Integrated General Hospital – A patient-centric approach to managingmultimorbidity

By Alexandra Hospital & NUHS


To tackle the healthcare demands of an increasingly multimorbid population, AH implemented a value-based care model, the IGH. Within the IGH, every admitted patient is assigned, in accordance with their clinical risk profile, to one of three acuity tiers which correspond to the acute, subacute and rehabilitation phases of care.  Resources are utilized in accordance with the patients’ care needs, as reflected by shifts in acuity tiers. Patients transit through these phases of care all within one hospital.  As opposed to a specialty-based ward allocation, patients are managed in a patient-centric environment within the IGH, with care driven by one care team.  Upon discharge, outpatient clinic reviews are rationalised and consolidated to one principal doctor.  AH remains one with the community as patients are provided with the means to connect back with the hospital through a Virtual Care Centre (VCC).

The IGH Value Driven Outcomes (VDO) comprises of seven indicators, each reflecting an anchoring theme within the care delivery process:

1) Acute hospital length-of-stay (LOS) ≤4 days

2) Community hospital length-of-stay (LOS) ≤ 7 days

3) Care consolidation

  • Proportion of patients who see an average of 1 physician up to a year post-discharge

4) No U-Turn (Up-triage of acuity tier to the acute or subacute phases of care)

5) Early rehabilitation within 2 days of admission

6) No re-admission within 30 days of discharge

7) Patient Experience Score (PES) ≥8 (maximum of 10 points)

  • Level of satisfaction in relation to hospital’s services

Administrative data from 6,141 admissions (2019-2022) was analysed and benchmarked against national level targets to develop the IGH VDO. The Clinical Quality Index (CQI) is a measure of the indicators in a single aggregate. An “all-or-none” methodology was used to compute the CQI, which refers to the proportion of admissions that fulfils all 7 quality indicators.

AH demonstrated an improvement in the CQI by 6% from 2019 to 2022.  In 2019, the compliance rates for the acute hospital LOS ≤4 and the community hospital LOS ≤ 7 were 48% and 78% respectively.  In 2020, owing to the mandatory need for all admitted patients with COVID19 infection to have two negative swabs prior to discharge, LOS was prolonged with a slight reduction in the compliance rate to 36%.  Following the COVID19 pandemic, compliance rates rebounded to 41% and 43% in 2021 and 2022 respectively. There was no U-turn observed in 79% of admissions, while early rehabilitation occurred in 83% of the admissions.  The compliance rates for care consolidation rose steadily from 89% in 2019 to 92% in 2022. The proportion of discharges without readmissions within 30 days was an average of 82%.  An average of 99% of patients scored at least 8 out of a maximum of 10 points on the PES.

Reflecting the journey of care from admission to discharge, the IGH VDO is novel, inaugurating a move away from the conventional disease-based indicators. The IGH VDO further serves as a guiding framework of self-evaluation for refinement of the IGH care model.