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

Author

Listed:
  • Zoe Zon Be Lim

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

  • Mumtaz Mohamed Kadir

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

  • Mimaika Luluina Ginting

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

  • Hubertus Johannes Maria Vrijhoef

    (Panaxea, 1098 XH Amsterdam, The Netherlands
    Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands)

  • Joanne Yoong

    (Geriatric Education and Research Institute, Singapore 768024, Singapore
    Center for Economic and Social Research, University of Southern Carolina, Los Angeles, CA 90089, USA
    Research for Impact, Singapore 159964, Singapore)

  • Chek Hooi Wong

    (Geriatric Education and Research Institute, Singapore 768024, Singapore
    Tsao Foundation, Singapore 168730, Singapore
    Health Services & Systems Research, Duke-NUS, Singapore 169857, Singapore)

Abstract

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).

Suggested Citation

  • 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.
  • Handle: RePEc:gam:jijerp:v:18:y:2021:i:21:p:11160-:d:663522
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    References listed on IDEAS

    as
    1. Lanham, Holly Jordan & Leykum, Luci K. & Taylor, Barbara S. & McCannon, C. Joseph & Lindberg, Curt & Lester, Richard T., 2013. "How complexity science can inform scale-up and spread in health care: Understanding the role of self-organization in variation across local contexts," Social Science & Medicine, Elsevier, vol. 93(C), pages 194-202.
    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. James Rufus John & Hir Jani & Kath Peters & Kingsley Agho & W. Kathy Tannous, 2020. "The Effectiveness of Patient-Centred Medical Home-Based Models of Care versus Standard Primary Care in Chronic Disease Management: A Systematic Review and Meta-Analysis of Randomised and Non-Randomise," IJERPH, MDPI, vol. 17(18), pages 1-42, September.
    4. repec:mpr:mprres:7634 is not listed on IDEAS
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    Cited by:

    1. 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.
    2. 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.

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