title: Effectiveness of a transitional home care program in reducing acute hospital utilization: a quasi-experimental study.
abstract: BACKGROUND
  Improving healthcare utilization is essential as health systems around the world grapple with the escalating demands for acute hospital resources. Evidence suggests that transitional care programs are effective to improve utilization of healthcare. However, the evidence for transitional care programs that enhance the home medical care model and provide multi-disciplinary patient-centered care is not well established. We evaluated if a transitional home care program operated by the Singapore General Hospital was effective in reducing acute hospital utilization.
  
  
  METHODS
  We performed a quasi-experimental study using a pre-post design to evaluate the effectiveness of a transitional home care program in reducing hospital admissions and emergency department attendances of medically complex patients enrolled into the program in a tertiary hospital in Singapore. Patients received a comprehensive needs assessment performed by the physician and a nurse case manager in the home setting, followed by an individualized care plan that included medical and nursing care, patient education and coordination of care with hospital specialists and community services. Primary study outcomes were emergency department attendances and hospital admissions to all hospitals. These were extracted from hospital administrative data and national health records. Wilcoxon Signed Ranks Test was used for assess differences in pre and post continuous data.
  
  
  RESULTS
  Overall, 262 patients were enrolled into the program and 259 were analyzed. Patients had a 51.6% and 52.8% reduction in hospital admissions in the three-month and six-month post enrollment, respectively. Similarly, a 47.1% and 48.2% reduction was observed for emergency department attendances in the three and six months post enrollment, respectively. The average difference in per patient hospital bed days in the pre- and post-enrollment periods were 12.05 days and 20.03 days at the 3-month and 6-month periods, respectively.
  
  
  CONCLUSIONS
  Patients enrolled in the transitional home care program had significantly lower acute hospital utilization through the reduction of emergency department attendances and hospital admissions. A comprehensive assessment of patients' medical and social needs in the home setting and formulation of an individualized care plan optimized post-discharge care for medically complex patients.
authors.affiliation: Department of Family Medicine and Continuing Care, Academia, Level 4 Singapore General Hospital, Singapore, 169856, Singapore. low.lian.leng@sgh.com.sg.|Duke-NUS Graduate Medical School, Singapore, Singapore. low.lian.leng@sgh.com.sg.
authors.forename: Lian Leng
authors.initials: LL
authors.lastname: Low
authors.affiliation: Department of Family Medicine and Continuing Care, Academia, Level 4 Singapore General Hospital, Singapore, 169856, Singapore. farhad.fakhrudin.vasanwala@sgh.com.sg.|Duke-NUS Graduate Medical School, Singapore, Singapore. farhad.fakhrudin.vasanwala@sgh.com.sg.
authors.forename: Farhad Fakhrudin
authors.initials: FF
authors.lastname: Vasanwala
authors.affiliation: Department of Family Medicine and Continuing Care, Academia, Level 4 Singapore General Hospital, Singapore, 169856, Singapore. ng.lee.beng@sgh.com.sg.|Duke-NUS Graduate Medical School, Singapore, Singapore. ng.lee.beng@sgh.com.sg.
authors.forename: Lee Beng
authors.initials: LB
authors.lastname: Ng
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore. a0024354@nus.edu.sg.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Family Medicine and Continuing Care, Academia, Level 4 Singapore General Hospital, Singapore, 169856, Singapore. lee.kheng.hock@sgh.com.sg.|Duke-NUS Graduate Medical School, Singapore, Singapore. lee.kheng.hock@sgh.com.sg.
authors.forename: Kheng Hock
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Department of Family Medicine and Continuing Care, Academia, Level 4 Singapore General Hospital, Singapore, 169856, Singapore. tan.shu.yun@sgh.com.sg.|Duke-NUS Graduate Medical School, Singapore, Singapore. tan.shu.yun@sgh.com.sg.
authors.forename: Shu Yun
authors.initials: SY
authors.lastname: Tan
mesh_terms: D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006295:Health Resources; D006699:Home Care Services; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D018802:Patient-Centered Care; D012846:Singapore; D062606:Tertiary Care Centers; D000069341:Transitional Care / Q000592:standards*