Potential of Interface Care Models to Deliver More Appropriate Care to Patients With Acute Medical Illness

National University Hospital, Singapore220 enrolled

Overview

Every country in the world is experiencing growth in both the size and the proportion of older persons. As a result of the changes, the profile and needs of people with medical illnesses have evolved. How care is delivered to patients has to keep pace with these changes, or patients will experience poor care at high cost and not have their needs met. A new model of care has emerged to meet these challenges: Acute Medical Unit. Despite considerable investment and popularity of this model, questions remain: (i) Who benefits most from this care model? (ii) How may these models be most effectively implemented for the best results? (iii) How effective are these models? Singapore is well-placed to answer these questions with its national healthcare system and excellent research institutions. The investigators plan to study how effective the model is by comparing patients with similar profiles exposed to both these care models compared to how hospital care is usually provided, looking for four differences: (i) how long patients stay in hospital, (ii) how often they use the emergency department (iii) quality of health (iv) cost. Additionally, the investigators seek to characterise patterns of health needs for this group of patients.

Study Type

OBSERVATIONAL

Enrollment

220

Conditions

Falls Injury Falls Hospitalization in Acute Care Chronic Obstructive Pulmonary Disease (COPD)

Eligibility

Sex: ALLMin age: 21 Years

Medical Language ↔ Plain English

Inclusion Criteria: * AMU inclusion criteria - admission from ED to AMU directly * Control group inclusion criteria - admission from ED to GW directly * Acute medical illnesses that includes infection-related conditions, falls-disequilibrium, and acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD). Exclusion Criteria: * Below 21 years old * Patients undergoing active chemotherapy * Patients with active pregnancy * Patients admitted less than 24 hours * Cerebrovascular disease requiring thrombolysis or intravascular intervention

Outcomes

Primary Outcomes

Mean acute care bed-days utilised

Average total days of acute hospital stay, including the index episode, for each patient. Measures efficiency of hospital care between AMU and GW groups.

Time frame: Up to 6 months following discharge

Secondary Outcomes

Patient Outcomes - Health-related Quality of Life (EQ-5D-5L)

Patients rate 5 areas - mobility, self-care, usual activities, pain/discomfort, and anxiety/depression on a 5-level scale from 1 (no problems) to 5 (extreme problems). Scores are combined into an overall health index, where higher scores indicate worse health status. This captures the patient's overall quality of life over the follow-up period.

Time frame: Baseline (Day 0, at discharge), 3 months post-discharge, and 6 months post-discharge

Patient Outcomes - Patient Activation Measure (PAM-13)

Patients answer 13 questions on a 4-point scale from "strongly disagree" to "strongly agree," with a "not applicable" option. Raw scores are converted to a 0-100 scale, where higher scores indicate greater engagement in self-care. Scores classify patients into four levels: Level 1 = disengaged, Level 2 = gaining confidence, Level 3 = taking action, Level 4 = confident and maintaining self-management.