Programme evaluation is defined as the systematic collection of information about the activities, characteristics, and outcomes of programmes, services, policies or processes, in order to make judgements about the programme, improve effectiveness, and/or inform decisions about future development. In general, programme evaluation comprises four different stages:
The HSR team is closely involved in the programme evaluations of key proof-of-concept projects that are being piloted at CGH. The findings have enabled project stakeholders to understand the clinical impact of these programmes on patient care, as well as to continually improve on the programmes to achieve better outcomes.
Programme evaluations that the team has done include:
Eastern Community Health Outreach (ECHO) Programme
With the pressures of modern day living, it can be hard to lead a healthy lifestyle. Poor diet, lack of exercise and other unhealthy lifestyle habits have led to skyrocketing rates of obesity, diabetes, high blood pressure, high cholesterol, and heart disease in Singapore.
The ECHO programme is a community-based, family-focused, annual health screening programme offered in partnership with selected grassroots organisations to help the community make more informed and better lifestyle choices. The programme includes healthy lifestyle activities and health screenings that aim to reduce the community's risk of diabetes, high blood pressure, and cholesterol. Registered ECHO participants will be invited to participate in annual health screening, physical activity and nutrition workshops, as well as other healthy lifestyle activities organised within the neighbourhood.
Thorough analysis of the programme will shed light on incidence rates of high blood pressure, high cholesterol and diabetes in the at-risk population in Singapore.
Integrated Building (IB) Evaluation
The home-like and age-friendly design of the new IB ward seeks to provide a specially designed environment for optimal functional rehabilitation of patients, so that they are better prepared for their transition back home. The ward's design is hypothesised to improve outcomes of patients who are admitted to geriatric and rehabilitation wards.
This study examines the effectiveness of such a prepared environment in improving outcomes, mobility and social interaction of patients in the geriatric and rehabilitation wards of CGH. It will employ various evaluation methods to compare the current and new IB ward population and environment. Observation studies, case notes review, environmental audit, routine data and staff and patient satisfaction surveys will be used to support the evaluation. As the IB concept is novel to Singapore, it is imperative to ensure that the ward operates optimally, using evidence-based measures.
Health Management Unit (HMU) - Chronic Obstructive Pulmonary Disease (COPD)
The burden of COPD is increasing worldwide, including in Singapore. Studies have shown that good care for COPD patients can lower mortality and reduce length of hospital stay after admission for an exacerbation.
This study evaluated the clinical and cost effectiveness of a tele-health service for COPD patients of CGH's respiratory medicine department. A retrospective cohort study of COPD patients discharged from the department from March 2012 to June 2013 was analysed. Patients who were enrolled in the tele-health service served as the intervention group (tele-health plus standard care) while those who declined the service were used as the control group (standard care).
The primary objectives of the study were to examine the mortality and healthcare utilisation patterns (hospital readmission, A&E visits, SOC visits and polyclinic visits) between the two groups. The secondary aims were to assess the progression of COPD using the Chronic Obstructive Pulmonary Disease Assessment Test and Modified British Medical Research Council Questionnaire on Breathlessness.
HMU - Diabetes Mellitus
Well-managed diabetes can prevent the onset of diabetes-related complications and reduce potential catastrophic events that may lead to hospital stays. HMU provides educational and tele-monitoring services to diabetic patients who were referred by a healthcare provider in the east to help them better manage their conditions.
An observational study of the first 15 months of the programme (June 2010 to September 2011) was performed to evaluate the clinical and cost-effectiveness of the intervention. Analysis was performed by comparing outcomes of patients with HbA1c > 8% who had completed HMU diabetes education modules versus those who received usual care. Outcomes for evaluation included HbA1c levels, diabetes-related readmission rates, blood pressure, lipid profile, weight, and all-cause admission rates at 6 months prior to programme enrolment and 6 months after intervention completion. Mixed effect models were applied for each of the outcomes of interest to examine the additional benefit of the programme on the intervention group versus the control group. Length of hospital stay estimation for diabetes-related admission was estimated from CGH discharge data, whilst hospitalisation cost estimates were derived from the Ministry of Health's website.
Transitional Care (TC) Programme
Piloted in 2010 and launched in 2012, the programme provides community care for elderly patients to bridge the gap between hospital and home for patients with complex or multiple care needs. TC services involve home visits from a team of doctors, nurses and therapists, to help patients manage the transition smoothly. HSR supports the study to evaluate the effectiveness of the programme in terms of reducing unnecessary readmissions and use of hospital resources. Further analysis will also be performed to determine if the programme's resources are appropriately utilised by patients who will benefit from it the most.
Interim Caregiver Service
This bridging service enables timely discharge of medically fit patients back to the community, who would otherwise be waiting for home care or community care arrangements to be finalised in the acute care setting, beyond what is medically warranted. It entails deployments of part-time caregivers who can provide basic home care services to post-discharge patients for six days per week, for up to four weeks. HSR supports the study to evaluate the effectiveness of the service in reducing the length of stay in the acute hospital as well as the level of customer satisfaction among family members.
GP Chronic Care (GPCC) Programme
Right-siting patients from specialist outpatient clinics (SOCs) to polyclinics and general practitioner (GP) clinics mitigates rising healthcare costs and frees specialists to provide care for complex patients. This study examines clinical outcomes of patients right-sited from SOCs to polyclinics and GP clinics.
The study was a retrospective review of electronic medical records extracted from the hospital's system. SOC patients with diabetes, ischaemic heart disease, heart failure and asthma who were deemed suitable to be managed by primary care physicians were right-sited from endocrinology, cardiovascular medicine and respiratory medicine between 2008 and 2011. Patient outcomes prior to right-siting were compared against outcomes one year after right-siting. Patients' compliance in terms of frequency of follow-up visits and tests done were also examined.
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