The Hospitalist Movement – A Complex Adaptive Response to The Hospitalist Movement – A Complex Adaptive Response to Fragmentation of Care in Hospitals

Lee, Kheng Hock

doi:10.47102/annals-acadmedsg.v37n2p145

Cited by 15 publications

(3 citation statements)

References 14 publications

(10 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Typical PJD consequences are delays, fragmentation, discontinuity and poor adherence. Fragmentation means that a patient has two or more parallel clinical pathways that are not coordinated (Lee, 2008) and may lead to contradictions and polypharmacy in the clinical pathway and confusion in the care pathway (Maciejewski et al ., 2017). Discontinuity occurs when a patient journey is terminated without a valid reason (Federman et al ., 2001; Kikano et al ., 2000; Nagraj et al ., 2013; Petersen et al ., 1994; Pitt, 2018; Rajbhandari et al ., 2016).…”

Section: Discussionmentioning

confidence: 99%

Concept analysis of patient journey disruptions: the obstacle of integrated care

Vesinurm,

Sylgren,

Bengts

et al. 2024

JICA

View full text Add to dashboard Cite

PurposeThis article aims to clarify the concepts used to understand, analyze and improve a patient’s progress through a health service system. A patient pathway describes plans and intentions. Within it, we distinguish between the clinical pathway of decisions and interventions and the care pathway of supportive activities. As a patient pathway is implemented, it turns into a patient journey of what is done, what happens to a patient’s medical condition and what is experienced and felt. We introduce “patient journey disruption” (PJD) as a concept describing the events that need to be prevented from happening to accomplish integrated, coordinated and seamless care.Design/methodology/approachThe method used in this paper is concept analysis. First, an expert steering group worked to refine the concept of PJDs; second, an analysis of similar concepts from related fields was done to root the concept into existing theories, and third, semi-structured interviews with professionals and patients were done to test the concept of PJDs in the home care context.FindingsPJDs are agency-based harmful events in the execution of the care pathway that deviate the patient journey from what can be reasonably expected. PJDs are management failures, which is why they should be studied by healthcare operations management (HOM) and service science scholars with the intention to find ways to prevent them from happening.Research limitations/implicationsThis study has limitations, including presenting conceptual ideas and preliminary results that are only indicative.Practical implicationsWe believe that the introduction of the concept of PJDs into the literature provides a new, systematic way of approaching the different shortcomings in our healthcare production systems. Moreover, by systematically identifying different PJDs, interventions can be designed and targeted more appropriately.Originality/valueManagerial challenges regarding healthcare processes have been studied but have not been well defined. The concept of PJDs is an original, well-thought-out definition.

show abstract

Section: Discussionmentioning

confidence: 99%

Concept analysis of patient journey disruptions: the obstacle of integrated care

Vesinurm,

Sylgren,

Bengts

et al. 2024

JICA

View full text Add to dashboard Cite

show abstract

“…Singapore’s healthcare system comprises a network of private primary care clinics, public polyclinics, public hospitals, tertiary-specialist care centres and private hospitals 10–12. Care provision is fairly fragmented: the private sector, comprising hundreds of individual providers, is the main provider of primary care (about 80% of the market), while the public sector, comprising three large regional health systems, is the major provider of hospital care (also about 80% of that market) 13 14. The intermediate and long-term care sector is run by a mixture of private enterprises and not-for-profit voluntary welfare organisations 10 15.…”

