We Are Doing It Because They Demanded It

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Reply:
We appreciate the opportunity to respond to these excellent comments. Our vision for the perioperative surgical home was inspired by the excellent work of Dr. Carli and his colleagues at McGill.
As we began trials in prehabilitation, we noted strong patient preference to participate in preoperative training programs, giving us pause about assigning to the control group. Focus groups noted patient empowerment, clinical engagement, and fear alleviation as powerful positive forces. This motivated our development of the current nonresearch, clinical program.
This inexpensive patient-centered clinical program has now enrolled more than 1000 patients.1 The primary outcomes have been financial, in an effort to build a business case for this patient-centered program. Our attempts to implement this simple, home-based intervention across the state of Michigan have been daunting. Patient-tailored, complex, and nonhome–based programs suggested by the authors will never be able to be implemented across broad populations.
Studies that follow physiologic outcomes are important to understand mechanism; they do not provide pragmatic solutions to the problems that our patients face. Understanding why our program works requires partnerships with social scientists and psychologists; this work is underway. In the mean time, we will continue with this program because preoperative positive psychology is good for patients and good for business.
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