Core elements of the perioperative medicine for older people undergoing surgery (POPS) model of care

Hospital surgical services that utilise the approach of the perioperative medicine for older people undergoing surgery (POPS) model of care improve outcomes for older people contemplating and undergoing surgery. Complex models of care like POPS may be difficult to implement without understanding the elements that comprise that model of care. Logic models can be used to aid implementation by visually depicting theoretical relationships between the elements of the model of care. Our objective was to understand the core elements of the POPS model of care at health services other than where it was first developed.

A qualitative case study at three contextually different health services in England with POPS models of care of varying implementation maturity was undertaken. We conducted semi-structured interviews with clinicians and managers involved in POPS (n = 56). The interviews were analysed using inductive and deductive methods.

We developed a logic model with seven domains and themes that described the core elements of the POPS model of care compared and contrasted across the three health services. We found POPS could be adapted to 'fit' the local contexts of our study and still achieve its desired outcomes if it remained true to the principles of comprehensive geriatric assessment and optimisation and was delivered by staff with expert skills and attitudes.

Our logic model provides potentially generalisable information about the core elements of the POPS service in three health services. This information can be used to aid the implementation of the POPS model of care in healthcare settings similar to our study. Further research may be required to test the logic model in other healthcare contexts.