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

Bibliographic Data

ID15468360
AuthorsGrace Sum (0000-0002-0309-2700, Geriatric Education and Research Institute, corresponding author), Silvia Yu Hui Sim (0000-0001-5196-8271, Geriatric Education and Research Institute), Junxing Chay (0000-0002-3291-4523, Duke-NUS Medical School), Soon Hoe Ho (Geriatric Education and Research Institute), Mimaika Luluina Ginting (0000-0002-0319-8097, Geriatric Education and Research Institute), Zoe Zon Be Lim (0000-0002-8256-9924, Geriatric Education and Research Institute), Joanne Yoong (0000-0002-0162-9885, Geriatric Education and Research Institute), Chin-Huat Wong (0000-0002-3048-0477, Duke-NUS Medical School)
Year2023
Volume20
Issue19
Pages6848-6848
Publication date2023-09-27
Open AccessYes
TypeARTICLE
VenueInternational Journal of Environmental Research and Public Health (JOURNAL)
Journal identifiersISSN: 1661-7827 • E-ISSN: 1660-4601
PublisherMultidisciplinary Digital Publishing Institute (PUBLISHER • CH)
DOI10.3390/ijerph20196848
PMID37835116
OpenAlexW4387137210
LanguageEN
Citations received2
References cited44

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

Comorbidity · Disease burden · Emergency department · Environmental health · Family medicine · Health care · Intervention (counseling · Medical home · Observational study · Population · Primary care · Propensity score matching · Psychiatry · Psychological intervention · Chronic Disease Management Strategies · Global Health Care Issues · Medicine · Nursing · Primary Care and Health Outcomes · Gerontology

Tools

Open DOIOpen Access