Chua Crystal Min Siu, Lim Eward Wei Zheng, See Tho Win Hon, Asada Yuka, Peters Karen E, Lai Yi Feng
MOH Office for Healthcare Transformation, Singapore, Singapore.
School of Public Health, University of Illinois Chicago, Chicago, Illinois, United States of America.
PLoS One. 2025 Jun 2;20(6):e0323679. doi: 10.1371/journal.pone.0323679. eCollection 2025.
Many Hospital-at-Home (HaH) programs have proliferated in recent years to cope with the increasing demands of an ageing population and global hospital bed shortages. Singapore has implemented its own version, Mobile Inpatient Care at Home (MIC@Home). However, many HaH programs remain small, raising concerns about their scalability. Hence, a clear implementation strategy is needed.
To address: (1) What is the readiness of Singapore's health system partners to scale up MIC@Home? and (2) What multi-level strategies are necessary for the successful scaling of MIC@Home in Singapore?.
A descriptive qualitative study design was used. Through purposive sampling, 32 participants (16 HaH clinicians, 11 enabling units, and 5 regulators) were recruited and semi-structured interviews were conducted. The interviews were transcribed using Trint and thematically analysed using Atlas.ti via Braun and Clarke's six-step inductive approach. This analysis was guided by the Health Policy and Partnership Readiness Assessment Framework.
The key themes were: (1) perceived readiness to scale, focusing on stakeholder motivation and capacity; (2) implementation strategies, highlighting the need for training, collaborations, and operational refinements; and (3) policy strategies, addressing financial sustainability, governance, and regulation. MIC@Home is seen as a viable solution to acute bed shortages, with high readiness for scaling. Effective governance requires stakeholder buy-in, organizational alignment, partnerships, and adequate manpower. Regulatory strategies should be adjusted to sustain MIC@Home and improve patient access. For service provision, standardized guideline and data is vital to prove MIC@Home's effectiveness and safety, while convincing clinicians and patients of its value will increase acceptability. Finally, refining governance and establishing regulations for minimum care standards will support smooth operations and long-term success.
Despite the challenges of scaling MIC@Home, the findings underscore the potential of MIC@Home to enhance healthcare delivery through identifying readiness and strategies to position MIC@Home as an alternative to traditional care.
近年来，许多居家医院（HaH）项目不断涌现，以应对人口老龄化带来的日益增长的需求以及全球医院床位短缺的问题。新加坡实施了自己的版本，即居家移动住院护理（MIC@Home）。然而，许多HaH项目规模仍然较小，这引发了对其可扩展性的担忧。因此，需要一个明确的实施策略。
解决以下问题：（1）新加坡的卫生系统合作伙伴扩大MIC@Home规模的准备情况如何？（2）在新加坡成功扩大MIC@Home规模需要哪些多层次策略？
采用描述性定性研究设计。通过目的抽样，招募了32名参与者（16名HaH临床医生、11个支持单位和5名监管者），并进行了半结构化访谈。访谈内容使用Trint转录，并通过Braun和Clarke的六步归纳法，使用Atlas.ti进行主题分析。该分析以卫生政策与伙伴关系准备情况评估框架为指导。
关键主题包括：（1）感知到的扩大规模的准备情况，重点是利益相关者的动机和能力；（2）实施策略，强调培训、合作和运营优化的必要性；（3）政策策略，涉及财务可持续性、治理和监管。MIC@Home被视为解决急性床位短缺的可行方案，具有很高的扩大规模的准备度。有效的治理需要利益相关者的认可、组织协调、伙伴关系和充足的人力。监管策略应进行调整，以维持MIC@Home并改善患者的可及性。对于服务提供，标准化的指南和数据对于证明MIC@Home的有效性和安全性至关重要，而让临床医生和患者相信其价值将提高可接受性。最后，完善治理并建立最低护理标准的法规将支持平稳运营和长期成功。
尽管扩大MIC@Home规模存在挑战，但研究结果强调了MIC@Home通过识别准备情况和策略，将其定位为传统护理替代方案来加强医疗服务提供的潜力。
