Integrating acute and subacute care through dynamic adaption of care intensity: The Integrated General Hospital Pilot in Singapore

Abstract

Introduction: Conventional healthcare systems consist of facilities which provide different intensities of care. Typically, patients with acute conditions receive high intensity care in acute hospitals, then transferred to step-down facilities for subacute and rehabilitative care when their acuity levels drop. This means shifting patients from one facility to another to receive different types and intensity of care, resulting in care fragmentation, multiple handovers between care teams and system inefficiency. We piloted a new Integrated General Hospital (IGH) concept where intensity of care is dynamically varied to match the acuity of patients' conditions without moving them across different facilities. Methods: This study was aimed at evaluating the feasibility of a novel care model where a simple acuity-tier system is used to define acuity and match care intensity for each patient. Over a 3- month period, 1379 patients were assigned different acuity-tier levels (Level 1, 2 or 3) up