The Office of Healthcare Transformation under Singapore's Ministry of Health has tied up with the nation's three public healthcare clusters to scale their pilot home hospitalisation programmes. 

These programmes – National University Health System’s NUHS@Home, Singapore General Hospital’s SGH@Home and Yishun Health Medical Home – are now providing eligible patients with general medical conditions, such as skin infections, urinary tract infections, and COVID-19, with an option to be admitted to a virtual ward. 

Backed by the MOH, the pilot programmes are being implemented as part of a regulatory and financing sandbox, which provides patients subsidies similar to healthcare financing coverage for standard hospital admission.

Soft launched in April, the sandbox pilots will conclude by March 2024. 

WHAT IT'S ABOUT

The Mobile Inpatient Care@Home (MIC@Home) programme is being offered to patients as an alternative to hospitalisation.

A nurse meets a patient at their home and sets up medication and equipment for treatment and devices for teleconsultation and remote monitoring. Each day, a care team remotely monitors them either by teleconsultation or home visits. They are also available round the clock via teleconsultation for urgent medical issues. 

Nurses can also visit patients up to several times a day to administer drip-based medication or draw blood for testing. Physiotherapists too can visit them at home if needed. 

Should a patient's condition deteriorates, care escalation protocols, including transfer back to the hospital, could be initiated. 

During the care process, patients will also be evaluated for their understanding of their own condition, medication, and home environment. A follow-up for post-discharge care will be prepared for them by a care team. They will only be discharged once their condition improved and they no longer require daily treatment.

For this new pilot, MIC@Home will use a range of health technology solutions, including smart medical devices and apps for vital signs monitoring and teleconsultations. "The solutions will include smart dashboards with decision support to the care providers, and provide alerts on anomalous health indicators," said Alan Goh, assistant chief executive for platform services at the Integrated Health Information Systems. 

WHY IT MATTERS

Based on a press statement, the MIC@Home Sandbox aims to "provide care of comparable and increased resource efficiency relative to usual inpatient care without compromising safety." It also intends to identify suitable medical conditions that could be included under the programme, and develop relevant regulatory requirements for the services. 

Current results showed that the programme delivers better patient-centred care; comparable clinical outcomes to inpatient hospitalisation; and flexible hospital bed capacity. 

In SGH's pilot, they were able to identify eligible patients from their ED and inpatient wards who can be safely cared for in a home setting. "Patient satisfaction is high as they can recover in a familiar home environment while the SGH team remains accessible to them," claimed Dr Low Lian Leng, director of SGH's Population Health and Integrated Care Office.

"MIC@Home has helped to save bed stays for the hospital and allowed the hospital to care for sicker patients," he added.

Additionally, through the sandbox, participating hospitals will be able to trial and implement new care models and integrate it with their existing processes. 

THE LARGER CONTEXT

The Office of Healthcare Transformation decided to support the three home hospitalisation programmes after feasibility studies done by NUHS and Yishun Health Medical Home found the MIC@Home "effective and safe" for selected patients, particularly those with low to moderate clinical acuity. Conducted between 2019 and 2021, the studies also noted that the programme received high patient receptivity among patients and caregivers at Alexandra Hospital and National University Hospital.

Meanwhile, during the Delta and Omicron surges last year, NUH, SGH, and the Khoo Teck Puat Hospital in Yishun were able to quickly set up their respective virtual wards to treat patients with COVID-19 at home. They were already testing the MIC@Home concept before this, and so, during the recent waves of infections, they were able to collectively save over 5,000 bed days.