Prevalence of care fragmentation among outpatients attending specialist clinics in a regional hospital in Singapore: a cross-sectional study

Kailasam, Manimegalai; Guo, Wenjia; Hsann, Yin Maw; Yang, Kok Soong

doi:10.1136/bmjopen-2018-022965

Cited by 22 publications

(11 citation statements)

References 27 publications

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“…Because low-quality primary care is related to skipping primary care and direct access to secondary care, 22 the quality of primary care could affect the care fragmentation. Moreover, since older population is associated with high FCI, 21 33 the target of the study might affect the high FCI in this study. However, in the study, age was related to lower FCI among older adults aged ≥75 years.…”

Section: Discussionmentioning

confidence: 98%

“…As an indicator of fragmentation, we employed the Fragmentation of Care Index (FCI). 21 33 The FCI is developed from the Continuity of Care Index. 33 It is ‘based on the total number of visits, different institutions visited, and proportion of visits to each institution’ 33 :…”

Section: Methodsmentioning

confidence: 99%

“…11 17 Moreover, population ageing will induce expanding fragmented care because a number of patients with multimorbidity will increase with ageing. [18][19][20][21] Continuity of care is not only dependent on an individual doctor-patient relationship but also on the healthcare system. The reason is that continuity of care overlaps coordination of care.…”

Section: Introductionmentioning

confidence: 99%

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Fragmentation of ambulatory care among older adults: an exhaustive database study in an ageing city in Japan

et al. 2022

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ObjectivesContinuity of care is a core dimension of primary care, and better continuity is associated with better patient outcomes. Therefore, care fragmentation can be an indicator to assess the quality of primary care, especially in countries without formal gatekeeping system, such as Japan. Thus, this study aimed to describe care fragmentation among older adults in an ageing city in Japan.DesignCross-sectional study.SettingThe most populated basic municipality in Japan.ParticipantsOlder adults aged 75 years and older.InterventionsThis study used a health claims database, including older adults who visited medical facilities at least four times a year in an urban city in Japan. The Fragmentation of Care Index (FCI) was used as an indicator of fragmentation. The FCI was developed from the Continuity of Care Index and is based on the total number of visits, different institutions visited and proportion of visits to each institution. We employed Tobit regression analysis to examine the association between the FCI and age, sex, type of insurance and most frequently visited facility.ResultsThe total number of participants was 413 600. The median age of the study population was 81 years, and 41.6% were men. The study population visited an average of 3.42 clinics/hospitals, and the maximum number of visited institutions was 20. The proportion of patients with FCI >0 was 85.0%, with a mean of 0.583. Multivariable analysis showed that patients receiving public assistance had a lower FCI compared with patients not receiving public assistance, with a coefficient of 0.137.ConclusionsTo our knowledge, this is the first study to demonstrate care fragmentation in Japan. Over 80% of the participants visited two or more medical facilities, and their mean FCI was 0.583. The FCI could be a basic indicator for assessing the quality of primary care.

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Section: Discussionmentioning

confidence: 98%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fragmentation of ambulatory care among older adults: an exhaustive database study in an ageing city in Japan

et al. 2022

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“…This can be attributed to various factors, including a lack of regulation, as well as a lack of integration of information systems in these healthcare sectors. In a study by Kailasam et al, the greatest fragmentation was found in hematology, endocrinology, and anesthesia clinics [34]. The lack of coordination of specialist care may lead to further hospitalizations.…”

Section: Rehospitalizations For Cardiovascular Causes-the Impact Of Outpatient Specialty Carementioning

confidence: 98%

Long-Term Outpatient Care and Rehospitalizations in Patients after Cardiac Electrotherapy Device Implantation

