Implementing an Individual-Centric Discharge Process across Singapore Public Hospitals
Singapore is one of the first known countries to implement an individual-centric discharge process across all public hospitals to manage frequent admissions—a perennial challenge for public healthcare, especially in an aging population. Specifically, the process provides daily lists of high-risk pat...
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doaj-a2d76bc43a1c44379598c58712c002782021-08-26T13:50:00ZengMDPI AGInternational Journal of Environmental Research and Public Health1661-78271660-46012021-08-01188700870010.3390/ijerph18168700Implementing an Individual-Centric Discharge Process across Singapore Public HospitalsReuben Ng0Kelvin Bryan Tan1Lee Kuan Yew School of Public Policy, National University of Singapore, 469C Bukit Timah Rd, Singapore 259772, SingaporeMinistry of Health, 16 College Road, Singapore 169854, SingaporeSingapore is one of the first known countries to implement an individual-centric discharge process across all public hospitals to manage frequent admissions—a perennial challenge for public healthcare, especially in an aging population. Specifically, the process provides daily lists of high-risk patients to all public hospitals for customized discharge procedures within 24 h of admission. We analyzed all public hospital admissions (<i>N</i> = 150,322) in a year. Among four models, the gradient boosting machine performed the best (AUC = 0.79) with a positive predictive value set at 70%. Interestingly, the cumulative length of stay (LOS) in the past 12 months was a stronger predictor than the number of previous admissions, as it is a better proxy for acute care utilization. Another important predictor was the “number of days from previous non-elective admission”, which is different from previous studies that included both elective and non-elective admissions. Of note, the model did not include LOS of the index admission—a key predictor in other models—since our predictive model identified frequent admitters for pre-discharge interventions during the index (current) admission. The scientific ingredients that built the model did not guarantee its successful implementation—an “art” that requires the alignment of processes, culture, human capital, and senior management sponsorship. Change management is paramount, otherwise data-driven health policies, no matter how well-intended, may not be accepted or implemented. Overall, our study demonstrated the viability of using artificial intelligence (AI) to build a near real-time nationwide prediction tool for individual-centric discharge, and the critical factors for successful implementation.https://www.mdpi.com/1660-4601/18/16/8700predictive analyticspublic healthcarepolicy implementationacute carechange managementAsia |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Reuben Ng Kelvin Bryan Tan |
spellingShingle |
Reuben Ng Kelvin Bryan Tan Implementing an Individual-Centric Discharge Process across Singapore Public Hospitals International Journal of Environmental Research and Public Health predictive analytics public healthcare policy implementation acute care change management Asia |
author_facet |
Reuben Ng Kelvin Bryan Tan |
author_sort |
Reuben Ng |
title |
Implementing an Individual-Centric Discharge Process across Singapore Public Hospitals |
title_short |
Implementing an Individual-Centric Discharge Process across Singapore Public Hospitals |
title_full |
Implementing an Individual-Centric Discharge Process across Singapore Public Hospitals |
title_fullStr |
Implementing an Individual-Centric Discharge Process across Singapore Public Hospitals |
title_full_unstemmed |
Implementing an Individual-Centric Discharge Process across Singapore Public Hospitals |
title_sort |
implementing an individual-centric discharge process across singapore public hospitals |
publisher |
MDPI AG |
series |
International Journal of Environmental Research and Public Health |
issn |
1661-7827 1660-4601 |
publishDate |
2021-08-01 |
description |
Singapore is one of the first known countries to implement an individual-centric discharge process across all public hospitals to manage frequent admissions—a perennial challenge for public healthcare, especially in an aging population. Specifically, the process provides daily lists of high-risk patients to all public hospitals for customized discharge procedures within 24 h of admission. We analyzed all public hospital admissions (<i>N</i> = 150,322) in a year. Among four models, the gradient boosting machine performed the best (AUC = 0.79) with a positive predictive value set at 70%. Interestingly, the cumulative length of stay (LOS) in the past 12 months was a stronger predictor than the number of previous admissions, as it is a better proxy for acute care utilization. Another important predictor was the “number of days from previous non-elective admission”, which is different from previous studies that included both elective and non-elective admissions. Of note, the model did not include LOS of the index admission—a key predictor in other models—since our predictive model identified frequent admitters for pre-discharge interventions during the index (current) admission. The scientific ingredients that built the model did not guarantee its successful implementation—an “art” that requires the alignment of processes, culture, human capital, and senior management sponsorship. Change management is paramount, otherwise data-driven health policies, no matter how well-intended, may not be accepted or implemented. Overall, our study demonstrated the viability of using artificial intelligence (AI) to build a near real-time nationwide prediction tool for individual-centric discharge, and the critical factors for successful implementation. |
topic |
predictive analytics public healthcare policy implementation acute care change management Asia |
url |
https://www.mdpi.com/1660-4601/18/16/8700 |
work_keys_str_mv |
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