PSH model of care saves cost, improves quality in second year

Cost savings and quality improvement increased from the first year of implementation to the second in the Perioperative Surgical Home (PSH) model of care when used for knee or hip replacement patients at the University of California, Irvine School of Medicine, according to a study presented at the ANESTHESIOLOGY^® 2015 annual meeting. Evidence of long-term sustainability of the PSH model is significant for groups such as UC Irvine which anticipate extending the PSH to other specialty areas.

"This study shows us that the PSH is a viable and beneficial model of care for our patients," said Leslie Garson, M.D., co-author of the study and associate clinical professor, Department of Anesthesiology and Perioperative Care, UC Irvine. "Our study highlights that for joint replacement patients it is highly successful and now we can look to use it in other areas."

In the study, researchers reviewed data from 328 patients who had elective knee or hip replacement surgery in UC Irvine's PSH program between Oct. 1, 2012 and Sept. 30, 2014. Factors reviewed for improvement included length of stay (LOS), discharge location, 30-day readmission rate and postoperative pain scores.

Over the two-year period, LOS was significantly lower in the second year of the PSH. By procedure, LOS was much lower for hip patients in the second year, decreasing by 28 percent, while the median LOS didn't differ for knee surgery patients between the two years. Researchers also found that for total hip replacement patients, the percentage of patients going home, rather than to a skilled nursing facility, nearly doubled (from 17.6 percent to 32.9 percent) in the second year compared to the first year. Readmission rates and postoperative pain scores did not change significantly between the first and second year of the PSH.

The PSH is an innovative patient-centered, physician-led, multidisciplinary team-based model of coordinated care. In the PSH, a patient's entire surgical experience - preoperative, intraoperative and post-discharge - is fully coordinated and treated as a continuum of care. The PSH model emphasizes the cost-efficient use of resources as well as lead physician, multi-specialty team and patient shared decision-making.

"In today's health care environment, it's especially satisfying to be part of a model of care that is achieving the triple aim of better health, better health care and lower costs," said Dr. Garson.