Retrospective evaluation of healthcare utilisation and mortality of two post-discharge care programmes in Singapore.
BMJ Open
; 9(5): e027220, 2019 05 22.
Article
em En
| MEDLINE
| ID: mdl-31122989
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 11 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 OUTCOMEMEASURES:
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.Palavras-chave
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Mortalidade
/
Assistência ao Convalescente
/
Serviços de Saúde
Tipo de estudo:
Diagnostic_studies
/
Evaluation_studies
/
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Aged80
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Female
/
Humans
/
Male
País/Região como assunto:
Asia
Idioma:
En
Revista:
BMJ Open
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Singapura