Potential of Interface Care Models to Deliver More Appropriate Care to Patients With Acute Medical Illness in Singapore and Decrease Utilisation of Acute Care Bed-days
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 220
- 试验地点
- 1
- 主要终点
- Mean acute care bed-days utilised
研究概览
简要总结
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.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 21 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •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).
排除标准
- •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
研究组 & 干预措施
Acute Medical Unit (AMU) Patients
Patients admitted to the AMU from the Emergency Department (ED) or specialist clinics as their first admission ward. The AMU provides rapid assessment and early intervention to improve efficiency of care. Participants will primarily include adults with acute medical illnesses such as infection-related conditions, falls/disequilibrium, or acute exacerbation of COPD.
General Ward (GW) Control Patients
Patients admitted directly from the ED to General Wards under the Division of Advanced Internal Medicine. Patients will be matched to the AMU group by diagnosis group, age, gender, illness severity, comorbidities, frailty, and functional status to minimize confounding factors.
结局指标
主要结局
Mean acute care bed-days utilised
时间窗: Up to 6 months following discharge
Average total days of acute hospital stay, including the index episode, for each patient. Measures efficiency of hospital care between AMU and GW groups.
次要结局
- Patient Outcomes - Health-related Quality of Life (EQ-5D-5L)(Baseline (Day 0, at discharge), 3 months post-discharge, and 6 months post-discharge)
- Patient Outcomes - Patient Activation Measure (PAM-13)(Baseline (Day 0, at discharge) and 6 months post-discharge)
- Patient Outcomes - World Health Organisation Five Wellbeing (WHO-5)(Baseline (Day 0, at discharge), 3 months post-discharge, and 6 months post-discharge)
- Patient Outcomes - Patient Health Questionnaire (PHQ-9)(Baseline (Day 0, at discharge) and 6 months post-discharge)
- Patient Outcomes - Functional Dependence (Barthel Index)(Baseline (Day 0, at discharge) and 6 months post-discharge)
- System Outcomes - Number of Emergency Department (ED) visits(Baseline (Day 0, at discharge) and 6 months post-discharge)
- System Outcomes - Specialist Outpatient Clinic visit(Baseline (Day 0, at discharge) and 6 months post-discharge)
- System Outcomes - Polyclinic Visits(Baseline (Day 0, at discharge) and 6 months post-discharge)
- System Outcomes - Hospital Admissions(6 months post-discharge)