et al. 2022

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Background and Objectives: Cardiovascular implantable electronic device (CIED) treatment is widely used in modern cardiology. Indications for this type of treatment are increasing. However, a significant proportion of CIED implantation patients require subsequent hospitalization for cardiovascular reasons. Older age and the associated complex clinical picture necessitate multidisciplinary outpatient specialist care for these patients. The aim of this study was to analyze the reasons for subsequent hospitalizations in the cardiology department and the impact of outpatient specialty care on these hospitalizations. To the best of our knowledge, there are no such studies in the available literature. Materials and Methods: This study was conducted on a population of patients treated with CIED. Reasons for subsequent hospitalizations were divided into clinically and statistically valid groups according to the main diagnosis. Using an electronic database, causes of hospitalization were determined based on this diagnosis. Using data on consultations at outpatient specialty clinics, a logistic regression model was created for the probability of subsequent hospitalization for cardiovascular causes according to the specialty of the clinic. Results: The 9-year follow-up included a population of 2071 patients treated with CIED. During the follow-up period, 508 patients (approximately 24.5%) required subsequent hospitalization for cardiovascular reasons. The most common leading causes were heart failure, atrial fibrillation, and coronary artery disease. The need for consultation at outpatient specialty clinics increased the likelihood of hospitalization. Moreover, the need to consult patients in nephrology outpatient, pulmonary disease outpatient, and orthopedic outpatient clinics was the most significant. Conclusions: The use of electronic implantable cardiovascular devices is a very important part of therapy in modern cardiology. The methods for their use are constantly being improved. However, they represent only one stage of cardiac treatment. After CIED procedures, patients require further care in both inpatient and outpatient specialty care settings. In this paper, we outline the reasons for subsequent hospitalizations and the importance of outpatient specialty care in this context. Effective organization of care after CIED procedures may be important in reducing the most expensive component of this care, that is, inpatient treatment.

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“…1 The prevalence of chronic diseases in Singapore is something that cannot be overlooked as chronic disease management becomes more complex and threatens to fuel exponential growth in healthcare expenditure. 2,3 The concept of integrated care has also gained prominence as the favoured approach for enhancing patient care through the horizontal and vertical integration of various care and service sectors. 4–10…”

Section: Introductionmentioning

confidence: 99%

General medicine at the frontline of acute care delivery: Comparison with family medicine hospitalist model implementation in Singapore

Lai

Leow

Lee

et al. 2020

Proceedings of Singapore Healthcare

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Introduction This mixed methods study seeks to assess the clinical outcomes and qualitative insights associated with the pragmatic implementation of a general medicine (GM) physician-led inpatient care model, first at Alexandra Hospital (AH) and then at Sengkang General Hospital (SKH), and to compare them with findings reported in an earlier implementation of the family medicine (FM) hospitalist model in Singapore. Methods Anonymous quantitative demographic and clinical data including length of stay, 30-day readmission rate, inpatient mortality rate and gross cost of hospitalisation bills were extracted from the hospital information system. Comparative analyses with the FM hospitalist model and usual care were made. Secondary qualitative data that were gathered focused on increased understanding of the proposed model, its perceived challenges and future opportunities for its implementation. Results The adapted GM care model implemented first at AH and then at SKH seemed to suggest that such a model run by physicians from various backgrounds was capable of producing similarly superior outcomes when compared with the FM hospitalist model piloted in 2011, which was juxtaposed with usual care. With regard to qualitative insights, three findings were reported: (a) perception of and mindset in relation to generalists, which illustrates the barriers to implementing GM; (b) education and training of generalists, which underlines the current lack of adequate supply of GM specialists; and (c) operational issues of care model implementation, which highlights the current mismatches between the prevailing healthcare philosophy and the requirements for successful implementation of the GM care model. Conclusion The success of a GM care model hinges on how it is operationalised. With clear protocols, definitions, and a high level of protocol compliance by healthcare team members, the intended outcomes show promise for replication at other interested sites.

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Prevalence of care fragmentation among outpatients attending specialist clinics in a regional hospital in Singapore: a cross-sectional study

Cited by 22 publications

References 27 publications

Fragmentation of ambulatory care among older adults: an exhaustive database study in an ageing city in Japan

Fragmentation of ambulatory care among older adults: an exhaustive database study in an ageing city in Japan

Long-Term Outpatient Care and Rehospitalizations in Patients after Cardiac Electrotherapy Device Implantation

General medicine at the frontline of acute care delivery: Comparison with family medicine hospitalist model implementation in Singapore

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