ArticleInternational journal of integrated care2017
Transitional Home Care Program Utilizing the Integrated Practice Unit Concept (THC-IPU): Effectiveness in Improving Acute Hospital Utilization.
Article in International journal of integrated care, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Dimensions and components of hospital-at-home care: a systematic review.BMC health services research · 2024Pooled it
- Effects of Virtually Led Value-Based Preoperative Assessment on Safety, Efficiency, and Patient and Professional Satisfaction.Journal of clinical medicine · 2025Article
- Five years' experience with value-based quality improvement teams: the key factors to a successful implementation in hospital care.BMC health services research · 2022Article
- The heterogeneous health state profiles of high-risk healthcare utilizers and their longitudinal hospital readmission and mortality patterns.BMC health services research · 2019Article
- Retrospective evaluation of healthcare utilisation and mortality of two post-discharge care programmes in Singapore.BMJ open · 2019Article
- Implementation fidelity of a strategy to integrate service delivery: learnings from a transitional care program for individuals with complex needs in Singapore.BMC health services research · 2019Article
- Integrated Care for Multimorbidity Population in Asian Countries: A Scoping Review.International journal of integrated careArticle
- Examining the Influence of Integrated Home and Community Care Programs on Quadruple Aim and Health Equity Outcomes Across the Health Care System: A Scoping Review.International journal of integrated careArticle
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOrganizing care into integrated practice units (IPUs) around conditions and patient segments has been proposed to increase value. We organized transitional care into an IPU (THC-IPU) for a patient segment of functionally dependent patients with limited community ambulation.
methods1,166 eligible patients were approached for enrolment into THC-IPU. THC-IPU patients received a comprehensive assessment within two weeks of discharge; medication reconciliation; education using standardized action plans and a dedicated nurse case manager for up to 90 days after discharge. Patients who rejected enrolment into THC-IPU received usual post-discharge care planned by their attending hospital physician, and formed the control group. The primary outcome was the proportion of patients with at least one unscheduled readmission within 30 days after discharge.
resultsWe found a statistically significant reduction in 30-day readmissions and emergency department visits in patients on THC-IPU care compared to usual care, even after adjusting for confounders.
conclusionDelivering transitional care to patients with functional dependence in the form of home visits and organized into an IPU reduced acute hospital utilization in this patient segment. Extending the program into the pre-hospital discharge phase to include discharge planning can have incremental effectiveness in reducing avoidable hospital readmissions.
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