A Patient-Centred Medical Home Care Model for Community-Dwelling Older Adults in Singapore: A Mixed-Method Study on Patient’s Care Experience (original) (raw)
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Background: Patients with complex needs require greater biopsychosocial support. Fragmented services often result in gaps, duplication or incompatibility in treatments, leading to poorer health outcomes and higher utilization of costly hospital-based healthcare services. Patient-Centred Medical Home (PCMH) is a primary care model reform advocated as more appropriate for patients with complex needs. This analysis assessed the impact of a PCMH demonstration on healthcare utilization for patients with complex needs in Singapore. Methods: This study assessed the Community for Successful Ageing (ComSA)-PCMH in Singapore that was launched in Nov’2016. ComSA-PCMH serves adults aged 40 and above with complex needs, delivering care integrated between its primary care clinic, home-based care management, an acute hospital and other community-based services. This was a matched cohort analysis that used a difference-in-difference approach to compare quarterly healthcare utilization of PCMH study...
BMC Geriatrics, 2021
Background The first Patient-Centered Medical Home (PCMH) demonstration in Singapore was launched in November 2016, which aimed to deliver integrated and patient-centered care for patients with bio-psycho-social needs. Implementation was guided by principles of comprehensiveness, coordinated care, shared decision-making, accessible services, and quality and safety. We aimed to investigate the impact of implementing the PCMH in primary care on quality of life (QoL) and patient activation. Methods The study design was a prospective single-arm pre-post study. We applied the 5-level EuroQol 5-dimension (EQ-5D-5L) and Visual Analog Scale (EQ VAS) instruments to assess health-related QoL. The CASP-19 tool was utilised to examine the degree that needs satisfaction was fulfilled in the domains of Control, Autonomy, Self-realisation, and Pleasure. The 13-item Patient Activation Measure (PAM-13) was used to evaluate knowledge, skills and confidence in management of conditions and ability to s...
Annals of the Academy of Medicine, Singapore
Introduction: The Patient-Centred Medical Home (PCMH) demonstration in Singapore, launched in November 2016, aimed to deliver integrated and patient-centred care for patients with biopsychosocial needs. Implementation was based on principles of comprehensiveness, coordinated care and shared decision-making. Method: We conducted a prospective single-arm pre-post study design, which aimed to perform cost analysis of PCMH from the perspectives of patients, healthcare providers and society. We assessed short-to-intermediate-term health-related costs by analysing data on resource use and unit costs of resources. Results: We analysed 165 participants enrolled in PCMH from November 2017 to April 2020, with mean age of 77 years. Compared to the 3-month period before enrolment, mean total direct and indirect participant costs and total health system costs increased, but these were not statistically significant. There was a significant decrease in mean cost for primary care (government primar...
Impact on Seniors of the Patient-Centered Medical Home: Evidence From a Pilot Study
The Gerontologist, 2012
To assess the impact on health care cost and quality among seniors of a patient-centered medical home (PCMH) pilot at Group Health Cooper ative, an integrated health care system in Washington State. Design and Methods: A prospective before-and-after evaluation of the experience of seniors receiving primary care services at 1 pilot clinic compared with seniors enrolled at the remaining 19 primary care clinics owned and operated by Group Health. Analyses of secondary data on quality and cost were conducted for 1,947 seniors in the PCMH clinic and 39,396 seniors in the 19 control clinics. Patient experience with care was based on survey data collected from 487 seniors in the PCMH clinic and of 668 in 2 specifi c control clinics that were selected for their similarities in organization and patient composition to the pilot clinic. Results: After adjusting for baseline, seniors in the PCMH clinic reported higher ratings than controls on 3 of 7 patient experience scales. Seniors in the PCMH clinic had signifi cantly greater quality outcomes over time, but this difference was not signifi cant relative to control. PCMH patients used more e-mail, phone, and specialist visits but fewer emergency services and inpatient admissions for ambulatory care sensitive conditions. At 1 and 2 years, the PCMH and control clinics did not differ signifi cantly in overall costs. Implications: A PCMH redesign can be associated with improvements in patient experience and quality without increasing overall cost.
