Saturday 19 November 2011

Eastern Health Alliance - All-rounded care under one grouping

Eastern Health Alliance set up to provide integrated patient care
By Melissa Pang, The Straits Times, 18 Nov 2011

Residents living in the eastern part of Singapore can now look forward to seamless care with the setting up of the Eastern Health Alliance (EHA).

The first-of-its-kind regional health system sees Changi General Hospital, St Andrew's Community Hospital, SingHealth Polyclinics and The Salvation Army Peacehaven Nursing Home, working together to provide integrated patient care.

Founding members of the alliance signed a joint Memorandum of Understanding on Friday morning at Changi General Hospital, with Health Minister Gan Kim Yong launching the alliance.

As part of this collaboration, a new programme known as the Grace Corner Transitional Convalescent Facility at Peachhaven will start next month, with the objective of helping patients with debilitating hip fractures recover in a home-like environment.

Chairman of the EHA, Mr Gerard Ee, said that as Singapore's population ages and chronic disease incidence rise, patient care has become more complex and requires a 'collective, integrated response'.

'The Eastern Health Alliance aims to reshape current models of healthcare to meet these challenges... Ultimately, we aim to deliver quality care that is seamless, and empowers patients and caregivers to manage their health well for as long as possible.'

New alliance boosts quality of health care in the east
Patients can expect streamlined care and less red tape
By Salma Khalik, The Straits Times, 18 Nov 2011

AN ACUTE hospital, a community hospital, a nursing home and a clutch of polyclinics in the east come together from today to form the Eastern Health Alliance.

Its mission: to ensure that people living there stay healthy and out of hospital, and to deliver a standard level of health care with less hassle for them.

Until now, the four institutions - Changi General Hospital, St Andrew's Community Hospital, The Salvation Army's Peacehaven Nursing Home and the SingHealth polyclinics - have worked together only incidentally, each doing things its own way.

With the alliance, they will move like an organic whole - the first time health-care delivery has been structured this way here. So, instead of each having its own way of treating, say, a hip fracture, they will all fall in to deliver coordinated care to the patient.

The set-up of the alliance will bring a more marked change to patients who qualify for government subsidies.

Under the current system, the patient with the hip fracture will need to prove his eligibility for a subsidy to the social worker at Changi General, and again if he moves to a nursing home for his convalescence and physiotherapy. At each stop, he will need to produce documentary support. With the alliance, this patient will do it just once to apply for subsidies across the institutions in the set-up.

Changi General's chief executive T. K. Udairam, who will helm the new alliance, also wants to 'align' the subsidies provided by the institutions, so it will make financial sense for a patient to move from acute hospital to community hospital or nursing home.

It is cheaper for the Government for a patient to be moved from Changi General into say, a nursing home, but the different subsidy structure offered in the home could make the move unattractive for the patient who fails to qualify for its subsidy.

The alliance will also bring changes to the 400-bed Peacehaven. It will set aside a ward with 32 beds from next month for Changi General patients who have undergone surgery following a major fracture.

These patients generally need a month or more before they are fit for rehabilitation. They could go home, but many do not have caregiver support there, and are unable to move about on their own.

But if they stayed on in hospital, they will take up valuable beds there.

The alliance will put them instead in the nearby Peacehaven, where they will continue to be seen by Changi General's doctors, who will drop by at least thrice a week.

Mr Udairam said the scheme will start with those with fractures; stroke patients are slated to follow, probably next year.

Under the alliance, St Andrew's Community Hospital will receive funds to reconfigure its wards. It now has 16 patients to a ward, sharing communal toilets. This becomes a problem when the gender of patients is imbalanced.

For instance, if 18 female and four male patients from Changi General need beds at St Andrew's, two women cannot be accommodated, because they would need to share a toilet with the men.

Changi General told the Ministry of Health that it would thus have to keep the two women as its inpatients, adding to its bed crunch.

The alliance will now give funding to St Andrew's for it to reorganise each of its 16-bed wards into eight-bed units, each with its own toilet, thus cutting down on unused beds.

Work on this begins early next year.

In addition to all this, staff from Peacehaven and St Andrew's will be entitled to refresher courses in care techniques run by Changi General.

And if a patient is released by Changi General to his general practitioner (GP), the hospital will contact the doctor to fill him in on the case.

SingHealth polyclinics will give GPs backup in caring for patients with chronic problems through their community health centres, which run, for example, eye and foot screening for diabetics.

GPs in the east have asked to be linked up to rehabilitation services too, so these will likely be added.

The alliance intends to be pro-active. Rather than wait for the sick to turn up, the hospitals will start community health screening drives next year to identify and treat those with chronic ailments.

Mr Udairam said the target is to screen more than 2,000 Tampines residents aged 35 and above who are not already being treated for chronic ailments.

A pilot that Changi General did with 500 older Simei residents found that half had at least one chronic problem like diabetes.

Left on their own, these will become major health problems, said Mr Udairam, who, as alliance head, feels he has gone from running Changi General to being 'responsible for looking after the people in the east'.

In his foreword in the book marking the alliance's birth, Health Minister Gan Kim Yong wrote: 'A hospital's responsibility towards its patients cannot end when the patients are discharged. We must step up efforts to keep Singaporeans healthy and ensure they are well taken care of within the community, away from hospitals as much as possible!'

All-rounded care under one grouping

Preventive care:

The Eastern Community Health Outreach (Echo) will run health screening, health coaching and healthy lifestyle activities.

Primary care:

Nurses from the Health Management Unit will call discharged patients to ensure that they are taking their medicine as directed and keeping to the recommended diet and lifestyle.

A second community health centre will be set up to support the care by general practitioners by providing eye and foot screening for diabetics, and diet and lifestyle coaching. Rehabilitation services may also be added, following requests by GPs in the east.

