ABSTRACT: The aim of this study was to assess a newly introduced hospitalist care model in a Singapore hospital. Clinical outcomes of the family medicine hospitalists program were compared with the traditional specialists-based model using the hospital's administrative database.
Retrospective cohort study of hospital discharge database for patients cared for by family medicine hospitalists and specialists in 2008. Multivariate analysis models were used to compare the clinical outcomes and resource utilization between patients cared for by family medicine hospitalists and specialist with adjustment for demographics, and comorbidities.
Of 3493 hospitalized patients in 2008 who met the criteria of the study, 601 patients were under the care of family medicine hospitalists. As compared with patients cared for by specialists, patients cared for by family medicine hospitalists had a shorter hospital length of stay (adjusted LOS, geometric mean, GM, 4.4 vs. 5.3 days; P < 0.001) and lower hospitalization costs (adjusted cost, GM, $2250.7 vs. $2500.0; P= 0.003), but a similar in-patient mortality rate (4.2% vs. 5.3%, P= 0.307) and 30-day all-cause unscheduled readmission rate (7.5% vs. 8.4%, P= 0.231) after adjustment for age, ethnicity, gender, intensive care unit (ICU) admission, numbers of organ failures, and comorbidities.
The family medicine hospitalist model was associated with reductions in hospital LOS and cost of care without adversely affecting mortality or 30-day all-cause readmission rate. These findings suggest that the hospitalist care model can be adapted for health systems outside North America and may produce similar beneficial effects in care efficiency and cost savings.
Journal of Hospital Medicine 03/2011; 6(3):115-21. · 1.40 Impact Factor
ABSTRACT: Patient-centredness is an accepted guiding principle for health system reform, patient care and medical education. Although these attitudes are strongly linked with cultural values, few studies have examined attitudes towards patient-centredness in a cross-cultural setting.
This prospective study evaluated attitudes towards patient-centredness in a cohort of Asian medical students and examined changes in these attitudes in the same students on completion of their junior clinical clerkships.
The study was conducted in a cohort of 228 medical students entering Year 3 in medical school. The Patient-Practitioner Orientation Scale (PPOS), a validated instrument which scores an individual's level of patient-centredness, was used.
Being female and having personal experience of continuing care were significantly associated with higher scores. Students in the USA were previously reported to have similar 'caring' but higher 'sharing' scores on the same scale. At the end of the junior clinical clerkship, there were improvements in the 'caring' subscale, but no change or a reduction in 'sharing'. Students who did not have previous personal experience with continuing care experienced a greater increase in overall PPOS score.
When compared with students in the USA, the students in our study appear to have a lower propensity to view the doctor-patient relationship as a partnership. This may be a reflection of differences in cultural norms and expectations of doctor-patient interaction in different societies. Our finding that attitudes towards patient-centredness did not decline over the course of the year, which contrasts with findings of other studies, may be attributed to various factors and warrants further study.
Medical Education 10/2008; 42(11):1092-9. · 3.18 Impact Factor
ABSTRACT: The increasing complexity of healthcare is accelerating the rate of specialisation in medicine, which in turn aggravates the fragmentation of care in hospitals. The hospitalist movement advocates for the return of generalist physicians to the hospital to provide general and more holistic medical care to inpatients. This can be seen as an adaptive response to care fragmentation. Starting in the mid-1990s in North America, where the impact of healthcare complexity and fragmentation has been most widely felt, the hospital movement has gained strength and spread across the continent rapidly. This paper examines the phenomenon of the hospitalist movement in the United States, Canada and Singapore. The conclusion is that variants of the hospital movement may emerge in different parts of the world as healthcare systems adapt to common global trends that drive the increasing complexity of healthcare.
Annals of the Academy of Medicine, Singapore 03/2008; 37(2):145-50. · 1.25 Impact Factor