International Journal of Environmental Research and Public Health
Patient-Centered Medical Home (PCMH) has been found to improve care for complex needs patients in some countries but has not yet been widely adopted in Singapore. This study explored the ground-up implementation of a PCMH in Singapore by describing change strategies and unpacking initial experience and perception. In-depth interviews were conducted for twenty-two key informants from three groups: the implementers, their implementation partners, and other providers. “Diffusion of innovations” emerged as an overarching theory to contextualize PCMH in its early implementation. Three core “innovations” differentiated the PCMH from usual primary care: (i) team-based and integrated care; (ii) empanelment; and (iii) shared care with other general practitioners. Change strategies employed to implement these innovations included repurposing pre-existing resources, building a partnership to create supporting infrastructure and pathways in the delivery system, and doing targeted outreach to in...
2021
Background: Primary care (PC) reform is imperative to meet the demands of a rising number of chronically ill patients with complex needs. Patient-Centered Medical Home (PCMH) is a new care model that was found to improve care for complex needs patients in some countries but has not yet been widely adopted in Singapore. Guided by the PCMH principles, “ComSA-PCMH” was developed to proactively deliver integrated PC to a specific population with complex needs. This study explored the change strategies, initial experience and perception, and lessons learnt during its early implementation.Methods: A grounded theory approach was employed. In-depth interviews were conducted for twenty-two key informants from three groups: the implementers, their implementation partners and other PC providers. The theoretical framework on diffusion of innovations by Greenhalgh and colleagues (2015) was used to determine theoretical saturation, reorganize data, and provide insights to the emerging themes.Resu...
Implementing Person-Centred Care in Singapore in a Residential Care Home: An Operational User Guide
2019
Person-centred care (PCC) is based on the ideology where care provision is revolved around the needs of a person and is dependent on the understanding of unique individual traits via an interpersonal relationship. For the end-user(s) of health and social services (Note: Residents of care homes are referred as ‘end-users’), delivering person-centred care would mean placing them and their families at the centre of decisions, recognising the person as an equal partner, and valuing him/her as an expert, whilst working together with professionals to achieve the best outcome and solutions possible. Besides having a compassionate, empathetic and respectful attitude, care professionals also need to work with the individual, to consider the individual’s relationship with others, their practices, their environment and the type of physical care administered in order to deliver PCC that is suitably tailored to the individual’s needs (Brooker 2004; Kitwood 1997).
Patient-Centered Medical Homes and the Care of Older Adults
The purpose of the PCMH is to position the primary care system to provide better health care, better health, and lower cost per capita coupled with high quality, accessible, and efficient care for all patients. How comprehensive care coordination, community connections, and person-directed care can make a difference. A patient centered medical home (PCMH) can have great success in supporting and treating older adults. PCMH teams strive to access the web of community based organizations available to older adults in the service area and make meaningful connections to them for referral.
Journal of Clinical Nursing, 2011
Aim. This is a preliminary study to identify older people service needs in Hong Kong from the users' and service providers' perspective. Background. As the Hong Kong population is ageing rapidly, it is important to identify the needs for care of older people. Although a wide variety of medical and social services have been provided to meet the needs of older people, there has been little evaluation from the users' or service providers' perspective regarding what the needs are and how well current service provisions match their needs. In recent years the importance of patient-centred care has been emphasised, where patient's expectation of care has been given a central role in guiding and improving the provision of health. However few studies have been carried out with respect to services for older people. Design. To identify the service needs, a focus group study was conducted. Both service providers and older people were interviewed. This preliminary study used a qualitative research method to identify older people's service needs, generating rich information which could be used to inform older people care service development. Method. Data were collected by conducting eight focus group discussions. The focus group interviews were audio-taped. Interviews were then transcribed and themes were identified. Results. The study identified several areas for improvement in services for older people, covering adequacy, accessibility and affordability of medical services, coordination of health and social care, quality of long-term care, negative perceptions and training needs. Some themes such as service adequacy and negative staff attitudes occurred in both older people and health professional focus groups. The themes of fast access, continuity of care and smooth transition, affordability, provision of information of available health and social services appear to be universal as these have also been identified in similar studies in other countries. Conclusion. In addition to other objective outcomes, such as duration of stay in hospital or re-admission rates after hospital discharges, changes in service provisions towards improvement should be evaluated from the users as well as professional care providers' perspectives. Relevance to clinical practice. Areas of improvement in service delivery include timely access, continuity, affordability, better coordination of health and social care, quality of care particularly in the long-term residential care setting and healthcare professionals' communication and caring skills and attitude.