ValuedCare program: a population health model for the delivery of evidence-based care across care continuum for hip fracture patients in Eastern Singapore
Abstract Background To test a population health program which could, through the application of process redesign, implement multiple evidence-based practices across the continuum of care in a functionally integrated health delivery system and deliver highly reliable and consistent evidence-based sur...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-05-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13018-018-0819-9 |
| _version_ | 1798005401436815360 |
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| author | Chikul Mittal Hsien Chieh Daniel Lee Kiat Sern Goh Cheng Kiang Adrian Lau Leeanna Tay Chuin Siau Yik Hin Loh Teck Kheng Edward Goh Chit Lwin Sandi Chien Earn Lee |
| author_facet | Chikul Mittal Hsien Chieh Daniel Lee Kiat Sern Goh Cheng Kiang Adrian Lau Leeanna Tay Chuin Siau Yik Hin Loh Teck Kheng Edward Goh Chit Lwin Sandi Chien Earn Lee |
| author_sort | Chikul Mittal |
| collection | DOAJ |
| description | Abstract Background To test a population health program which could, through the application of process redesign, implement multiple evidence-based practices across the continuum of care in a functionally integrated health delivery system and deliver highly reliable and consistent evidence-based surgical care for patients with fragility hip fractures in an acute tertiary general hospital. Methods The ValuedCare (VC) program was developed in three distinct phases as an ongoing collaboration between the Geisinger Health System (GHS), USA, and Changi General Hospital (CGH), Singapore, modelled after the GHS ProvenCare® Fragile Hip Fracture Program. Clinical outcome data on consecutive hip fracture patients seen in 12 months pre-intervention were then compared with the post-intervention group. Both pre- and post-intervention groups were followed up across the continuum of care for a period of 12 months. Results VC patients showed significant improvement in median time to surgery (97 to 50.5 h), as well as proportion of patients operated within 48 h from hospital admission (48% from 18.8%) as compared to baseline pre-intervention data. These patients also had significant reduction (p value < 0.001) of acute inpatient complications such as delirium, pneumonia, urinary tract infections, and pressure sores. VC program has shown significant reduction in median length of stay for acute hospital (13 to 9 days) as well as median combined length of stay for acute and sub-acute rehabilitation hospital (46 to 39 days), thus reducing the total duration of hospitalization and saving total hospital bed days. Operative and inpatient mortality, together with readmission rates, remained low and comparable to international Geriatric Fracture Centers (GFCs). Conclusion The implementation of VC methodology has enabled consistent delivery of high-quality, reliable and comprehensive evidence-based care for hip fracture patients at Changi General Hospital. This has also reflected successful change management and interdisciplinary collaboration within the organization through the program. There is potential for testing this methodology as a quality improvement framework replicable to other disease groups in a functionally integrated healthcare system. |
| first_indexed | 2024-04-11T12:38:56Z |
| format | Article |
| id | doaj.art-6c35abc33260474ca3b303a600e7b3af |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-11T12:38:56Z |
| publishDate | 2018-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-6c35abc33260474ca3b303a600e7b3af2022-12-22T04:23:33ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2018-05-0113111010.1186/s13018-018-0819-9ValuedCare program: a population health model for the delivery of evidence-based care across care continuum for hip fracture patients in Eastern SingaporeChikul Mittal0Hsien Chieh Daniel Lee1Kiat Sern Goh2Cheng Kiang Adrian Lau3Leeanna Tay4Chuin Siau5Yik Hin Loh6Teck Kheng Edward Goh7Chit Lwin Sandi8Chien Earn Lee9Clinical Services, Level 2, Changi General HospitalValuedCare Program Office, Changi General HospitalDepartment of Geriatric Medicine, Changi General HospitalDepartment of Orthopaedics, Changi General HospitalValuedCare Program Office, Changi General HospitalValuedCare Program Office, Changi General HospitalExecutive Office, St. Andrews Community HospitalMedical Services, St. Andrews Community HospitalHealth Services Research, Changi General HospitalExecutive Office, Changi General HospitalAbstract Background To test a population health program which could, through the application of process redesign, implement multiple evidence-based practices across the continuum of care in a functionally integrated health delivery system and deliver highly reliable and consistent evidence-based surgical care for patients with fragility hip fractures in an acute tertiary general hospital. Methods The ValuedCare (VC) program was developed in three distinct phases as an ongoing collaboration between the Geisinger Health System (GHS), USA, and Changi General Hospital (CGH), Singapore, modelled after the GHS ProvenCare® Fragile Hip Fracture Program. Clinical outcome data on consecutive hip fracture patients seen in 12 months pre-intervention were then compared with the post-intervention group. Both pre- and post-intervention groups were followed up across the continuum of care for a period of 12 months. Results VC patients showed significant improvement in median time to surgery (97 to 50.5 h), as well as proportion of patients operated within 48 h from hospital admission (48% from 18.8%) as compared to baseline pre-intervention data. These patients also had significant reduction (p value < 0.001) of acute inpatient complications such as delirium, pneumonia, urinary tract infections, and pressure sores. VC program has shown significant reduction in median length of stay for acute hospital (13 to 9 days) as well as median combined length of stay for acute and sub-acute rehabilitation hospital (46 to 39 days), thus reducing the total duration of hospitalization and saving total hospital bed days. Operative and inpatient mortality, together with readmission rates, remained low and comparable to international Geriatric Fracture Centers (GFCs). Conclusion The implementation of VC methodology has enabled consistent delivery of high-quality, reliable and comprehensive evidence-based care for hip fracture patients at Changi General Hospital. This has also reflected successful change management and interdisciplinary collaboration within the organization through the program. There is potential for testing this methodology as a quality improvement framework replicable to other disease groups in a functionally integrated healthcare system.http://link.springer.com/article/10.1186/s13018-018-0819-9Value-based carePopulation healthHip fractureSingaporeEvidence-based medicineValuedCare |
| spellingShingle | Chikul Mittal Hsien Chieh Daniel Lee Kiat Sern Goh Cheng Kiang Adrian Lau Leeanna Tay Chuin Siau Yik Hin Loh Teck Kheng Edward Goh Chit Lwin Sandi Chien Earn Lee ValuedCare program: a population health model for the delivery of evidence-based care across care continuum for hip fracture patients in Eastern Singapore Journal of Orthopaedic Surgery and Research Value-based care Population health Hip fracture Singapore Evidence-based medicine ValuedCare |
| title | ValuedCare program: a population health model for the delivery of evidence-based care across care continuum for hip fracture patients in Eastern Singapore |
| title_full | ValuedCare program: a population health model for the delivery of evidence-based care across care continuum for hip fracture patients in Eastern Singapore |
| title_fullStr | ValuedCare program: a population health model for the delivery of evidence-based care across care continuum for hip fracture patients in Eastern Singapore |
| title_full_unstemmed | ValuedCare program: a population health model for the delivery of evidence-based care across care continuum for hip fracture patients in Eastern Singapore |
| title_short | ValuedCare program: a population health model for the delivery of evidence-based care across care continuum for hip fracture patients in Eastern Singapore |
| title_sort | valuedcare program a population health model for the delivery of evidence based care across care continuum for hip fracture patients in eastern singapore |
| topic | Value-based care Population health Hip fracture Singapore Evidence-based medicine ValuedCare |
| url | http://link.springer.com/article/10.1186/s13018-018-0819-9 |
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