Anesthesiology. 2021 Apr 1;134(4):526-540. doi: 10.1097/ALN.0000000000003717.
Health care is undergoing major transformation with a shift from fee-for-service care to fee-for-value. The advent of new care delivery and payment models is serving as a driver for value-based care. Hospitals, payors, and patients increasingly expect physicians and healthcare systems to improve outcomes and manage costs. The impact of the coronavirus disease 2019 (COVID-19) pandemic on surgical and procedural practices further highlights the urgency and need for anesthesiologists to expand their roles in perioperative care, and to impact system improvement. While there have been substantial advances in anesthesia care, perioperative complications and mortality after surgery remain a key concern. Anesthesiologists are in a unique position to impact perioperative health care through their multitude of interactions and influences on various aspects of the perioperative domain, by using the surgical experience as the first touchpoint to reengage the patient in their own health care. Among the key interventions that are being effectively instituted by anesthesiologists include proactive engagement in preoperative optimization of patients' health; personalization and standardization of care delivery by segmenting patients based upon their complexity and risk; and implementation of best practices that are data-driven and evidence-based and provide structure that allow the patient to return to their optimal state of functional, cognitive, and psychologic health. Through collaborative relationships with other perioperative stakeholders, anesthesiologists can consolidate their role as clinical leaders driving value-based care and healthcare transformation in the best interests of patients.
医疗保健正经历着重大转型，从按服务收费模式转变为按价值收费模式。新的医疗服务和支付模式的出现正在推动基于价值的医疗保健发展。医院、支付方和患者越来越期望医生和医疗系统改善治疗效果并控制成本。2019 冠状病毒病（COVID-19）大流行对手术和操作实践的影响进一步凸显了麻醉师扩大其在围手术期护理中的作用并影响系统改进的紧迫性和必要性。尽管麻醉护理方面取得了重大进展，但手术后的围手术期并发症和死亡率仍然是一个主要关注点。麻醉师通过其在围手术期领域各个方面的众多互动和影响，具有独特的地位来影响围手术期医疗保健，将手术经历作为重新让患者参与自身医疗保健的第一个接触点。麻醉师正在有效实施的主要干预措施包括积极参与患者术前健康状况的优化；根据患者的复杂性和风险对护理进行个性化和标准化；以及实施基于数据和证据的最佳实践，提供结构，使患者能够恢复到最佳的功能、认知和心理健康状态。通过与其他围手术期利益相关者建立合作关系，麻醉师可以巩固其作为临床领导者的角色，以患者的最佳利益为出发点，推动基于价值的医疗保健和医疗保健转型。
