@article{e27c86e43c22425eb98282e70369b98f,
title = "Retrospective evaluation of healthcare utilisation and mortality of two post-discharge care programmes in Singapore",
abstract = "Objective To evaluate the impact on healthcare utilisation frequencies and charges, and mortality of a programme for frequent hospital utilisers and a programme for patients requiring high acuity post-discharge care as part of an integrated healthcare model.Design A retrospective quasi-experimental study without randomisation where patients who received post-discharge care interventions were matched 1: 1 with unenrolled patients as controls.Setting The National University Health System (NUHS) Regional Health System (RHS), which was one of six RHS in Singapore, implemented the NUHS RHS Integrated Interventions and Care Extension (NICE) programme for frequent hospital utilisers and the NUHS Transitional Care Programme (NUHS TCP) for high acuity post-discharge care. The programmes were supported by the Ministry of Health in Singapore, which is a city-state nation located in Southeast Asia with a 5.6 million population.Participants Linked healthcare administrative data, for the time period of January 2013 to December 2016, were extracted for patients enrolled in NICE (n=554) or NUHS TCP (n=270) from June 2014 to December 2015, and control patients.Interventions For both programmes, teams conducted follow-up home visits and phone calls to monitor and manage patients' post-discharge.Primary outcome measures One-year pre-and post-enrolment healthcare utilisation frequencies and charges of all-cause inpatient admissions, emergency admissions, emergency department attendances, specialist outpatient clinic (SOC) attendances, total inpatient length of stay and mortality rates were compared.Results Patients in NICE had lower mortality rate, but higher all-cause inpatient admission, emergency admission and emergency department attendance charges. Patients in NUHS TCP did not have lower mortality rate, but had higher emergency admission and SOC attendance charges.Conclusions Both NICE and NUHS TCP had no improvements in 1 year healthcare utilisation across various setting and metrics. Singular interventions might not be as impactful in effecting utilisation without an overhauling transformation and restructuring of the hospital and healthcare system.",
keywords = "admissions, base, follow-up, management, people, quality, risk, transitional care, visits, ADMISSIONS, MANAGEMENT, QUALITY, VISITS, FOLLOW-UP, RISK, BASE, TRANSITIONAL CARE, PEOPLE",
author = "I.Y.H. Ang and C.S. Tan and M. Nurjono and X.Q. Tan and G.C.H. Koh and H.J.M. Vrijhoef and S. Tan and S.E. Ng and S.A. Toh",
note = "Funding Information: Contributors HJMV and SAT initiated and conceptualised the study. IYHA and CST developed the analysis approach, and MN, XQT, GK, ST and SAT provided feedback for the refinement of the analysis approach. IYHA conducted the data analysis for this study. SEN was the programme director that contributed to the design of the intervention programmes, and provided information on the overall structures of the programmes. IYHA wrote the first draft and the final version of the manuscript. All authors read, edited, provided suggestions for revision and approved the final manuscript. Funding This work was supported by an internal grant from the NUHS Research Office (grant number NUHSRO/2016/008/RO5+5/FY16CF/LOA), the Centre for Health Services and Policy Research (CHSPR) core funding, and the Singapore Ministry of Health{\textquoteright}s National Medical Research Council Centre Grant Programme (grant number NMRC/CG/C026/2017\_NUHS) for Singapore Population Health Improvement Centre (SPHERiC). Funding Information: Singapore is a city-state nation located in Southeast Asia with a total population of 5.6 million, of which over 3.9 million are citizens and permanent residents.24 The population has an ethnic composition of 74.1\% Chinese, 13.4\% Malays, 9.2\% Indians and 3.3\% Others,25 and a life expectancy of 82.9 years.24 For the time period from which the healthcare utilisation data were extracted (January 2013 to December 2016), NUHS RHS was one of six RHS in Singapore. The funding for the NICE programme and NUHS TCP was supported by the Ministry of Health as two of its six nation-wide priority areas, covering the management of frequent hospital utilisers and the timely discharge from acute hospitals through transitional care, respectively. Funding Information: Objective To evaluate the impact on healthcare utilisation frequencies and charges, and mortality of a programme for frequent hospital utilisers and a programme for patients requiring high acuity post-discharge care as part of an integrated healthcare model. Design A retrospective quasi-experimental study without randomisation where patients who received post-discharge care interventions were matched 1:1 with unenrolled patients as controls. setting The National University Health System (NUHS) Regional Health System (RHS), which was one of six RHS in Singapore, implemented the NUHS RHS Integrated Interventions and Care Extension (NICE) programme for frequent hospital utilisers and the NUHS Transitional Care Programme (NUHS TCP) for high acuity post-discharge care. The programmes were supported by the Ministry of Health in Singapore, which is a city-state nation located in Southeast Asia with a 5.6 million population. Participants Linked healthcare administrative data, for the time period of January 2013 to December 2016, were extracted for patients enrolled in NICE (n=554) or NUHS TCP (n=270) from June 2014 to December 2015, and control patients. Interventions For both programmes, teams conducted follow-up home visits and phone calls to monitor and manage patients{\textquoteright} post-discharge. Primary outcome measures One-year pre-and post-enrolment healthcare utilisation frequencies and charges of all-cause inpatient admissions, emergency admissions, emergency department attendances, specialist outpatient clinic (SOC) attendances, total inpatient length of stay and mortality rates were compared. results Patients in NICE had lower mortality rate, but higher all-cause inpatient admission, emergency admission and emergency department attendance charges. Patients in NUHS TCP did not have lower mortality rate, but had higher emergency admission and SOC attendance charges. Conclusions Both NICE and NUHS TCP had no improvements in 1 year healthcare utilisation across various setting and metrics. Singular interventions might not be as impactful in effecting utilisation without an overhauling transformation and restructuring of the hospital and healthcare system. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",
year = "2019",
month = may,
day = "1",
doi = "10.1136/bmjopen-2018-027220",
language = "English",
volume = "9",
journal = "BMJ Open",
issn = "2044-6055",
publisher = "BMJ Publishing Group",
number = "5",
}