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Integrated, Personalized Care from the Perioperative Optimization of Senior Health (POSH) Clinic

The POSH Clinic at Massachusetts General Hospital aims to improve surgical outcomes for older adult patients by implementing personalized risk-reduction strategies before, during, and after surgery. The clinic provides integrated, evidence-based care plans based on individual risks to boost pre- and post-operative health. This tailored, comprehensive care approach helps to support older adults as they prepare for surgery and ensure a smooth recovery following it.

The Mass General POSH Clinic follows a similar model of care to the one designed by Duke University School of Medicine, which has been tested and proven to help older surgical patients recovery quicker and with fewer complications.

Referral to the POSH Clinic Ahead of Surgery

Patients can be referred to the POSH Clinic by their primary care doctors and/or surgeons, if it is determined that care from our team aligns with the patient’s unique health needs and goals.

Our Approach to Care

The multidisciplinary team that leads the POSH Clinic is comprised of specialists that are experts in the care of older adult patients. They are dedicated to working closely with patients and caregivers at every stage of their care journey to ensure they make informed decisions about surgery, receive treatment that is aligned with their personal goals and values, and experience the best possible outcomes.

Prior to surgery, patients at increased risk of experiencing complications after their operation are identified and referred to the Mass General POSH Clinic for an assessment. As part of the clinic, Mass General geriatric, surgical, physical therapy, and anesthesia specialists help older adult patients manage their symptoms, prepare for every stage of their surgical care, and ensure their goals and values are reflected in the treatment plan.

Patients will meet with the POSH Clinic care team for a comprehensive evaluation to identify factors that may affect surgical outcomes, and review their goals and values. From there, they will work together to develop a personalized care and recovery plan.

The Importance of Reducing Surgical Risk for Older Adult Patients

Older adult patients are at a higher risk of experiencing complications after surgery due to a variety of age-related factors. Sometimes, these complications are not related to the surgery at all, but rather to existing comorbidities or medications that put stress on the body and/or make it harder to undergo surgery and recover quickly.

Some physical, mental, and social challenges older adult patients uniquely face that put them at higher risk of complications from surgery include:

  • One or more chronic diseases (multimorbidity)
  • Mobility and movement difficulty
  • Hearing and vision impairments
  • Cognitive impairment or frailty
  • Heightened anxiety or depression
  • Multiple medication prescriptions (polypharmacy)
  • Planning for transitions of care from hospital to home

When an increased risk of complications is identified and preventative measures are put into place, the outcome following surgery is greatly improved.

What to Expect When Receiving Care at the POSH Clinic

Prior to surgery, patients who are at an increased risk of experiencing complications will be identified by the surgical team and referred to the multidisciplinary team at the POSH Clinic. In partnership with the patient, the Mass General POSH team will assess their whole health to determine if there are any existing issues that might impact the surgery and create a personalized plan that addresses these issues so that every patient experiences the best possible outcome. This may include:

  • A prehabilitation plan to ensure patients go into surgery strong and healthy
  • An adjustment of medications
  • An exercise or physical therapy regimen
  • Dietary changes
  • Management of chronic conditions
  • Individualized anesthesia plan

The team also collaborates closely with the patient’s surgeon and anesthesia providers to ensure that all providers are well-informed of the patient’s health and unique needs prior to surgery.

If a patient is admitted to the hospital for an inpatient stay, the POSH team is available for a postoperative consultation.

What Outcomes Does POSH Improve?

The POSH Clinic is designed to improve a variety of outcomes for older adult patients undergoing surgery and anesthesia, including:

  • Reduced likelihood of physical complications after surgery
  • Shorter length of hospital stay
  • Lower readmission rate
  • Improved functional independence
  • Increased possibility for direct-to-home discharge without the need for additional care from a nursing home or home-health team
  • Enhanced long-term cognitive health

Frequently Asked Questions

How do I make an appointment with the POSH Clinic?

The primary care doctor or surgeon will refer patients who are at an increased risk of experiencing complications to our team at the POSH Clinic prior to surgery, if they determine that care from our team aligns with their unique health needs and goals.

How is the Mass General POSH Clinic improving outcomes for older adults undergoing surgery?

The Mass General POSH Clinic creates personalized, evidence-based care plans to enhance pre- and post-operative health for older adult patients based on individual risks. These plans improve surgical outcomes for older adult patients by conducting assessments and implementing risk-reduction strategies before, during, and after surgery.

What should caregivers know ahead of their loved one’s surgery?

It is important for the caregiver and/or health care proxy to be involved in the planning of the patient’s care from start to finish. Please join the patient for every appointment, and come prepared with any questions that you would like to ask the patient’s care team.

How do I plan for my POSH visit?

To your POSH visit, please bring:

  • Your list of medications and dosages
  • A family member or friend who can support you at every stage of your care journey
  • And/or your health care proxy
  • Any important health care documents, e.g., living wills, health care proxy forms, MOLST, etc.

Your doctor will share more specific instructions for anything else that you should do to prepare for your POSH appointment.

How does the POSH Clinic ensure continuity of care?

Our POSH team collaborates with the other members of your care team every step of the way, including your primary care provider and surgeon. We regularly host and participate in multidisciplinary case conferences to review and discuss your case as a team.

As you progress in your care, the recommendations for your personalized treatment are filed in a medical record that all team members have access to and can reference at any time.

How long does a POSH appointment last?

The POSH appointments vary in length depending on the patient and their unique needs. They can go up to 90 minutes long.