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An Integrated Patient-Centred Medical Home (PCMH) Care Model Reduces Prospective Healthcare Utilisation for Community-Dwelling Older Adults with Complex Needs: A Matched Observational Study in Singapore

The global ageing population is associated with increased health service use. The PCMH care model integrates primary care and home-based care management to deliver comprehensive and personalised healthcare to community-dwelling older adults with bio-psycho-social needs. We examined if an integrated...

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Autores principales: Sum, Grace, Sim, Silvia Yu Hui, Chay, Junxing, Ho, Soon Hoe, Ginting, Mimaika Luluina, Lim, Zoe Zon Be, Yoong, Joanne, Wong, Chek Hooi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10572627/
https://www.ncbi.nlm.nih.gov/pubmed/37835116
http://dx.doi.org/10.3390/ijerph20196848
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author Sum, Grace
Sim, Silvia Yu Hui
Chay, Junxing
Ho, Soon Hoe
Ginting, Mimaika Luluina
Lim, Zoe Zon Be
Yoong, Joanne
Wong, Chek Hooi
author_facet Sum, Grace
Sim, Silvia Yu Hui
Chay, Junxing
Ho, Soon Hoe
Ginting, Mimaika Luluina
Lim, Zoe Zon Be
Yoong, Joanne
Wong, Chek Hooi
author_sort Sum, Grace
collection PubMed
description The global ageing population is associated with increased health service use. The PCMH care model integrates primary care and home-based care management to deliver comprehensive and personalised healthcare to community-dwelling older adults with bio-psycho-social needs. We examined if an integrated PCMH reduced healthcare utilisation burden of older persons in Singapore. We compared the healthcare utilisation between the intervention group and coarsened exact matched controls for a follow-up of 15 months. Baseline matching covariates included socio-demographics, health status, and past healthcare use. We accounted for COVID-19 social distancing effects on health-seeking behaviour. The intervention group consisted of 165 older adults with complex needs. We analysed national administrative healthcare utilisation data from 2017 to 2020. We applied multivariable zero-inflated regression modelling and presented findings stratified by high (CCI ≥ 5) and low disease burden (CCI < 5). Compared to controls, there were significant reductions in emergency department (β = −0.85; 95%CI = −1.55 to −0.14) and primary care visits (β = −1.70; 95%CI = −2.17 to −1.22) and a decrease in specialist outpatient visits (β = −0.29; 95%CI = −0.64 to 0.07) in the 3-month period immediately after one-year enrolment. The number of acute hospitalisations remained stable. Compared to controls, the intervention group with high and low comorbidity burden had significant decreases in primary care use, while only those with lower comorbidity burden had significant reductions in utilisation of other service types. An integrated PCMH appears beneficial in reducing healthcare utilisation for older persons with complex needs after 1 year in the programme. Future research can explore longer-term utilisation and scalability of the care model.
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spelling pubmed-105726272023-10-14 An Integrated Patient-Centred Medical Home (PCMH) Care Model Reduces Prospective Healthcare Utilisation for Community-Dwelling Older Adults with Complex Needs: A Matched Observational Study in Singapore Sum, Grace Sim, Silvia Yu Hui Chay, Junxing Ho, Soon Hoe Ginting, Mimaika Luluina Lim, Zoe Zon Be Yoong, Joanne Wong, Chek Hooi Int J Environ Res Public Health Article The global ageing population is associated with increased health service use. The PCMH care model integrates primary care and home-based care management to deliver comprehensive and personalised healthcare to community-dwelling older adults with bio-psycho-social needs. We examined if an integrated PCMH reduced healthcare utilisation burden of older persons in Singapore. We compared the healthcare utilisation between the intervention group and coarsened exact matched controls for a follow-up of 15 months. Baseline matching covariates included socio-demographics, health status, and past healthcare use. We accounted for COVID-19 social distancing effects on health-seeking behaviour. The intervention group consisted of 165 older adults with complex needs. We analysed national administrative healthcare utilisation data from 2017 to 2020. We applied multivariable zero-inflated regression modelling and presented findings stratified by high (CCI ≥ 5) and low disease burden (CCI < 5). Compared to controls, there were significant reductions in emergency department (β = −0.85; 95%CI = −1.55 to −0.14) and primary care visits (β = −1.70; 95%CI = −2.17 to −1.22) and a decrease in specialist outpatient visits (β = −0.29; 95%CI = −0.64 to 0.07) in the 3-month period immediately after one-year enrolment. The number of acute hospitalisations remained stable. Compared to controls, the intervention group with high and low comorbidity burden had significant decreases in primary care use, while only those with lower comorbidity burden had significant reductions in utilisation of other service types. An integrated PCMH appears beneficial in reducing healthcare utilisation for older persons with complex needs after 1 year in the programme. Future research can explore longer-term utilisation and scalability of the care model. MDPI 2023-09-27 /pmc/articles/PMC10572627/ /pubmed/37835116 http://dx.doi.org/10.3390/ijerph20196848 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Sum, Grace
Sim, Silvia Yu Hui
Chay, Junxing
Ho, Soon Hoe
Ginting, Mimaika Luluina
Lim, Zoe Zon Be
Yoong, Joanne
Wong, Chek Hooi
An Integrated Patient-Centred Medical Home (PCMH) Care Model Reduces Prospective Healthcare Utilisation for Community-Dwelling Older Adults with Complex Needs: A Matched Observational Study in Singapore
title An Integrated Patient-Centred Medical Home (PCMH) Care Model Reduces Prospective Healthcare Utilisation for Community-Dwelling Older Adults with Complex Needs: A Matched Observational Study in Singapore
title_full An Integrated Patient-Centred Medical Home (PCMH) Care Model Reduces Prospective Healthcare Utilisation for Community-Dwelling Older Adults with Complex Needs: A Matched Observational Study in Singapore
title_fullStr An Integrated Patient-Centred Medical Home (PCMH) Care Model Reduces Prospective Healthcare Utilisation for Community-Dwelling Older Adults with Complex Needs: A Matched Observational Study in Singapore
title_full_unstemmed An Integrated Patient-Centred Medical Home (PCMH) Care Model Reduces Prospective Healthcare Utilisation for Community-Dwelling Older Adults with Complex Needs: A Matched Observational Study in Singapore
title_short An Integrated Patient-Centred Medical Home (PCMH) Care Model Reduces Prospective Healthcare Utilisation for Community-Dwelling Older Adults with Complex Needs: A Matched Observational Study in Singapore
title_sort integrated patient-centred medical home (pcmh) care model reduces prospective healthcare utilisation for community-dwelling older adults with complex needs: a matched observational study in singapore
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10572627/
https://www.ncbi.nlm.nih.gov/pubmed/37835116
http://dx.doi.org/10.3390/ijerph20196848
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