Co-management between internal medicine and surgical specialities: the identification of the high risk patient

Quality of care for older surgical in-patients, often suffering from pre-existing co-morbidity, requires hospital organiza- tion fostering the cooperation of multi-disciplinary teams. Co-management programmes have proved to be the most adequate for this purpose. However, the costs involved in this approach warrant careful patient selection. Ascertaining surgical risk in individual patients is a pre-re- quisite for quality and outcome control. The patient’s specific characteristics, the surgical procedure itself and the institu- tional environment are the three main groups of inputs for a comprehensive selection and decision-making framework. Comparative effectiveness research is required to gather clinical evidence to support the rational use of collaborative and differentiated management of selected patients in mo- dern hospital settings. A literature-based review article was done that included an overview of outcomes research and outcome measures.