Bringing generalists into the hospital: Outcomes of a family medicine hospitalist model in Singapore

Abstract

The authors declare that no financial or other relationships exist that might lead to a conflict of interest.Disclosure: Nothing to report. PURPOSE:The aim of this study was to assess a newly introduced hospitalist care model in a Singapore hospital. Clinical outcomes of the family medicine hospitalists program were compared with the traditional specialists-based model using the hospital's administrative database. METHODS:Retrospective cohort study of hospital discharge database for patients cared for by family medicine hospitalists and specialists in 2008. Multivariate analysis models were used to compare the clinical outcomes and resource utilization between patients cared for by family medicine hospitalists and specialist with adjustment for demographics, and comorbidities. RESULTS:Of 3493 hospitalized patients in 2008 who met the criteria of the study, 601 patients were under the care of family medicine hospitalists. As compared with patients cared for by specialists, patients cared for by family medicine hospitalists had a shorter hospital length of stay (adjusted LOS, geometric mean, GM, 4.4 vs. 5.3 days; P < 0.001) and lower hospitalization costs (adjusted cost, GM, $2250.7 vs. $2500.0; P¼ 0.003), but a similar in-patient mortality rate (4.2% vs. 5.3%, P¼ 0.307) and 30-day all-cause unscheduled readmission rate (7.5% vs. 8.4%, P¼ 0.231) after adjustment for age, ethnicity, gender, intensive care unit (ICU) admission, numbers of organ failures, and comorbidities. CONCLUSION:The family medicine hospitalist model was associated with reductions in hospital LOS and cost of care without adversely affecting mortality or 30-day all-cause readmission rate. These findings suggest that the hospitalist care model can be adapted for health systems outside North America and may produce similar beneficial effects in care efficiency and cost savings.

Applying the Integrated Practice Unit Concept to a Modified Virtual Ward Model of Care for Patients at Highest Risk of Readmission: A Randomized Controlled Trial

“…A medical social worker who spends 0.5 full time equivalent time in the team supports both the inpatient and outpatient teams in activating the appropriate community and social services that supports the patient in the home setting. Family physicians in SGH function as hospitalists providing general medical care to medical inpatients [23], including follow-up care of patients in the outpatient specialist clinic upon hospital discharge. The nurse case managers’ main function is to provide discharge planning and case management to patients who are admitted in the hospital or in the virtual wards.…”

Applicability of a previously validated readmission predictive index in medical patients in Singapore: a retrospective study

“…It has 29 clinical departments, many of which are established as national referral centers. There are 1 600 beds, and care is provided for approximately 80 000 inpatients per year serving approximately one-quarter of Singapore’s population [10]. …”

Dancing Around Death

“…Hospitalists now number 30,000 in the United States, and self-define as delivering comprehensive care to hospitalized patients while improving care at the system level (Society of Hospital Medicine, 2010). Multiple specialties and countries now employ the model (Hock Lee, Yang, Soong Yang, Chi Ong, & Seong Ng, 2011; Maa, Carter, Gosnell, Wachter, & Harris, 2007; Mussman & Conway, 2011). Positive outcomes include increased patient satisfaction, reduced lengths of stay, reduced costs, and improved medical education (Fulton, Drevs, Ayala, & Malott, 2011; Wachter & Goldman, 2002).…”