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Early Implementation of a Patient-Centered Medical Home in Singapore: A Qualitative Study Using Theory on Diffusion of Innovations

Patient-Centered Medical Home (PCMH) has been found to improve care for complex needs patients in some countries but has not yet been widely adopted in Singapore. This study explored the ground-up implementation of a PCMH in Singapore by describing change strategies and unpacking initial experience...

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Autores principales: Lim, Zoe Zon Be, Mohamed Kadir, Mumtaz, Ginting, Mimaika Luluina, Vrijhoef, Hubertus Johannes Maria, Yoong, Joanne, Wong, Chek Hooi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8583400/
https://www.ncbi.nlm.nih.gov/pubmed/34769680
http://dx.doi.org/10.3390/ijerph182111160
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author Lim, Zoe Zon Be
Mohamed Kadir, Mumtaz
Ginting, Mimaika Luluina
Vrijhoef, Hubertus Johannes Maria
Yoong, Joanne
Wong, Chek Hooi
author_facet Lim, Zoe Zon Be
Mohamed Kadir, Mumtaz
Ginting, Mimaika Luluina
Vrijhoef, Hubertus Johannes Maria
Yoong, Joanne
Wong, Chek Hooi
author_sort Lim, Zoe Zon Be
collection PubMed
description Patient-Centered Medical Home (PCMH) has been found to improve care for complex needs patients in some countries but has not yet been widely adopted in Singapore. This study explored the ground-up implementation of a PCMH in Singapore by describing change strategies and unpacking initial experience and perception. In-depth interviews were conducted for twenty-two key informants from three groups: the implementers, their implementation partners, and other providers. “Diffusion of innovations” emerged as an overarching theory to contextualize PCMH in its early implementation. Three core “innovations” differentiated the PCMH from usual primary care: (i) team-based and integrated care; (ii) empanelment; and (iii) shared care with other general practitioners. Change strategies employed to implement these innovations included repurposing pre-existing resources, building a partnership to create supporting infrastructure and pathways in the delivery system, and doing targeted outreach to introduce the PCMH. Initial experience and perception were characterized by processes to “adopt” and “assimilate” the innovations, which were identified as challenging due to less predictable, self-organizing behaviors by multiple players. To work with the inherent complexity and novelty of the innovations, time, leadership, standardized methods, direct communication, and awareness-building efforts are needed. This study was retrospectively registered (Protocol ID: NCT04594967).
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spelling pubmed-85834002021-11-12 Early Implementation of a Patient-Centered Medical Home in Singapore: A Qualitative Study Using Theory on Diffusion of Innovations Lim, Zoe Zon Be Mohamed Kadir, Mumtaz Ginting, Mimaika Luluina Vrijhoef, Hubertus Johannes Maria Yoong, Joanne Wong, Chek Hooi Int J Environ Res Public Health Article Patient-Centered Medical Home (PCMH) has been found to improve care for complex needs patients in some countries but has not yet been widely adopted in Singapore. This study explored the ground-up implementation of a PCMH in Singapore by describing change strategies and unpacking initial experience and perception. In-depth interviews were conducted for twenty-two key informants from three groups: the implementers, their implementation partners, and other providers. “Diffusion of innovations” emerged as an overarching theory to contextualize PCMH in its early implementation. Three core “innovations” differentiated the PCMH from usual primary care: (i) team-based and integrated care; (ii) empanelment; and (iii) shared care with other general practitioners. Change strategies employed to implement these innovations included repurposing pre-existing resources, building a partnership to create supporting infrastructure and pathways in the delivery system, and doing targeted outreach to introduce the PCMH. Initial experience and perception were characterized by processes to “adopt” and “assimilate” the innovations, which were identified as challenging due to less predictable, self-organizing behaviors by multiple players. To work with the inherent complexity and novelty of the innovations, time, leadership, standardized methods, direct communication, and awareness-building efforts are needed. This study was retrospectively registered (Protocol ID: NCT04594967). MDPI 2021-10-24 /pmc/articles/PMC8583400/ /pubmed/34769680 http://dx.doi.org/10.3390/ijerph182111160 Text en © 2021 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
Lim, Zoe Zon Be
Mohamed Kadir, Mumtaz
Ginting, Mimaika Luluina
Vrijhoef, Hubertus Johannes Maria
Yoong, Joanne
Wong, Chek Hooi
Early Implementation of a Patient-Centered Medical Home in Singapore: A Qualitative Study Using Theory on Diffusion of Innovations
title Early Implementation of a Patient-Centered Medical Home in Singapore: A Qualitative Study Using Theory on Diffusion of Innovations
title_full Early Implementation of a Patient-Centered Medical Home in Singapore: A Qualitative Study Using Theory on Diffusion of Innovations
title_fullStr Early Implementation of a Patient-Centered Medical Home in Singapore: A Qualitative Study Using Theory on Diffusion of Innovations
title_full_unstemmed Early Implementation of a Patient-Centered Medical Home in Singapore: A Qualitative Study Using Theory on Diffusion of Innovations
title_short Early Implementation of a Patient-Centered Medical Home in Singapore: A Qualitative Study Using Theory on Diffusion of Innovations
title_sort early implementation of a patient-centered medical home in singapore: a qualitative study using theory on diffusion of innovations
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8583400/
https://www.ncbi.nlm.nih.gov/pubmed/34769680
http://dx.doi.org/10.3390/ijerph182111160
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