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.
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).
Below 21 years old
Patients undergoing active chemotherapy
Patients with active pregnancy
Patients admitted less than 24 hours
The study population will consist of adult patients admitted to the National University Hospital (NUH), Singapore, for acute medical conditions. Participants will be recruited either from the Acute Medical Unit (AMU) or directly to the General Ward (GW) following presentation to the Emergency Department. Patients represent a typical mix of acute medical admissions seen in a tertiary hospital setting, including infection-related illnesses, falls with disequilibrium, and acute exacerbations of chronic diseases such as Chronic Obstructive Pulmonary Disease (COPD).
Cohort
Prospective
Not listed
Mean acute care bed-days utilised
Average total days of acute hospital stay, including the index episode, for each patient. Measures efficiency of hospital care between AMU and GW groups.
Patient Outcomes - Health-related Quality of Life (EQ-5D-5L)
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)
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)
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)
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.
Cost-effectiveness
Estimate the change to 'total costs' and the change to 'health benefits' as measured by Quality Adjusted Life Years (QALYS) from a decision to adopt AMU as compared to the 'existing acute care chain' in Singapore
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National University Hospital, Singapore
Lead sponsor
Duke-NUS Graduate Medical School
Collaborator
