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dc.titleImplementation fidelity of a strategy to integrate service delivery: learnings from a transitional care program for individuals with complex needs in Singapore
dc.contributor.authorMILAWATY NURJONO
dc.contributor.authorShrestha, Pami
dc.contributor.authorAng, Ian Yi Han
dc.contributor.authorFARAH SHIRAZ
dc.contributor.authorYoong, Joanne Su-Yin
dc.contributor.authorSUE-ANNE TOH EE SHIOW
dc.contributor.authorVrijhoef, Hubertus Johannes Maria
dc.identifier.citationMILAWATY NURJONO, Shrestha, Pami, Ang, Ian Yi Han, FARAH SHIRAZ, Yoong, Joanne Su-Yin, SUE-ANNE TOH EE SHIOW, Vrijhoef, Hubertus Johannes Maria (2019-03-19). Implementation fidelity of a strategy to integrate service delivery: learnings from a transitional care program for individuals with complex needs in Singapore. BMC HEALTH SERVICES RESEARCH 19 (1). ScholarBank@NUS Repository.
dc.description.abstract© 2019 The Author(s). Background: To cope with rising demand for healthcare services in Singapore, Regional Health Systems (RHS) comprising of health and social care providers across care settings were set up to integrate service delivery. Tasked with providing care for the western region, in 2012, the National University Health System (NUHS) - RHS developed a transitional care program for elderly patients with complex healthcare needs who consumed high levels of hospital resources. Through needs assessment, development of personalized care plans and care coordination, the program aimed to: (i) improve quality of care, (ii) reduce hospital utilization, and (iii) reduce healthcare-related costs. In this study, recognizing the need for process evaluation in conjunction with outcome evaluation, we aim to evaluate the implementation fidelity of the NUHS-RHS transitional care program to explain the outcomes of the program and to inform further development of (similar) programs. Methods: Guided by the modified version of the Conceptual Framework for Implementation Fidelity (CFIF), adherence and moderating factors influencing implementation were assessed using non-participatory observations, reviews of medical records and program databases. Results: Most (10 out of 14) components of the program were found to be implemented with low or moderate level of fidelity. The frequency or duration of the program components were observed to vary based on the needs of users, availability of care coordinators (CC) and their confidence. Variation in fidelity was influenced predominantly by: (1) complexity of the program, (2) extent of facilitation through guiding protocols, (3) facilitation of program implementation through CCs’ level of training and confidence, (4) evolving healthcare participant responsiveness, and (5) the context of suboptimal capability among community providers. Conclusion: This is the first study to assess the context-specific implementation process of a transitional care program in the context of Southeast Asia. It provides important insights to facilitate further development and scaling up of transitional care programs within the NUHS-RHS and beyond. Our findings highlight the need for greater focus on engaging both healthcare providers and users, training CCs to equip them with the relevant skills required for their jobs, and building the capability of the community providers to implement such programs.
dc.subjectScience & Technology
dc.subjectLife Sciences & Biomedicine
dc.subjectHealth Care Sciences & Services
dc.subjectIntegrated care
dc.subjectPost-discharge care
dc.subjectTransitional care
dc.subjectImplementation fidelity
dc.subjectMixed methods
dc.contributor.departmentSAW SWEE HOCK SCHOOL OF PUBLIC HEALTH
dc.contributor.departmentYONG LOO LIN SCHOOL OF MEDICINE
dc.description.sourcetitleBMC HEALTH SERVICES RESEARCH
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