title: An Ambulatory Surgery Perioperative Surgical Home in Kaiser Permanente Settings: Practice and Outcomes.
abstract: The aim of this study is to describe the design, implementation, and associated outcome changes of a Perioperative Surgical Home (PSH) for patients undergoing ambulatory laparoscopic cholecystectomy in a Kaiser Permanente practice model.
  
  
  
  A multidisciplinary planning committee of 15 individuals developed and implemented a new PSH program. A total of 878 subjects were included in the preimplementation period (T-fast), and 1082 patients were included in the postimplementation period (PSH) based on the date of their surgery. The primary goal of this report was to assess the changes in patient outcomes associated with this new PSH implementation on variables such as total length of stay and unplanned hospital admission (UHA).
  
  
  
  Patients assigned to the PSH model had a significantly shorter mean length of stay compared with patients in the T-fast group (162 ± 308 vs 369 ± 790 minutes, P = .00005). UHA was significantly higher in the T-fast group as compared with the PSH group (8.5% [95% CI 6.6-10.4] vs 1.7% [0.9-2.5], P < .00005). There was no difference in the 7 days readmission rates between patients managed in the T-fast track and the PSH track (5.4% [3.8-7.0] vs 5.0% [3.6-6.3], P = .066).
  
  
  
  Introduction of the PSH into a Kaiser Permanente model of care was associated with a simultaneous decrease of length of stay and UHA for laparoscopic cholecystectomy patients.
authors.affiliation: From the *Department of Anesthesiology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California; †Department of Anesthesiology and Perioperative Care, University of California Irvine, Orange, California; ‡Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, California; and §Department of Surgery, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California.
authors.forename: Chunyuan
authors.initials: C
authors.lastname: Qiu
authors.forename: Joseph
authors.initials: J
authors.lastname: Rinehart
authors.forename: Vu T
authors.initials: VT
authors.lastname: Nguyen
authors.forename: Maxime
authors.initials: M
authors.lastname: Cannesson
authors.forename: Atef
authors.initials: A
authors.lastname: Morkos
authors.forename: Diana
authors.initials: D
authors.lastname: LaPlace
authors.forename: Narendra S
authors.initials: NS
authors.lastname: Trivedi
authors.forename: Philip D
authors.initials: PD
authors.lastname: Mercado
authors.forename: Zeev N
authors.initials: ZN
authors.lastname: Kain
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000379:methods* / Q000592:standards; D017081:Cholecystectomy, Laparoscopic / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000592:standards; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000379:methods* / Q000592:standards; D019990:Perioperative Care / Q000379:methods* / Q000592:standards; D012189:Retrospective Studies; D016896:Treatment Outcome