A Patient-Centred Medical Home Care Model for Community-Dwelling Older Adults in Singapore: A Mixed-Method Study on Patient’s Care Experience

Abstract
Patient-Centred Medical Home (PCMH) is a strategy to enhance patient-centredness to improve care experience. We aimed to understand patient experience of an integrated PCMH model for complex community-dwelling older adults in Singapore. We used a mixed-method design with a prospective single-group pre-post quantitative component and a concurrent qualitative component. Participants were administered the validated Consumer Assessment of Health Providers and Systems Clinician & Group Survey (CG-CAHPS) at baseline (N = 184) and 6-month (N = 166) post-enrolment. We conducted focus group discussions (FGDs) on a purposive sample of 24 participants. Both methods suggest better care experience in PCMH relative to usual care. There were improvements in the CG-CAHPS measures on patient-provider communication, care coordination, office staff interactions, support for patients in caring for their own health, and provider rating in PCMH relative to usual care. In the FGDs, participants reported benefits of consolidated appointments and positive experience in sustained patient-provider relationship, shared-decision making, and family/caregiver engagement in PCMH. Participants may not fully comprehend the concept of integrated care, hindering both the effective communication of the intended care model and perceived benefits such as the provision of multidisciplinary team-based care.

Keywords: care quality; integrated care; mixed-method; patient experience; patient-centred care; patient-centred medical home.

Conflict of interest statement
C.H.W. is employed by Tsao Foundation, the entity leading the PCMH implementation evaluated in this study by the time following manuscript writing, but not affiliated to it at the time of study conception, data collection, data analysis, and manuscript writing. H.J.M.V. has received previous funding from Tsao Foundation as the advisor for this study and currently receiving funding for other studies. This entity has no part in data collection, analysis, or manuscript writing. The remaining authors declare that they have no competing interests. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Read the article on Pubmed here: https://pubmed.ncbi.nlm.nih.gov/35457642/