Outcomes Following Initial Perioperative Surgical Home Integration at a Rural Community Hospital

Background: The Perioperative Surgical Home (PSH) model of care was developed to deliver value-based care that improves population health, reduces care costs, satisfies patients and gratifies providers. Rural and remote health centers have the greatest need to coordinate surgical care to improve patient access and outcomes. However, limited PSH model fidelity currently exists for rural and remote care facilities. This study integrated and assessed the PSH model within a rural, community hospital to create a system-level model to adapt/customize PSH to meet the needs of the staff, clinicians, patients, and communities served in three rural counties. The aim of this study was to assess system functionality by tracking preliminary clinical and rehabilitative patient outcomes after initial PSH implementation at a rural community hospital. Methods: An initial PSH system model was created using field-based user observations during normal clinic operations, investigator-led debriefs of staff, and longitudinal patient outcomes. This system model was created using the critical path method, bottleneck analysis and cause and effect diagramming. An initial cohort of 17 orthopedic joint replacement patients were followed from PSH enrollment to 90-days post hospital discharge to assess clinical and rehabilitative outcomes as well as to assess PSH system functionality in a rural care network. Results: The first system analysis was performed with the primary stakeholder being the patient (patient-centric). Several linked service processes form the surgical episode with inputs from a variety of stakeholders. Average length of stay decreased to 2.23 days, hospital discharge to home increased to 86% and readmissions decreased to 5.9%. Conclusion: During the system mapping process several areas were identified for improvement including information flow and duplicative work. Two primary process bottlenecks were found and included sleep apnea screening with a positive result and post-acute inpatient care scheduling. The PSH model of care is feasible in a small, rural community hospital. Patient outcome improvements demonstrate the important roles of centrally-based and proactive care management for major care episodes.