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Title: ValuedCare program: A population health model for the delivery of evidence-based care across care continuum for hip fracture patients in Eastern Singapore
Authors: Mittal, C
Lee, H.C.D
Goh, K.S
Lau, C.K.A
Tay, L
Siau, C 
Loh, Y.H
Goh, T.K.E
Sandi, C.L
Lee, C.E
Keywords: aged
evidence based medicine
hip fracture
integrated health care system
patient care
population health
program development
very elderly
Aged, 80 and over
Continuity of Patient Care
Delivery of Health Care, Integrated
Evidence-Based Medicine
Hip Fractures
Population Health
Program Development
Issue Date: 2018
Citation: Mittal, C, Lee, H.C.D, Goh, K.S, Lau, C.K.A, Tay, L, Siau, C, Loh, Y.H, Goh, T.K.E, Sandi, C.L, Lee, C.E (2018). 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 13 (1) : 129. ScholarBank@NUS Repository.
Rights: Attribution 4.0 International
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. © 2018 The Author(s).
Source Title: Journal of Orthopaedic Surgery and Research
ISSN: 1749799X
DOI: 10.1186/s13018-018-0819-9
Rights: Attribution 4.0 International
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