A Patient-Centred Medical Home Care Model for Community-Dwelling Older Adults in Singapore: A Mixed-Method Study on Patient’s Care Experience

Abstract

Patient-Centred Medical Home (PCMH) is a strategy to enhance patient-centredness to improve care experience. We aimed to understand patient experience of an integrated PCMH model for complex community-dwelling older adults in Singapore. We used a mixed-method design with a prospective single-group pre-post quantitative component and a concurrent qualitative component. Participants were administered the validated Consumer Assessment of Health Providers and Systems Clinician & Group Survey (CG-CAHPS) at baseline (N = 184) and 6-month (N = 166) post-enrolment. We conducted focus group discussions (FGDs) on a purposive sample of 24 participants. Both methods suggest better care experience in PCMH relative to usual care. There were improvements in the CG-CAHPS measures on patient–provider communication, care coordination, office staff interactions, support for patients in caring for their own health, and provider rating in PCMH relative to usual care. In the FGDs, participants reported benefits of consolidated appointments and positive experience in sustained patient–provider relationship, shared-decision making, and family/caregiver engagement in PCMH. Participants may not fully comprehend the concept of integrated care, hindering both the effective communication of the intended care model and perceived benefits such as the provision of multidisciplinary team-based care.

Cost analysis of a Patient-Centred Medical Home for community-dwelling older adults with complex needs in Singapore

“…12 The integrated PCMH care model in this study is part of a community-wide initiative (Community for Successful Ageing) on an integrated care system of comprehensive programmes and services promoting the well-being and health of older adults in Singapore. 6,13,14 Our integrated PCMH model differs from current advanced primary care models in Singapore that centres on a multidisciplinary team to deliver chronic disease management, 15 or Family Medicine Clinics that provide a "one-stop platform" for individualised chronic condition prevention and management by general practitioners. 16 The integrated PCMH model in this article targets community-dwelling older adults with complex biopsychosocial needs, assessed via social health, psychological and medical evaluations.…”

“…16 The integrated PCMH model in this article targets community-dwelling older adults with complex biopsychosocial needs, assessed via social health, psychological and medical evaluations. 6,13,14 Our model follows overarching principles on ageing in place (growing old at home), life-course approach (promoting the earlier implementation of interventions for health), socioecological model of care (health as an outcome of an individual's interaction with family, caregivers and community), and population health management. 6,13,14 Our study aimed to address gaps in the literature on the evaluation of costs associated with the implementation of an integrated PCMH model for community-dwelling older adults with complex needs.…”

“…6,13,14 Our model follows overarching principles on ageing in place (growing old at home), life-course approach (promoting the earlier implementation of interventions for health), socioecological model of care (health as an outcome of an individual's interaction with family, caregivers and community), and population health management. 6,13,14 Our study aimed to address gaps in the literature on the evaluation of costs associated with the implementation of an integrated PCMH model for community-dwelling older adults with complex needs. Our study examined costs not only from the health system perspective, but also from the perspectives of patients and the wider society.…”

“…6 Home-based care management provided extended care in the home setting, and addressed the physical home environment, financial needs, behavioural needs, and support systems by caregivers. 6,13…”

“…Informed consent was taken from participants or proxies. As mentioned in our previous publications, these were the eligibility criteria included: 6,13 (1) Patients with high biopsychosocial health risk defined by the 37-item BioPsychoSocial Risk Screener validated in the Singapore setting, 17 pre-existing risk stratification criteria used by referring healthcare institutes, and/or clinical assessment. Functional ability and frailty were not part of the inclusion and exclusion criteria.…”