Potential of Interface Care Models to Deliver More Appropriate Care to Patients With Acute Medical Illness

Официальное название

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

Обзор

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.

Первичные конечные точки

• Mean acute care bed-days utilised [Срок оценки: Up to 6 months following discharge]

Вторичные конечные точки (9)

• Patient Outcomes - Health-related Quality of Life (EQ-5D-5L) [Срок оценки: Baseline (Day 0, at discharge), 3 months post-discharge, and 6 months post-discharge]
• Patient Outcomes - Patient Activation Measure (PAM-13) [Срок оценки: Baseline (Day 0, at discharge) and 6 months post-discharge]
• Patient Outcomes - World Health Organisation Five Wellbeing (WHO-5) [Срок оценки: Baseline (Day 0, at discharge), 3 months post-discharge, and 6 months post-discharge]
• Patient Outcomes - Patient Health Questionnaire (PHQ-9) [Срок оценки: Baseline (Day 0, at discharge) and 6 months post-discharge]
• Patient Outcomes - Functional Dependence (Barthel Index) [Срок оценки: Baseline (Day 0, at discharge) and 6 months post-discharge]
• System Outcomes - Number of Emergency Department (ED) visits [Срок оценки: Baseline (Day 0, at discharge) and 6 months post-discharge]
• System Outcomes - Specialist Outpatient Clinic visit [Срок оценки: Baseline (Day 0, at discharge) and 6 months post-discharge]
• System Outcomes - Polyclinic Visits [Срок оценки: Baseline (Day 0, at discharge) and 6 months post-discharge]
• System Outcomes - Hospital Admissions [Срок оценки: 6 months post-discharge]

Критерии участия

Критерии включения

• 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).

Критерии исключения

• 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

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Модель наблюдения

Когортное

Центры проведения

Сингапур · 1 центр

• National University Hospital — Singapore

Публикации

• 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

Идентификаторы

NCT: NCT07536035 · MOH-001435-00

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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