Piloting the Patient-Centered Medical Home concept: Singapore's initial experience

Koh, T.W.; Tai, E Shyong; Wee, HL; Tham, Tat Yean; Sim, Kld; Khoo, Yin Hao; Wee, S.; Lim, Yee Wei

doi:10.5334/ijic.1492

Cited by 6 publications

(7 citation statements)

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“…In Singapore, the initial report on implementing PCMH outside of the United States has demonstrated its potential to improve patient access to medical care and to reduce hospital-based care, but no detailed results have been reported (Koh et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Integration of a Patient-Centered Medical Home Into Ambulatory Health Care Services Centers in Abu Dhabi

Ketbi¹,

Kwuiti²,

Abdulbaqi³

et al. 2018

Journal of Ambulatory Care Management

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This study describes the transformation of Abu Dhabi Ambulatory Healthcare Services into patient-centered medical homes (PCMH) in 3 pilot sites by applying the National Commission for Quality Assurance (NCQA) PCMH standards. The intervention was system redesign, population management, team building, and optimizing electronic medical records toward patient-centered care. The pilot centers outperformed non-pilot centers in clinical key performance indicators. Based on the NCQA 2011 PCMH criteria, the pilot achieved 84% compared with 42% at the start of the project. In conclusion this study shed light on a firm path to operationalizing PCMH to enhance the quality and access to care.

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Section: Discussionmentioning

confidence: 99%

Integration of a Patient-Centered Medical Home Into Ambulatory Health Care Services Centers in Abu Dhabi

Ketbi¹,

Kwuiti²,

Abdulbaqi³

et al. 2018

Journal of Ambulatory Care Management

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“…This emphasizes care coordination and communication to transform primary care into integrated care that responds to patients' preferences and needs [23]. Patient-centric and seamless care are highlighted as key goals of the integrated RHS that seeks to provide comprehensive and customized services for different patient groups.…”

Section: Levels Of Pacs Maturitymentioning

confidence: 99%

A stage model of information technology in healthcare

2015

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The healthcare industry faces significant challenges such as spiraling costs, shortage of qualified personnel, a rapidly aging population, and increase in chronic diseases as well as epidemics. Healthcare information technology (IT) has been suggested as a mitigator for some of these challenges. Particularly, IT can enable the automation, integration, and management of clinical and administrative functions in healthcare. This has the potential to lower costs, relieve the workload of healthcare professionals, and obtain improvements in healthcare quality as advances in IT take place. In this regard, studying the stages of healthcare IT progression is essential to understand the past trends, address the current challenges, and make use of IT to enhance the provision of healthcare in future. However, although there is considerable literature on the stages of IT evolution, studies specific to healthcare IT are sparse. With the unique challenges of the healthcare sector, we aim to address such a gap in our study. Drawing on the Nolan stage model, we propose a model to explain the stages of IT evolution in the healthcare sector, incorporating initiation, contagion, control, and integration stages. The model was developed with a focus on healthcare IT in Singapore, due to Singapore's advanced IT and medical infrastructure and relatively lower spending on healthcare compared to other developed countries. In this manner, this study contributes to the understanding of the role of IT in healthcare from a dynamic and evolutionary view.

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“…Examples of PC innovations implemented at the national level include the redesign of private practices to become team-based Family Medicine Clinics led by family physicians, creation of Community Health Centers to provide support services to private general practitioners (GPs), the introduction of team-let care in the polyclinics, development of a supportive network and shared services for GPs through the Primary Care Network, and the integration and co-location of health and social services for older adults in one-stop centers called Geriatric Service Hubs (33,30). Into this landscape, PCMH was initially introduced by a private GP group, two acute hospitals and a non-pro t family foundation (34,35). However, relatively little has been published about these pioneering PCMH initiatives.…”

Section: Pc Reforms and Early Adoption Of Pcmhs In Singaporementioning

confidence: 99%

Early Implementation of a Patient-centered Medical Home in Singapore: a Qualitative Study Using Theories on Diffusion of Innovations

Lim

Kadir

Ginting

et al. 2021

Preprint

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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.Results: “Diffusion of innovation” emerged as an overarching theory to contextualize ComSA-PCMH and its early implementation. ComSA-PCMH was differentiated from usual PC through three innovations: i) team-based and integrated care; ii) empanelment; and iii) shared care with private general practitioners. Their corresponding change strategies were: i) repurposing pre-existing services and infrastructure; ii) partnership to create supporting infrastructure and pathways in the delivery system; and iii) targeted outreach. Initial experience of the implementers was characterized by “assimilation”, which was a cyclical process of experimentation, negotiations, and adaptations. Initial perception of the implementation partners was characterized by “adoption”, which was affected by perceived value of ComSA-PCMH and perceived burden in implementation. Initial perception of the private general practitioners was also characterized by adoption, which was affected by a lack of awareness and understanding of ComSA-PCMH. Lessons were learnt about ways to work with the complexity and novelty of the innovations.Conclusions: ComSA-PCMH employed creative and pragmatic strategies to overcome country-specific contextual challenges and the inherent complexities of the care model. Assimilation and adoption were identified as the challenging steps, as they involve complex processes participated by multiple players who might exhibit less predictable, self-organizing behaviors.Trial Registration: This study was retrospectively registered with ClinicalTrials.gov (Protocol ID: NCT04594967).

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Piloting the Patient-Centered Medical Home concept: Singapore's initial experience

Cited by 6 publications

References 0 publications

Integration of a Patient-Centered Medical Home Into Ambulatory Health Care Services Centers in Abu Dhabi

Integration of a Patient-Centered Medical Home Into Ambulatory Health Care Services Centers in Abu Dhabi

A stage model of information technology in healthcare

Early Implementation of a Patient-centered Medical Home in Singapore: a Qualitative Study Using Theories on Diffusion of Innovations

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