Implementation fidelity of a strategy to integrate service delivery: learnings from a transitional care program for individuals with complex needs in Singapore

 

Abstract Background: To cope with rising demand for healthcare services in Singapore, Regional Health Systems (RHS) comprising of health and social care providers across care settings were set up to integrate service delivery. Tasked with providing care for the western region, in 2012, the National University Health System (NUHS) – RHS developed a transitional care program for elderly patients with complex healthcare needs who consumed high levels of hospital resources. Through needs assessment, development of personalized care plans and care coordination, the program aimed to: (i) improve quality of care, (ii) reduce hospital utilization, and (iii) reduce healthcare-related costs. In this study, recognizing the need for process evaluation in conjunction with outcome evaluation, we aim to evaluate the implementation fidelity of the NUHS-RHS transitional care program to explain the outcomes of the program and to inform further development of (similar) programs.

 

Methods: Guided by the modified version of the Conceptual Framework for Implementation Fidelity (CFIF), adherence and moderating factors influencing implementation were assessed using non-participatory observations, reviews of medical records and program databases.

Results: Most (10 out of 14) components of the program were found to be implemented with low or moderate level of fidelity. The frequency or duration of the program components were observed to vary based on the needs of users, availability of care coordinators (CC) and their confidence. Variation in fidelity was influenced predominantly by: (1) complexity of the program, (2) extent of facilitation through guiding protocols, (3) facilitation of program implementation through CCs’ level of training and confidence, (4) evolving healthcare participant responsiveness, and (5) the context of suboptimal capability among community providers.

 

Conclusion: This is the first study to assess the context-specific implementation process of a transitional care program in the context of Southeast Asia. It provides important insights to facilitate further development and scaling up of transitional care programs within the NUHS-RHS and beyond. Our findings highlight the need for greater focus on engaging both healthcare providers and users, training CCs to equip them with the relevant skills required for their jobs, and building the capability of the community providers to implement such programs.

 

Keywords: Integrated care, Post-discharge care, Transitional care, Implementation fidelity, Mixed methods

 
Access the whole report at BMC Health Services Research (Implementation fidelity of a strategy to integrate service delivery: learnings from a transitional care program for individuals with complex needs in Singapore)
Source: IHF Newsletter, BMC Health Services Research,

 

Copyright: International Hospital Federation Newsletter, WHO TDR

Social innovation in health: leaving no one behind

On 12 February, in Geneva, Switzerland, IHF secreteriat staff attended a seminar co-organized by the WHO, UNAIDS and TDR. Healthcare delivery issues are far from being solved. With over 1 billion people still lacking proper access to healthcare, research and partnerships must be enhanced to move all countries closer to UHC through innovative approaches. The Social Innovation in Health Initiative highlights the beneficial impacts of relational cultures and community inclusion on people’s lives and health outcomes. They demonstrate that innovation is sometimes “just” about going back to social basics and embracing them.

Read more: Social innovation in health: leaving no one behind

Copyright: World Health Organization

"Countries are spending more on health, but people are still paying too much out of their own pockets", according to the latest news release from the World health Organization.

Overview

The 2018 global health financing report presents health spending data for all WHO Member States between 2000 and 2016 based on the SHA 2011 methodology. It shows a transformation trajectory for the global spending on health, with increasing domestic public funding and declining external financing. This report also presents, for the first time, spending on primary health care and specific diseases and looks closely at the relationship between spending and service coverage.
The report’s key messages include:
  • Global trends in health spending confirm the transformation of the world’s funding of health services.

  • Domestic spending on health is central to universal health coverage, but there is no clear trend of increased government priority for health.

  • Primary health care is a priority for expenditure tracking.

  • Allocations across disease and interventions differ between external and government sources and

  • Performance of government spending on health can improve.

Access the whole report here.

Source: IHF Newsletter

International Hospital Federation Official Journal 2018 Volume 54 Number 4 

This fourth issue of the World Hospitals and Health Services Journal, second part describes the repercussion of environmental pollution on health expenditures and raises the awareness of policy makers, health care providers and others of the analysis and recommendations for a strong action plan by the recent Lancet Commission on Pollution and Health. 

In the first part, (International Hospital Federation Official Journal 2018 Volume 54 Number 3) it was discussed about the focuses on how global identifiers (barcoding) can support the monitoring of safe healthcare and improve efficiency while reducing waste.

Copyrights: International Hospital Federation

 

Introduction
The IHF World Hospital Congress is a unique global forum where multidisciplinary exchange of knowledge, expertise and experiences in health sector management and service delivery is facilitated. This forum brings together leaders, gurus, delegates and participants conversant in healthcare policies and reforms, management practices, financing trends and solutions, quality and safety, to engage in constructive dialogue on best practices and innovations in hospital and healthcare management and leadership aimed at improving the overall health and wellness of our patients and communities. 

Hosted by the Ministry of Health of the Sultanate of Oman, the 43rd World Hospital Congress will be held on 6 - 9 November 2019 in Muscat, Oman with the theme: People at the heart of health services in peace and crisis.

Submission of Abstracts
Health sector leaders and professionals wishing to present their work, orally or as a poster, at the 43rd World Hospital Congress are invited to submit an abstract to the Scientific Committee for consideration through the IHF website

Copyright: International Hospital Federation

 

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