Acute Exacerbation of Asthma, Chronic Obstructive Pulmonary Disease (COPD), Falls, Falls Injury, Hospitalization in Acute Care, Infection, Pneumonia, URTI - Viral Upper Respiratory Tract Infection, UTI - Urinary Tract Infection
Conditions
Keywords
Acute Medical Unit, Acute Medicine, Interface Care, Clinical effectiveness, Cost effectiveness, prospective observational, matched controlled
Brief summary
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.
Interventions
None listed
Sponsors
National University Hospital, Singapore
Duke-NUS Graduate Medical School
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
21 Years to No maximum
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mean acute care bed-days utilised | 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patient Outcomes - Health-related Quality of Life (EQ-5D-5L) | Baseline (Day 0, at discharge), 3 months post-discharge, and 6 months post-discharge | 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. |
| Patient Outcomes - Patient Activation Measure (PAM-13) | Baseline (Day 0, at discharge) and 6 months post-discharge | 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. |
| Patient Outcomes - World Health Organisation Five Wellbeing (WHO-5) | Baseline (Day 0, at discharge), 3 months post-discharge, and 6 months post-discharge | Patient answers five questions that assess mood, energy, and interest in daily life over the past two weeks, scored 0 (at no time) to 5 (all of the time). The total score (0-25) is multiplied by 4 to create a 0-100 scale, where higher scores indicate better wellbeing. |
| Patient Outcomes - Patient Health Questionnaire (PHQ-9) | Baseline (Day 0, at discharge) and 6 months post-discharge | PHQ-9 includes 9 items scored 0 (not at all) to 3 (nearly every day), total 0-27; higher scores indicate more severe depressive symptoms. |
| Patient Outcomes - Functional Dependence (Barthel Index) | Baseline (Day 0, at discharge) and 6 months post-discharge | Measures independence in 10 daily activities, scored 0 (fully dependent) to 100 (fully independent). Higher scores indicate greater ability to perform daily activities without assistance. |
| System Outcomes - Number of Emergency Department (ED) visits | Baseline (Day 0, at discharge) and 6 months post-discharge | Number of ED visits recorded in hospital records within 6 months. Higher counts reflect greater acute care needs. |
| System Outcomes - Specialist Outpatient Clinic visit | Baseline (Day 0, at discharge) and 6 months post-discharge | Number of outpatient specialist visits, as recorded in hospital system. |
| System Outcomes - Polyclinic Visits | Baseline (Day 0, at discharge) and 6 months post-discharge | Number of visits to public polyclinics captured through health records |
| System Outcomes - Hospital Admissions | 6 months post-discharge | Number of inpatient hospital admissions during follow-up, excluding the index admission. |
Countries
Singapore
Contacts
CONTACTJohn TY Soong, PhD
Outcome results
None listed