Rehabilitative care:

St Andrew's Community Hospital, linked to Changi General Hospital by a bridge, provides recovering patients with rehabilitation care. St Andrew's also provides home-care services such as changing of urinary catheters, removal of stitches following surgery and dressing of wounds.

The Salvation Army's Peacehaven Nursing Home is a place for recovering patients who are not yet fully fit to go home. It will teach patients and their caregivers to provide the needed care at home.

Palliative care:

There are plans for this, but details are unavailable.

Changi General Hospital programme seeks to reduce re-admissions of elderly patients
By Ng Jing Yng, TODAY, 18 Nov 2011

For Madam Ng Kwai Twei, 83, who has gall bladder infection and other medical conditions such as hypertension and diabetes, the attentive care she received in hospital did not stop after she was discharged in August.

A team comprising a doctor, a nurse and allied health workers regularly visited Mdm Ng. Apart from monitoring her condition, the team provided dietary advice to her caregivers to make sure her chronic ailments are kept under control even as she resumed her normal diet.

Since April, under a new programme by the Changi General Hospital (CGH) aimed at reducing hospital readmissions of elderly patients, they have continued to receive medical care and advice at home up to three months after they are discharged. Between April and September, 61 patients were enrolled on the programme. Of these, 13 were re-admitted. 

And under the Eastern Health Alliance - which will be officially launched today - this "Transitional Care" programme will be enhanced to allow patients to continue receiving palliative care from providers within the network.

The alliance comprises CGH, St Andrew's Community Hospital, The Salvation Army Peacehaven Nursing home and SingHealth Polyclinics.

Another initiative will see Peacehaven receiving CGH patients for up to 12 weeks to help them regain physical mobility before they return home.

Apart from providing support for general practitioners (GPs), the alliance will also allow CGH to extend its programmes such as community health screenings and chronic disease management to more residents in the east.

CGH chief executive T K Udairam will head the alliance. Speaking to Today, Mr Udairam outlined three focuses: Placing patients with the right community partners after their discharge, health prevention measures to keep people out of the hospital and palliative care service, which CGH will be starting by next year.

Said Mr Udairam: "There is a need to build on palliative care for the eastern residents ... home palliative is an option but we are still looking at the best model that provides best care for the patient ."

Mr Udairam noted that some families are concerned over the fees they have to pay for home care services. But he believed that the Government subsidy for such services could be tweaked in the future. Under the regional clusters framework, GPs will take on some of the caseload at the hospitals.

In order to do this, initiatives might be introduced to get employers to designate some days as sick leave for workers - which would mean that patients do not have to visit a GP for a simple cough to get a medical certificate to be excused from work, Mr Udairam said.

Seamless health care with alliances
Project in east heralds others islandwide
By Melissa Pang, The Straits Times, 19 Nov 2011

SEAMLESS, hassle-free health care is in the works, not only for those living in the eastern part of the island, but everywhere.

Singapore's various health-care clusters are looking to partner more health-care providers in their areas - including community hospitals and general practitioners - to better care for patients here.

Revealing this yesterday, Health Minister Gan Kim Yong said they will be studying the experiences of the Eastern Health Alliance (EHA), which he launched at Changi General Hospital (CGH).

Under this alliance - the first to kick off - CGH will work with St Andrew's Community Hospital, The Salvation Army Peacehaven Nursing Home and SingHealth polyclinics.

For example, a person with a hip fracture might be warded at CGH, recuperate at St Andrew's or Peacehaven, and later be visited at home by health-care providers to ensure he is all right.

Because of the alliance, the doctors and nurses at the various institutions will be kept in the loop about his condition as he recovers. This will cut down on red tape and result in more comprehensive and seamless care. It will also mean sick people will be re-admitted to hospital less frequently, and recover better.

Mr Gan said the EHA will be a 'learning journey' for the other health clusters. 'From the lessons we learn from this alliance, we will then replicate a similar system across Singapore in other regions,' he said.

With the setting up of the EHA, Singapore now has six public health-care clusters. The others are Singapore Health Services, National University Health System, Alexandra Health, Jurong Health Services, and the National Healthcare Group. Each cluster comprises one or several acute hospitals and specialist centres. Some have polyclinics.

Mr Gan did not say when the other regional alliances would be ready. He noted that many already have bilateral collaborations, but the aim now is for multiple partners.

'Once the building blocks are ready, they will be able to roll out the whole integration plan,' he said, adding that different regions have different set-ups and needs, and each would have to evolve its own model.

Yesterday, the EHA's founding members signed a joint memorandum of understanding at CGH to formalise their collaboration.

The alliance has already led to joint projects. A health management unit has helped patients look after their long-term conditions, and an outreach scheme screens patients for chronic conditions. These will now be expanded to benefit more.

A pilot transitional convalescent facility will also be set up for patients with debilitating hip fractures who may need a longer recovery time.

Mr T.K. Udairam, who is jointly chief executive for the EH Alliance and CGH, sounded a cautious but optimistic note: 'We can't expect health-care delivery to transform overnight. This is a 'journey of a thousand miles' that we have taken the first very important steps upon.'

Other groups are already shaping up their plans for more integrated care.

SingHealth, which includes Singapore General Hospital and KK Women's and Children's Hospital, took over Bright Vision Hospital near Hougang in April so patients can be seamlessly transferred to them for care.

Khoo Teck Puat Hospital's chief executive Liak Teng Lit said it was working closely with a community hospital and a few nursing homes in the north.

Mr Joe Sim, chief executive officer of National University Hospital, said the hospital has existing partnerships, such as an agreement with step-down care facility St Luke's Hospital to send patients there. Other collaborations are in the pipeline.

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