Section: Introductionmentioning

confidence: 99%

Using the Johns Hopkins ACG Case-Mix System for population segmentation in a hospital-based adult patient population in Singapore

et al. 2023

View full text Add to dashboard Cite

ObjectivePopulation health management involves risk characterisation and patient segmentation. Almost all population segmentation tools require comprehensive health information spanning the full care continuum. We assessed the utility of applying the ACG System as a population risk segmentation tool using only hospital data.DesignRetrospective cohort study.SettingTertiary hospital in central Singapore.Participants100 000 randomly selected adult patients from 1 January to 31 December 2017.InterventionHospital encounters, diagnoses codes and medications prescribed to the participants were used as input data to the ACG System.Primary and Secondary Outcome MeasuresHospital costs, admission episodes and mortality of these patients in the subsequent year (2018) were used to assess the utility of ACG System outputs such as resource utilisation bands (RUBs) in stratifying patients and identifying high hospital care users.ResultsPatients placed in higher RUBs had higher prospective (2018) healthcare costs, and were more likely to have healthcare costs in the top five percentile, to have three or more hospital admissions, and to die in the subsequent year. A combination of RUBs and ACG System generated rank probability of high healthcare costs, age and gender that had good discriminatory ability for all three outcomes, with area under the receiver-operator characteristic curve (AUC) values of 0.827, 0.889 and 0.876, respectively. Application of machine learning methods improved AUCs marginally by about 0.02 in predicting the top five percentile of healthcare costs and death in the subsequent year.ConclusionA population stratification and risk prediction tool can be used to appropriately segment populations in a hospital patient population even with incomplete clinical data.

show abstract

“…Lee's contribution on the hospitalist movement is timely, as it brings a fresh perspective to the role of family physicians in hospitals, the traditional domain of specialists. 12 What else can be done? The editors' natural inclination is to shy away from calling for more government intervention but, in this instance, as the largest purchaser and provider of healthcare, the state must play a larger role in correcting some of the distortions to allow for genuine removal of this specialist-primary care gap.…”

mentioning

confidence: 99%

Bridging the Gap between Primary and Specialist Care: Formidable Challenges Ahead

Koh

Lim

2008

Ann Acad Med Singap

View full text Add to dashboard Cite

The strong guiding hand and deep pockets of the state have brought about the growth of hospitals and national specialist centres while leaving the primary care sector largely to free market forces. Thus, it is not surprising that the evolution of Singapore's healthcare system has largely favoured specialisation and tertiary care.However, primary care has not been stagnant and, through the efforts of many pioneers including Associate Professors Goh Lee Gan, Cheong Pak Yean and Lim Lean Huat, it has taken tentative steps towards attaining its rightful place in the healthcare system. Nevertheless, optimum benefit to individual patients and the whole health system can only be achieved by better bridging the gap between specialist and primary care. The present era of medicine requires all of us to work together, as no single provider can adequately or cost-effectively manage all the medical and psycho-social issues associated with chronic diseases. Although formidable challenges lie ahead, this is the first time that this specialist journal has sought to specifically address specialists' interactions with primary care: this in itself is a cause for optimism.We have sought local papers on thriving shared care programmes that tackle major chronic diseases, [1][2][3] comparative research between primary and tertiary healthcare, 4,5 and commentaries on ongoing collaborations between family physicians in patient care improvement 6 and post-graduate training. 7 We also have invited papers from respected US and UK authors on improving the transition of care between hospital and community in medication use and palliative care respectively. 8,9 In the spirit of this issue, effort has been made to include both primary care physicians (PCPs) and specialists as authors in each paper and in the peer review process.What are some of the roadblocks to integrated healthcare that lie on the horizon? These problems include the inadequacy of a viable business model that bridges the specialist-family physician divide and a generation of minds moulded to "favour" tertiary care practice. In chronic disease management, patients remain un-persuaded of the personal benefits of right siting despite the Ministry of

show abstract

The Hospitalist Movement – A Complex Adaptive Response to The Hospitalist Movement – A Complex Adaptive Response to Fragmentation of Care in Hospitals

Cited by 15 publications

References 14 publications

Concept analysis of patient journey disruptions: the obstacle of integrated care

Concept analysis of patient journey disruptions: the obstacle of integrated care

Using the Johns Hopkins ACG Case-Mix System for population segmentation in a hospital-based adult patient population in Singapore

Bridging the Gap between Primary and Specialist Care: Formidable Challenges Ahead

Contact Info

Product

Resources

About