demonstrates that intraoperative fluid management strategies based on the concept of perioperative goal-directed therapy can be facilitated by using a noninvasive and operator-independent cardiac output monitoring system Anesthesia & Analgesia. 118(5):901-902, May 2014.

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http://journals.lww.com/anesthesia-analgesia/Fulltext/2014/05000/Enhanced_Recovery_after_Surgery_Versus.4.aspx
Strategies for Net Cost Reductions with the Expanded Role and Expertise of Anesthesiologists in the Perioperative Surgical Home Dexter, Franklin; Wachtel, Ruth E. The Perioperative Surgical Home is a model adopted by the American Society of Anesthesiologists to increase quality and patient safety and to decrease costs. This Special Article is about the latter topic. Using narrative review, we show that there are two principal opportunities for net cost reduction. One opportunity is to reduce unnecessary interventions that do not have potential to benefit patients (e.g., preoperative laboratory studies in healthy patients undergoing low-risk surgery and use of substantial fresh gas flows with volatile anesthetics). The other opportunity is to optimize staff scheduling, case scheduling, and staff assignment. These two are the same as the principal ways that a positive return on investment can be achieved from use of an anesthesia information management system. Three other opportunities are much less likely to achieve as large (if any) net cost reduction among all patients but may at some hospitals. These are to reduce cancellations, operating room times, and/or hospital postoperative lengths of stay. Anesthesia & Analgesia:May 2014 - Volume 118 - Issue 5 - p 1062–1071

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http://journals.lww.com/anesthesia-analgesia/Fulltext/2014/05000/Strategies_for_Net_Cost_Reductions_with_the.27.aspx
The Perioperative Surgical Home as a Future Perioperative Practice Model Kain, Zeev N.; Vakharia, Shermeen; Garson, Leslie; Engwall, Scott; Schwarzkopf, Ran; Gupta, Ranjan; Cannesson, Maxime The Perioperative Surgical Home (PSH) is a practice model that has been proposed as one of the potential solutions to our fragmented and costly perioperative system. The PSH is defined by the American Society of Anesthesiologists as “a patient-centered and physician-led multidisciplinary and team-based system of coordinated care that guides the patient throughout the entire surgical experience”. The overall goal of the PSH is to provide improved clinical outcomes and better perioperative service at lower cost. The purpose of this The Open Mind is to detail how the PSH model will achieve these goals and how the specialty of anesthesiology may benefit from this practice model Anesthesia & Analgesia. 118(5):1126-1130, May 2014.

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http://journals.lww.com/anesthesia-analgesia/Fulltext/2014/05000/The_Perioperative_Surgical_Home_as_a_Future.34.aspx
The Perioperative Surgical Home: How Anesthesiology Can Collaboratively Achieve and Leverage the Triple Aim in Health Care Vetter, Thomas R.; Boudreaux, Arthur M.; Jones, Keith A.; More Factors contributing to excessive surgical expenditures include fragmentation and inefficiencies in delivery, defensive medicine, discordant incentives between stakeholders who deliver versus pay for care, and a lack of emphasis on value. To address these and other factors, the Perioperative Surgical Home (PSH) model has been developed using the guiding principles of the PCMH.9 The PSH is a patient-centered approach to the surgical patient, with a strong emphasis on standardization, coordination and transitions, and value of care, throughout the perioperative continuum, including the postdischarge phase. We posit in this The Open Mind article that the PSH can serve as the needed integrator for achieving and leveraging the IHI Triple Aim for surgical patients. Anesthesia & Analgesia:May 2014 - Volume 118 - Issue 5 - p 1131–1136

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http://journals.lww.com/anesthesia-analgesia/Fulltext/2014/05000/The_Perioperative_Surgical_Home___How.35.aspx