ValuedCare program: a population health model for the delivery of evidence-based care across care continuum for hip fracture patients in Eastern Singapore

Abstract

BackgroundTo test a population health program which could, through the application of process redesign, implement multiple evidence-based practices across the continuum of care in a functionally integrated health delivery system and deliver highly reliable and consistent evidence-based surgical care for patients with fragility hip fractures in an acute tertiary general hospital.MethodsThe ValuedCare (VC) program was developed in three distinct phases as an ongoing collaboration between the Geisinger Health System (GHS), USA, and Changi General Hospital (CGH), Singapore, modelled after the GHS ProvenCare® Fragile Hip Fracture Program. Clinical outcome data on consecutive hip fracture patients seen in 12 months pre-intervention were then compared with the post-intervention group. Both pre- and post-intervention groups were followed up across the continuum of care for a period of 12 months.ResultsVC patients showed significant improvement in median time to surgery (97 to 50.5 h), as well as proportion of patients operated within 48 h from hospital admission (48% from 18.8%) as compared to baseline pre-intervention data. These patients also had significant reduction (p value < 0.001) of acute inpatient complications such as delirium, pneumonia, urinary tract infections, and pressure sores. VC program has shown significant reduction in median length of stay for acute hospital (13 to 9 days) as well as median combined length of stay for acute and sub-acute rehabilitation hospital (46 to 39 days), thus reducing the total duration of hospitalization and saving total hospital bed days. Operative and inpatient mortality, together with readmission rates, remained low and comparable to international Geriatric Fracture Centers (GFCs).ConclusionThe implementation of VC methodology has enabled consistent delivery of high-quality, reliable and comprehensive evidence-based care for hip fracture patients at Changi General Hospital. This has also reflected successful change management and interdisciplinary collaboration within the organization through the program. There is potential for testing this methodology as a quality improvement framework replicable to other disease groups in a functionally integrated healthcare system.

Evaluation of Systemwide Improvement Programs to Optimize Time to Surgery for Patients With Hip Fractures

“…190 studies underwent full-text review, and 69 studies were selected for final analysis ( Figure and eAppendix 3 in the Supplement ). 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 …”

“…190 studies underwent full-text review, and 69 studies were selected for final analysis (Figure and eAppendix 3 in the Supplement). Among the final 69 improvement programs, 49 programs significantly decreased TTS 33,35,38,41,[43][44][45][46][47][48][49][51][52][53][54]56,57,[59][60][61][62][65][66][67][68][69][70][71][72][74][75][76][79][80][81][82][85][86][87][88]91,94,96,97,99,101,103 and 20 programs 39,40,42,50,…”

Effectiveness of Perioperative Comprehensive Evaluation of Hip Fracture in the Elderly

“…Through the comprehensive evaluation of elderly patients, we comprehensively collect the physical, mental, and other information needs of elderly patients, including medical evaluation (disease diagnosis, elderly complications, and multiple drugs), physical ability evaluation (self-care ability, mobility, and balance ability), and psychopsychological evaluation, socioeconomic factors, and environmental evaluation. CGA is not only for the disease itself but also for the overall situation of elderly patients [ 24 ] and not only pays attention to physical conditions but also pays more attention to cognitive and psychological conditions [ 25 , 26 ]. At present, the perioperative intervention effect of CGA on elderly hip fracture patients is not consistent, and there are very few studies on CGA in China [ 27 ].…”

Hip Fractures during the COVID-19 Pandemic: Our Experience in a General Hospital in Singapore

“…Early surgery for hip fractures leads to early mobilization, lesser risk of chest infections and shorter hospital stay. Our institution has a Value Care Program for Hip Fractures which has enabled consistent delivery of high-quality, reliable and comprehensive evidence-based care [11] . This program facilitates holistic care of patients and assists in optimizing patients for surgery.…”