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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

Author

Listed:
  • Grace Sum

    (Geriatric Education and Research Institute, Singapore 768024, Singapore)

  • Silvia Yu Hui Sim

    (Geriatric Education and Research Institute, Singapore 768024, Singapore)

  • Junxing Chay

    (Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore 169857, Singapore)

  • Soon Hoe Ho

    (Geriatric Education and Research Institute, Singapore 768024, Singapore)

  • Mimaika Luluina Ginting

    (Geriatric Education and Research Institute, Singapore 768024, Singapore)

  • Zoe Zon Be Lim

    (Geriatric Education and Research Institute, Singapore 768024, Singapore)

  • Joanne Yoong

    (Geriatric Education and Research Institute, Singapore 768024, Singapore
    Research for Impact, Singapore 159964, Singapore)

  • Chek Hooi Wong

    (Research for Impact, Singapore 159964, Singapore
    Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore)

Abstract

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.

Suggested Citation

  • Grace Sum & Silvia Yu Hui Sim & Junxing Chay & Soon Hoe Ho & Mimaika Luluina Ginting & Zoe Zon Be Lim & Joanne Yoong & Chek Hooi Wong, 2023. "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 Singapo," IJERPH, MDPI, vol. 20(19), pages 1-15, September.
    • Handle: RePEc:gam:jijerp:v:20:y:2023:i:19:p:6848-:d:1249048
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    References listed on IDEAS

    as
    1. Zoe Zon Be Lim & Mumtaz Mohamed Kadir & Mimaika Luluina Ginting & Hubertus Johannes Maria Vrijhoef & Joanne Yoong & Chek Hooi Wong, 2021. "Early Implementation of a Patient-Centered Medical Home in Singapore: A Qualitative Study Using Theory on Diffusion of Innovations," IJERPH, MDPI, vol. 18(21), pages 1-20, October.
    2. Shilpa Surendran & Chuan De Foo & Chen Hee Tam & Elaine Qiao Ying Ho & David Bruce Matchar & Josip Car & Gerald Choon Huat Koh, 2021. "The Missed Opportunity of Patient-Centered Medical Homes to Thrive in an Asian Context," IJERPH, MDPI, vol. 18(4), pages 1-11, February.
    3. Mimaika Luluina Ginting & Chek Hooi Wong & Zoe Zon Be Lim & Robin Wai Munn Choo & Sheena Camilla Hirose Carlsen & Grace Sum & Hubertus Johannes Maria Vrijhoef, 2022. "A Patient-Centred Medical Home Care Model for Community-Dwelling Older Adults in Singapore: A Mixed-Method Study on Patient’s Care Experience," IJERPH, MDPI, vol. 19(8), pages 1-24, April.
    4. King, Gary & Nielsen, Richard, 2019. "Why Propensity Scores Should Not Be Used for Matching," Political Analysis, Cambridge University Press, vol. 27(4), pages 435-454, October.
    5. Iacus, Stefano M. & King, Gary & Porro, Giuseppe, 2012. "Causal Inference without Balance Checking: Coarsened Exact Matching," Political Analysis, Cambridge University Press, vol. 20(1), pages 1-24, January.
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