Potential of Interface Care Models to Deliver More Appropriate Care to Patients With Acute Medical Illness
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- This is an observational study: the protocol does not assign a study treatment.
- Who it may be relevant to
- Registry conditions: Falls Injury, Falls, Hospitalization in Acute Care, Chronic Obstructive Pulmonary Disease (COPD). Basic parameters: from 21 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Singapore
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Official title
Potential of Interface Care Models to Deliver More Appropriate Care to Patients With Acute Medical Illness in Singapore and Decrease Utilisation of Acute Care Bed-days
Overview
Every country in the world is experiencing growth in both the size and the proportion of older persons. As a result of the changes, the profile and needs of people with medical illnesses have evolved. How care is delivered to patients has to keep pace with these changes, or patients will experience poor care at high cost and not have their needs met. A new model of care has emerged to meet these challenges: Acute Medical Unit. Despite considerable investment and popularity of this model, questions remain: (i) Who benefits most from this care model? (ii) How may these models be most effectively implemented for the best results? (iii) How effective are these models? Singapore is well-placed to answer these questions with its national healthcare system and excellent research institutions. The investigators plan to study how effective the model is by comparing patients with similar profiles exposed to both these care models compared to how hospital care is usually provided, looking for four differences: (i) how long patients stay in hospital, (ii) how often they use the emergency department (iii) quality of health (iv) cost. Additionally, the investigators seek to characterise patterns of health needs for this group of patients.
Primary outcome measures
- Mean acute care bed-days utilised [Time frame: Up to 6 months following discharge]
Secondary outcome measures (9)
- Patient Outcomes - Health-related Quality of Life (EQ-5D-5L) [Time frame: Baseline (Day 0, at discharge), 3 months post-discharge, and 6 months post-discharge]
- Patient Outcomes - Patient Activation Measure (PAM-13) [Time frame: Baseline (Day 0, at discharge) and 6 months post-discharge]
- Patient Outcomes - World Health Organisation Five Wellbeing (WHO-5) [Time frame: Baseline (Day 0, at discharge), 3 months post-discharge, and 6 months post-discharge]
- Patient Outcomes - Patient Health Questionnaire (PHQ-9) [Time frame: Baseline (Day 0, at discharge) and 6 months post-discharge]
- Patient Outcomes - Functional Dependence (Barthel Index) [Time frame: Baseline (Day 0, at discharge) and 6 months post-discharge]
- System Outcomes - Number of Emergency Department (ED) visits [Time frame: Baseline (Day 0, at discharge) and 6 months post-discharge]
- System Outcomes - Specialist Outpatient Clinic visit [Time frame: Baseline (Day 0, at discharge) and 6 months post-discharge]
- System Outcomes - Polyclinic Visits [Time frame: Baseline (Day 0, at discharge) and 6 months post-discharge]
- System Outcomes - Hospital Admissions [Time frame: 6 months post-discharge]
Eligibility criteria
Inclusion criteria
- AMU inclusion criteria - admission from ED to AMU directly
- Control group inclusion criteria - admission from ED to GW directly
- Acute medical illnesses that includes infection-related conditions, falls-disequilibrium, and acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD).
Exclusion criteria
- Below 21 years old
- Patients undergoing active chemotherapy
- Patients with active pregnancy
- Patients admitted less than 24 hours
- Cerebrovascular disease requiring thrombolysis or intravascular intervention
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Observational model
- Cohort
Study locations
Singapore · 1 center
- National University Hospital — Singapore
Publications
- Lateef A, Lee SH, Fisher DA, Goh WP, Han HF, Segara UC, Sim TB, Mahadehvan M, Goh KT, Cheah N, Lim AYT, Phan PH, Merchant RA. Impact of inpatient Care in Emergency Department on outcomes: a quasi-experimental cohort study. BMC Health Serv Res. 2017 Aug 14;17(1):555. doi: 10.1186/s12913-017-2491-x. PMID 28806942
- Balakrishnan T, Teo PSE, Lim WT, Xin XH, Yuen BH, Wong KS. Acute Medical Ward for better care coordination of patients admitted with infection - evidence from a tertiary hospital in Singapore. Acute Med. 2017;16(4):170-176. PMID 29300795
- Reid LE, Dinesen LC, Jones MC, Morrison ZJ, Weir CJ, Lone NI. The effectiveness and variation of acute medical units: a systematic review. Int J Qual Health Care. 2016 Sep;28(4):433-46. doi: 10.1093/intqhc/mzw056. Epub 2016 Jun 16. PMID 27313174
- Soong JTY, Bell D, Ong MEH. Meeting today's healthcare needs: Medicine at the interface. Ann Acad Med Singap. 2022 Dec;51(12):787-792. doi: 10.47102/annals-acadmedsg.2022196. PMID 36592147
- Roseveare C. Acute medicine and general practice: a key interface in managing emergency care pressures. Br J Gen Pract. 2014 Mar;64(620):122-3. doi: 10.3399/bjgp14X677392. No abstract available. PMID 24567628
- Soong JTY, Valderas JM, Bell D, Ghandi M, Graves N, Ong M. Clinical and cost-effectiveness of an acute medical unit model in Singapore: protocol for a pilot prospective cohort study. BMJ Open. 2026 Jul 27;16(7):e121444. doi: 10.1136/bmjopen-2026-121444. PMID 42509004
Identifiers
NCT: NCT07536035 · MOH-001435-00