Singapore's regional health systems-a data-driven perspective on frequent admitters and cross utilization of healthcare services in three systems

Saxena, Nakul; You, Alex Xiaobin; Zhu, Zhiwei; Sun, Yan; George, Pradeep Paul; Teow, Kiok Liang; Chong, Phui-Nah; Sim, Joshua Dao Wei; Wong, John; Ong, Benjamin; Foo, Hee Jug; Soh, Eugene Fidelis; Tham, Linus; Heng, Bee Hoon; Choo, P. W. J.

doi:10.1002/hpm.2300

Cited by 37 publications

(54 citation statements)

References 21 publications

(23 reference statements)

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“…20 Prior studies on frequent hospitalizations have focused mainly on general medical patients with vastly disparate profiles, healthcare utilization patterns and diagnoses, ranging from elective total knee arthroplasty to pneumonia. 13,21,22 In contrast, very few such studies have focused on patients with HF, despite the fact that HF is one of the commonest cause of readmissions worldwide, especially among the elderly. A recent study on HF patients with frequent readmissions measured all-cause readmissions, including but not limited to HF readmissions.…”

Section: Discussionmentioning

confidence: 99%

Defining a ‘frequent admitter’ phenotype among patients with repeat heart failure admissions

Sellmair

Allen

et al. 2018

European J of Heart Fail

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Aims We aimed to identify a ‘frequent admitter’ phenotype among patients admitted for acute decompensated heart failure (HF). Methods and results We studied 10 363 patients in a population‐based prospective HF registry (2008–2012), segregated into clusters based on their 3‐year HF readmission frequency trajectories. Using receiver‐operating characteristic analysis, we identified the index year readmission frequency threshold that most accurately predicts HF admission frequency clusters. Two clusters of HF patients were identified: a high frequency cluster (90.9%, mean 2.35 ± 3.68 admissions/year) and a low frequency cluster (9.1%, mean 0.50 ± 0.81 admission/year). An index year threshold of two admissions was optimal for distinguishing between clusters. Based on this threshold, ‘frequent admitters’, defined as patients with ≥ 2 HF admissions in the index year (n = 2587), were of younger age (68 ± 13 vs 69 ± 13 years), more often male (58% vs. 54%), smokers (38.4% vs. 34.4%) and had lower left ventricular ejection fraction (37 ± 17 vs. 41 ± 17%) compared to ‘non‐frequent admitters’ (< 2 HF admissions in the index year; n = 7776) (all P < 0.001). Despite similar rates of advanced care utilization, frequent admitters had longer length of stay (median 4.3 vs. 4.0 days), higher annual inpatient costs (€ 7015 vs. € 2967) and higher all‐cause mortality at 3 years compared to the non‐frequent admitters (adjusted odds ratio 2.33, 95% confidence interval 2.11–2.58; P < 0.001). Conclusion ‘Frequent admitters’ have distinct clinical characteristics and worse outcomes compared to non‐frequent admitters. This study may provide a means of anticipating the HF readmission burden and thereby aid in healthcare resource distribution relative to the HF admission frequency phenotype.

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Section: Discussionmentioning

confidence: 99%

Defining a ‘frequent admitter’ phenotype among patients with repeat heart failure admissions

Sellmair

Allen

et al. 2018

European J of Heart Fail

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“…These are the only two hospitals serving the western area of Singapore and receive patients referred from the four polyclinics (government funded primary care clinics) serving western Singapore. Eighty percent of patients with chronic disease who reside in this geographical area are seen at these polyclinics and anyone requiring specialist care is usually referred to either hospital . All patients with EIA seen by a rheumatologist at either hospital were invited to participate in the SEAC.…”

Section: Methodsmentioning

confidence: 99%

“…Eighty percent of patients with chronic disease who reside in this geographical area are seen at these polyclinics and anyone requiring specialist care is usually referred to either hospital. 15 All patients with EIA seen by a rheumatologist at either hospital were invited to participate in the SEAC. EIA was defined as inflammation of two or more joints, not caused by trauma, which persisted for more than 4 weeks and was confirmed by rheumatologist assessment.…”

Section: Methodsmentioning

confidence: 99%

Use of complementary and alternative medicines is associated with delay to initiation of disease‐modifying anti‐rheumatic drug therapy in early inflammatory arthritis

et al. 2017

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“…While there is a body of academic literature addressing Singapore's health systems reform and looking at specific areas of interest within the Singapore health system (e.g. health services and utilisation) (14)(15)(16)(17)(18)(19), at time of writing, there was no qualitative study on Singapore's most recent health systems reform. This study fills a gap in this body of research by addressing Singapore's health system reforms and how they develop at the nexus of complex social, political, and economic interactions.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Health systems reforms in Singapore: A qualitative study of key stakeholders

et al. 2018

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In response to a growing chronic disease burden and ageing population, Singapore implemented Regional Health Systems (RHS) in 2008. In January 2017, the MOH announced that the six RHS clusters would be reorganised into three in 2018. This qualitative study sought to identify the health system challenges, opportunities, and ways forward for the implementation of the RHS. We conducted semi-structured interviews with 35 key informants from RHS clusters, government, academia, and private and voluntary sectors. Integration, innovation, and people-centeredness were identified as the key principles of the RHS. The RHS was described as an opportunity to holistically care for a person across the care continuum, address social determinants of health, develop new models of care, and work with social and community partners. Challenges to RHS implementation included difficulties aligning the goals, values, and priorities of multiple actors, the need for better integration across clusters, differing care capabilities and capacities across partners, healthcare financing structures that may not reflect RHS goals, scalability and evaluation of pilot programmes, and disease-centricity, provider-centricity, and medicalisation in health and healthcare. Suggested ways forward included building relationships between actors to facilitate integration; exploring innovative new models of care; clear long-term/scale-up plans for successful pilots; healthcare financing reforms to meet changing patient and population needs; and developing evaluation systems reflective of RHS principles and priorities.

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Singapore's regional health systems-a data-driven perspective on frequent admitters and cross utilization of healthcare services in three systems

Cited by 37 publications

References 21 publications

Defining a ‘frequent admitter’ phenotype among patients with repeat heart failure admissions

Defining a ‘frequent admitter’ phenotype among patients with repeat heart failure admissions

Use of complementary and alternative medicines is associated with delay to initiation of disease‐modifying anti‐rheumatic drug therapy in early inflammatory arthritis

Health systems reforms in Singapore: A qualitative study of key stakeholders

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