title: Singapore's regional health systems-a data-driven perspective on frequent admitters and cross utilization of healthcare services in three systems.
abstract: BACKGROUND
  With population health management being a priority in the Singapore, this paper aims to provide a data-driven perspective of the population health management initiatives to aid program planning and serves as a baseline for evaluation of future implemented programs.
  
  
  METHODS
  A database with information on patient demographics, health services utilization, cost, diagnoses and chronic disease information from 2008 to 2013 for three regional health systems in Singapore was used for analysis. Patients with three or more inpatient admissions were considered as "Frequent Admitters." Health service utilization was quantified, and cross utilization of services was studied. One-year readmission rate for inpatients was studied, and a predictive model for readmission or death was developed.
  
  
  RESULTS
  There were a total of 2.8 M patients in the database. Frequent admitters accounted for 0.9% of all patients with an average cost per patient of S$29 547. Of these, 89% had chronic diseases. Cross utilization of health services showed that 8.2% of the patients utilized services from more than one hospital with 19.6% utilizing hospital and polyclinic services in 2013. The highest risk of readmission or death was for those patients who had five or more inpatient episodes in each of the preceding 2 years.
  
  
  CONCLUSIONS
  By understanding the profile of the patients and their utilization patterns in the three regional health systems, our study will help clinicians and decision makers design appropriate integrated care programs for patients with the aim of covering the healthcare needs for the enitre population across the healthcare spectrum in Singapore. Copyright © 2015 John Wiley & Sons, Ltd.
authors.affiliation: Health Services and Outcomes Research, National Healthcare Group, Singapore.|National Healthcare Group, Singapore.
authors.forename: Nakul
authors.initials: N
authors.lastname: Saxena
authors.affiliation: Health Services and Outcomes Research, National Healthcare Group, Singapore.|National Healthcare Group, Singapore.
authors.forename: Alex Xiaobin
authors.initials: AX
authors.lastname: You
authors.affiliation: Health Services and Outcomes Research, National Healthcare Group, Singapore.|National Healthcare Group, Singapore.
authors.forename: Zhecheng
authors.initials: Z
authors.lastname: Zhu
authors.affiliation: Health Services and Outcomes Research, National Healthcare Group, Singapore.|National Healthcare Group, Singapore.
authors.forename: Yan
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Health Services and Outcomes Research, National Healthcare Group, Singapore.|National Healthcare Group, Singapore.
authors.forename: Pradeep Paul
authors.initials: PP
authors.lastname: George
authors.affiliation: Health Services and Outcomes Research, National Healthcare Group, Singapore.|National Healthcare Group, Singapore.
authors.forename: Kiok Liang
authors.initials: KL
authors.lastname: Teow
authors.affiliation: National Healthcare Group Polyclinics, Singapore.
authors.forename: Phui-Nah
authors.initials: PN
authors.lastname: Chong
authors.affiliation: National University Health System, Singapore.
authors.forename: Joe
authors.initials: J
authors.lastname: Sim
authors.affiliation: National University Health System, Singapore.
authors.forename: John Eu Li
authors.initials: JE
authors.lastname: Wong
authors.affiliation: National University Health System, Singapore.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Ong
authors.affiliation: Alexandra Hospital, Singapore.
authors.forename: Hee Jug
authors.initials: HJ
authors.lastname: Foo
authors.affiliation: Tan Tock Seng Hospital, Singapore.
authors.forename: Eugene Fidelis
authors.initials: EF
authors.lastname: Soh
authors.affiliation: National Healthcare Group, Singapore.
authors.forename: Linus
authors.initials: L
authors.lastname: Tham
authors.affiliation: Health Services and Outcomes Research, National Healthcare Group, Singapore.|National Healthcare Group, Singapore.
authors.forename: Bee Hoon
authors.initials: BH
authors.lastname: Heng
authors.affiliation: National Healthcare Group, Singapore.
authors.forename: Philip
authors.initials: P
authors.lastname: Choo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D012846:Singapore; D055815:Young Adult
keywords: Singapore; health services utilization; healthcare management; planning; population health management