Retrospective evaluation of healthcare utilisation and mortality of two post-discharge care programmes in Singapore

• Published in: BMJ open 2019-05, Vol.9 (5), p.e027220-e027220
• Main Authors: Ang, Ian Yi Han, Tan, Chuen Seng, Nurjono, Milawaty, Tan, Xin Quan, Koh, Gerald Choon-Huat, Vrijhoef, Hubertus Johannes Maria, Tan, Shermin, Ng, Shu Ee, Toh, Sue-Anne
• Format: Article
• Language: English
• Subjects: Aftercare - methods; Aged; Aged, 80 and over; Ambulatory Care; Case management; Case reports; Community Health Services; Emergency Service, Hospital - economics; Emergency Service, Hospital - statistics & numerical data; Female; Health literacy; Health Services - economics; Health Services - statistics & numerical data; Health Services Research; Health services utilization; Home Care Services; Hospital Charges; Hospitalization - economics; Hospitalization - statistics & numerical data; Hospitals; House Calls; Humans; Intervention; Length of Stay; Male; Mortality; Patient admissions; Patient Discharge; Population; Program Evaluation; Proportional Hazards Models; Referral and Consultation; Retrospective Studies; Singapore; Telephone
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2018-027220

ObjectiveTo 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.DesignA retrospective quasi-experimental study without randomisation where patients who received post-discharge care interventions were matched 1:1 with unenrolled patients as controls.SettingThe 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.ParticipantsLinked 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.InterventionsFor both programmes, teams conducted follow-up home visits and phone calls to monitor and manage patients’ post-discharge.Primary outcome measuresOne-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.ResultsPatients 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.ConclusionsBoth 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.