Regional Health System Planning Office, National University Health System, Singapore.
Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
BMJ Open. 2019 May 22;9(5):e027220. doi: 10.1136/bmjopen-2018-027220.
To evaluate the impact on healthcare utilisation frequencies and charges, and mortality of a programme for frequent hospital utilisers and a programme for patients requiring high acuity post-discharge care as part of an integrated healthcare model.
A retrospective quasi-experimental study without randomisation where patients who received post-discharge care interventions were matched 1:1 with unenrolled patients as controls.
The National University Health System (NUHS) Regional Health System (RHS), which was one of six RHS in Singapore, implemented the NUHS RHS Integrated Interventions and Care Extension (NICE) programme for frequent hospital utilisers and the NUHS Transitional Care Programme (NUHS TCP) for high acuity post-discharge care. The programmes were supported by the Ministry of Health in Singapore, which is a city-state nation located in Southeast Asia with a 5.6 million population.
Linked healthcare administrative data, for the time period of January 2013 to December 2016, were extracted for patients enrolled in NICE (n=554) or NUHS TCP (n=270) from June 2014 to December 2015, and control patients.
For both programmes, teams conducted follow-up home visits and phone calls to monitor and manage patients' post-discharge.
One-year pre- and post-enrolment healthcare utilisation frequencies and charges of all-cause inpatient admissions, emergency admissions, emergency department attendances, specialist outpatient clinic (SOC) attendances, total inpatient length of stay and mortality rates were compared.
Patients in NICE had lower mortality rate, but higher all-cause inpatient admission, emergency admission and emergency department attendance charges. Patients in NUHS TCP did not have lower mortality rate, but had higher emergency admission and SOC attendance charges.
Both NICE and NUHS TCP had no improvements in 1 year healthcare utilisation across various setting and metrics. Singular interventions might not be as impactful in effecting utilisation without an overhauling transformation and restructuring of the hospital and healthcare system.
评估频繁住院患者计划和出院后高需求患者计划作为综合医疗模式的一部分对医疗利用频率和费用以及死亡率的影响。
一项回顾性准实验研究，未进行随机分组，接受出院后护理干预的患者与未参与的患者进行 1:1 匹配作为对照组。
新加坡六个地区卫生系统之一的新加坡国立大学卫生系统（NUHS）地区卫生系统（RHS）实施了 NUHS RHS 综合干预和护理延伸（NICE）计划，用于频繁住院患者，以及 NUHS 过渡护理计划（NUHS TCP）用于高需求出院后护理。该计划得到了新加坡卫生部的支持，新加坡是一个位于东南亚的城市国家，人口为 560 万。
从 2014 年 6 月至 2015 年 12 月，从 NICE（n=554）或 NUHS TCP（n=270）登记的患者和对照组患者中提取了 2013 年 1 月至 2016 年 12 月期间的医疗行政数据。
对于两个计划，团队进行随访家庭访问和电话，以监测和管理患者出院后的情况。
比较了所有原因住院入院、急诊入院、急诊就诊、专科门诊（SOC）就诊、总住院时间和死亡率的一年前后的医疗利用频率和费用。
NICE 组患者的死亡率较低，但所有原因住院入院、急诊入院和急诊就诊费用较高。NUHS TCP 组患者的死亡率没有降低，但急诊入院和 SOC 就诊费用较高。
NICE 和 NUHS TCP 在各种环境和指标下，在一年内的医疗利用方面都没有改善。在没有对医院和医疗系统进行全面改革和重构的情况下，单一干预措施可能不会对利用产生重大影响。
