Defining and Evaluating Norms for Health and Social Service (HASS) Use for Population Health Segments
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 1,006
- 试验地点
- 1
- 主要终点
- Concordance between actual HASS utilization vs HASS norms
研究概览
简要总结
Background In view of expected growth of the older population in Singapore in the next decades, the volume and complexity of needs for health care services is expected to increase, which amplifies stress on the current healthcare system. One approach to addressing this challenge is to consider service utilization in relationship to needs based on "population segmentation" and to plan and evaluate new services in light of unmet needs.
Specific Aims and Hypotheses Primary Aim 1: To establish health and social service (HASS) norms for population segments as defined by the Simple Segmentation Tool (SST) via a modified-Delphi methodology.
Primary Aim 2: To evaluate the concordance between the types of HASS that patients in each population segment actually utilize versus the types of HASS normatively defined for each population segment over a 3-month period from the point of hospital discharge.
Primary Hypothesis: The concordance between the actual utilization of different types of HASS versus normative HASS is not better than fair.
Secondary Aim: To assess the association between concordance of normative HASS and incidence of adverse outcomes which includes emergency department visits, unplanned hospital readmissions, nursing home placement, and all-cause mortality over a 12-month period from point of hospital discharge for all population segments.
Secondary Hypothesis: Patients with disagreement between normative HASS and actual utilization of HASS will have a higher incidence of adverse outcomes.
Methodology The investigators will use a modified-Delphi methodology to develop HASS norms and conduct a follow-up study of inpatients to evaluate the concordance between the types of HASS utilized and norm HASS, and to evaluate the association between this concordance and adverse outcomes in each population segment.
Significance to Health Services Delivery The transformation of the health care system to effectively meet growing needs in a patient-centric way requires practical tools for population planning and program development. The norms and evaluation approaches developed here will guide clinical and public policy decision makers in prioritizing population needs, and thus contribute to tangible improvements in health services delivery, patient care and health outcomes for an aging Singapore population.
详细描述
Background The Singaporean demographic transition has increased the proportion of older individuals in the population and the prevalence of multiple chronic health conditions. 1 in 4 Singaporeans aged 40 years and above has at least 1 chronic disease. Worldwide urgency to address chronic conditions is driven by the rapid rise in incidence and also by the associated social and financial costs for the health sector and society.
Often, patients with multiple chronic conditions require more services which are increasingly recognized to include a coordinated mix of clinical and social care. A promising strategy for planning and evaluation of services for an increasingly complex population is population segmentation, where individuals are assigned into groups based on similar health and health-related social needs. Understanding how people in various segments distribute across points of service and in the community more broadly can be used to guide the efficient provision of services. In addition to improved efficiency, meeting otherwise unmet needs would reduce the progression to worse health states and associated high cost medical services such as hospitalization. Through segmentation health care providers, regional health system (RHS) planners, and policy makers will be enabled to develop more person-centric services.
The specific aims and hypotheses of this study are as follows:
Primary Aim 1: To establish norms for high value services for population segments as defined by the SST via a modified-Delphi methodology.
Primary Aim 2: To evaluate the concordance between the types of HASS that patients in each population segment actually utilize versus the types of HASS normatively defined for each population segment over a 3-month period from the point of hospital discharge.
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
- 55 Years 至 100 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Provision of informed consent
- •Currently hospitalized
- •Age ≥ 55 years at time of recruitment
- •Singaporean or Permanent Resident
排除标准
- 未提供
结局指标
主要结局
Concordance between actual HASS utilization vs HASS norms
时间窗: Over a 3-month period from date of discharge
Information on the types of HASS that patients in each population segment actually utilize will be compared against the types of HASS normatively defined for each population segment over a 3-month period from the point of hospital discharge to evaluate concordance between the two. Type of services, frequency of utilization, reasons for taking and not taking the prescribed services, service expenditure, and adverse outcomes will be collected.
Health and social service (HASS) norms for population segments
时间窗: 5 months
HASS norms for population segments as defined by the Simple Segmentation Tool (SST) will be established via a modified-Delphi methodology analogous to that used in the RAND Appropriateness Initiative. The exercise will consist of two rounds of rating - an independent rating round and a group meeting to reconcile the results. The value of each indication by circling a number from 1 to 9 (1 being definitely not high value and 9 being definitely high value). The median panel rating to identify agreement or disagreement for each indication. Agreement is reached when 2 or fewer panel members vote outside the 3-point region containing the median. Disagreement is determined when 3 or more panelists rated in each extreme (1-3 and 7-9).
次要结局
- Association between concordance of normative HASS and incidence of adverse outcomes over a 12-month period from point of hospital discharge for all population segments.(Over a 12-month period from date of discharge)
研究者
Dr. David Matchar
Professor and Director, Health Services & Systems Research, Duke-NUS Medical School
National University of Singapore