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The Perioperative Surgical Home Cui Bono? ONLINE FIRST

David I. Soybel, MD1,2; Kayla Knuf, BS1,2
[+] Author Affiliations
1Department of Surgery, Pennsylvania State University College of Medicine, Hershey
2Department of Surgery, Milton S. Hershey Medical Center, Hershey, Pennsylvania
JAMA Surg. Published online August 10, 2016. doi:10.1001/jamasurg.2016.2056
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This Viewpoint reports on the concept of the Perioperative Surgical Home.

In recent years, attention has been directed to the concept of the Perioperative Surgical Home (PSH). The origin of this concept can be attributed to the introduction of ambulatory surgery and the rise of preadmission testing centers, which led to improvements in the preoperative recognition and management of risk factors and a reduction in the use of preoperative screening services and tests that provided no clear benefits.1 Beginning in the 1990s, a number of institutions began to formally address the problem of a perioperative system of anesthetic management for nonurgent procedures, viewing it through the Donabedian lens of quality2 that focuses attention on structure, process, and measurement of outcomes. Most recently, it has been recognized that outcomes of major elective operations can improve with the proactive, goal-directed, preoperative preparation of the patient coupled with early planning for discharge and postprocedure rehabilitation.3,4 The PSH is a vehicle for integrating preoperative, intraoperative, and postoperative phases of care on the theory that the highest value will be achieved for the patient and the payer. But it seems fair to ask, who actually will benefit?

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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