IDEAS home Printed from https://ideas.repec.org/a/gam/jijerp/v20y2023i19p6848-d1249048.html
   My bibliography  Save this article

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
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/1660-4601/20/19/6848/pdf
    Download Restriction: no
    File URL: https://www.mdpi.com/1660-4601/20/19/6848/
    Download Restriction: no
    ---><---

    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.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Christophe Loussouarn & Carine Franc & Yann Videau & Julien Mousquès, 2021. "Can General Practitioners Be More Productive? The Impact of Teamwork and Cooperation with Nurses on GP Activities," Health Economics, John Wiley & Sons, Ltd., vol. 30(3), pages 680-698, March.
    2. Philipp vom Berge & Achim Schmillen, 2023. "Effects of mass layoffs on local employment—evidence from geo-referenced data," Journal of International Economic Law, Oxford University Press, vol. 23(3), pages 509-539.
    3. Dolores Añón Higón & Ioannis Bournakis, 2024. "Participation in global value chains (GVCs) and markups: firm evidence from six European countries," International Economics and Economic Policy, Springer, vol. 21(2), pages 515-539, May.
    4. Ravi Bapna & Alok Gupta & Gautam Ray & Shweta Singh, 2023. "Single-Sourcing vs. Multisourcing: An Empirical Analysis of Large Information Technology Outsourcing Arrangements," Information Systems Research, INFORMS, vol. 34(3), pages 1109-1130, September.
    5. Wildmer Daniel Gregori & Maria Martinez Cillero & Michela Nardo, 2022. "The effects of cross-border acquisitions on firms’ productivity in the EU," Working Papers 2022.10, International Network for Economic Research - INFER.
    6. Hans Degryse & Yalin Gündüz & Kuchulain O'Flynn & Steven Ongena, 2020. "Identifying Empty Creditors with a Shock and Micro-Data," Swiss Finance Institute Research Paper Series 20-15, Swiss Finance Institute.
    7. Ainhoa Herrarte & Paloma Urcelay, 2022. "The Wage Penalty for Motherhood in Spain (2009-2017): The Role of the Male Partner’s Job Characteristic," Hacienda Pública Española / Review of Public Economics, IEF, vol. 241(2), pages 27-57, June.
    8. Anthony Howell & Chong Liu & Rudai Yang, 2020. "Explaining the urban premium in Chinese cities and the role of place-based policies," Environment and Planning A, , vol. 52(7), pages 1332-1356, October.
    9. Nazareno Panichella & Stefano Cantalini, 2023. "Is Geographical Mobility Beneficial? The Impact of the South-to-North Internal Migration on Occupational Achievement in Italy," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 42(5), pages 1-22, October.
    10. Mitra, Aniruddha & Bang, James T. & Abbas, Faisal, 2021. "Do remittances reduce women’s acceptance of domestic violence? Evidence from Pakistan," World Development, Elsevier, vol. 138(C).
    11. Konstantin Koerner & Michael Moritz & Johannes Schäffler, 2022. "Foreign direct investment and onshore employment dynamics: Evidence from German firms with affiliates in the Czech Republic," The World Economy, Wiley Blackwell, vol. 45(6), pages 1773-1829, June.
    12. Markku Maula & Wouter Stam, 2020. "Enhancing Rigor in Quantitative Entrepreneurship Research," Entrepreneurship Theory and Practice, , vol. 44(6), pages 1059-1090, November.
    13. Giampaolo Arachi & Debora Assisi & Berardino Cesi & Michele G. Giuranno & Felice Russo, 2022. "Inter-municipal Cooperation in Public Procurement," CEIS Research Paper 548, Tor Vergata University, CEIS, revised 19 Dec 2022.
    14. Renata Serra & Kelly A. Davidson, 2021. "Selling Together: The Benefits of Cooperatives to Women Honey Producers in Ethiopia," Journal of Agricultural Economics, Wiley Blackwell, vol. 72(1), pages 202-223, February.
    15. Cigdem Gedikli & Robert Hill & Oleksandr Talavera & Okan Yilmaz, 2023. "The hidden cost of smoking: Rent premia in the housing market," Real Estate Economics, American Real Estate and Urban Economics Association, vol. 51(3), pages 611-629, May.
    16. Jarkko Harju & Kaisa Kotakorpi & Tuomas Matikka & Annika Nivala, 2024. "How Do Firms Respond to Risk-based Tax Audits?," Working Papers 22, Finnish Centre of Excellence in Tax Systems Research.
    17. Serena Fatica & Roberto Panzica, 2021. "Green bonds as a tool against climate change?," Business Strategy and the Environment, Wiley Blackwell, vol. 30(5), pages 2688-2701, July.
    18. Costa-Font, Joan & Knapp, Martin & Vilaplana-Prieto, Cristina, 2023. "The ‘welcomed lockdown’ hypothesis? Mental wellbeing and mobility restrictions," LSE Research Online Documents on Economics 115323, London School of Economics and Political Science, LSE Library.
    19. Blázquez, Maite & Herrarte, Ainhoa & Moro-Egido, Ana I., 2024. "Has the COVID-19 pandemic widened the gender gap in paid work hours in Spain?," Journal of Demographic Economics, Cambridge University Press, vol. 90(2), pages 313-348, June.
    20. Elias Asproudis & Cigdem Gedikli & Oleksandr Talavera & Okan Yilmaz, 2023. "Returns to Solar Panels in the Housing Market: A Meta Learner Approach," Discussion Papers 23-01, Department of Economics, University of Birmingham.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jijerp:v:20:y:2023:i:19:p:6848-:d:1249048. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.