Lessons learned from the hospital to home community care program in Singapore and the supporting AI multiple readmissions prediction model.

In a prior practice and policy article published in Healthcare Science, we introduced the deployed application of an artificial intelligence (AI) model to predict longer-term inpatient readmissions to guide community care interventions for patients with complex conditions in the context of Singapore's Hospital to Home (H2H) program that has been operating since 2017. In this follow on practice and policy article, we further elaborate on Singapore's H2H program and care model, and its supporting AI model for multiple readmission prediction, in the following ways: (1) by providing updates on the AI and supporting information systems, (2) by reporting on customer engagement and related service delivery outcomes including staff-related time savings and patient benefits in terms of bed days saved, (3) by sharing lessons learned with respect to (i) analytics challenges encountered due to the high degree of heterogeneity and resulting variability of the data set associated with the population of program participants, (ii) balancing competing needs for simpler and stable predictive models versus continuing to further enhance models and add yet more predictive variables, and (iii) the complications of continuing to make model changes when the AI part of the system is highly interlinked with supporting clinical information systems, (4) by highlighting how this H2H effort supported broader Covid-19 response efforts across Singapore's public healthcare system, and finally (5) by commenting on how the experiences and related capabilities acquired from running this H2H program and related community care model and supporting AI prediction model are expected to contribute to the next wave of Singapore's public healthcare efforts from 2023 onwards. For the convenience of the reader, some content that introduces the H2H program and the multiple readmissions AI prediction model that previously appeared in the prior Healthcare Science publication is repeated at the beginning of this article.

Baseline characteristics of participants in the Pre-Diabetes Interventions and Continued Tracking to Ease-out Diabetes (Pre-DICTED) Program.

Objective: The Pre-Diabetes Interventions and Continued Tracking to Ease-out Diabetes (Pre-DICTED) Program is a diabetes prevention trial comparing the diabetes conversion rate at 3 years between the intervention group, which receives the incentivized lifestyle intervention program with stepwise addition of metformin, and the control group, which receives the standard of care. We describe the baseline characteristics and compare Pre-DICTED participants with other diabetes prevention trials cohort.

Research Design And Methods: Participants were aged between 21 and 64 years, overweight (body mass index (BMI) ≥23.

The Pre-Diabetes Interventions and Continued Tracking to Ease-out Diabetes (Pre-DICTED) program: study protocol for a randomized controlled trial.

Background: Community-based diabetes prevention programs varied widely in effectiveness, and the intervention strategy consisting of lifestyle interventions, stepwise addition of metformin, and financial incentives has not been studied in real-world clinical practice settings. The Pre-Diabetes Interventions and Continued Tracking to Ease-out Diabetes (Pre-DICTED) trial is a pragmatic trial that aims to compare the effectiveness of a community-based stepwise diabetes prevention program with added financial incentives (intervention) versus the standard of care (control) in reducing the risk of type 2 diabetes over 3 years among overweight or obese individuals with pre-diabetes.

Methods: This is an open-label, 1:1 randomized controlled trial which aims to recruit 846 adult individuals with isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT), or both IFG and IGT from Singapore.

Follow-Up Consultation Through a Healthcare Kiosk for Patients with Stable Chronic Disease in a Primary Care Setting: A Prospective Study.

Introduction: The global healthcare kiosk market is growing, and kiosks are projected to be a larger part of healthcare delivery in the coming decades. We developed an unmanned healthcare kiosk that automates the management of stable patients with chronic conditions to complement face-to-face primary care physician (PCP) visits.

Aim: The aim of our study was to show that the kiosk could be a feasible means of delivering care for stable patients with chronic conditions and could generate cost savings for the management of patients with stable chronic disease.

Development of an Automated Healthcare Kiosk for the Management of Chronic Disease Patients in the Primary Care Setting.

An increase in the prevalence of chronic disease has led to a rise in the demand for primary healthcare services in many developed countries. Healthcare technology tools may provide the leverage to alleviate the shortage of primary care providers. Here we describe the development and usage of an automated healthcare kiosk for the management of patients with stable chronic disease in the primary care setting.

A method comparison study to validate a novel parameter of obesity, the body adiposity index, in Chinese subjects.

Objective: A recently developed parameter, the body adiposity index (BAI)-a composite index based on hip circumference and height-estimates the percentage (%) body adiposity indirectly. The BAI was compared with dual energy X-ray absorptiometer (DEXA)-derived % adiposity to validate the BAI in the local Chinese population.

Design And Methods: 105 Chinese were recruited and % adiposity estimated by BAI was compared with that derived from DEXA using the Bland Altman plot.

Where the elderly die: the influence of socio-demographic factors and cause of death on people dying at home.

Introduction: The place of death of the elderly has implications on the overall healthcare delivery system. The aim of this study is to describe where deaths of elderly occur in Singapore and to determine the association of socio-demographic characteristics and the causes of death on dying at home.

Materials And Methods: Data of 10,399 Singapore resident decedents aged 65 years and above in 2006 were obtained from the national Registry of Births and Deaths.

Amendment of the Human Organ Transplant Act.

On 6 January 2004, the Human Organ Transplant Act (HOTA) was amended to allow more Singaporeans to benefit from organ donation. The main amendments to HOTA were (a) to extend HOTA beyond kidneys to include livers, hearts and corneas; (b) to extend HOTA beyond deaths due to accidents to include all causes of deaths; and (c) to extend HOTA beyond cadaveric organ donation to also regulate living donor organ transplants. In this article, we review the amendments to HOTA and the Interpretation (Determination and Certification of Death) Regulations and examine the impact of HOTA on organ procurement and transplantation in Singapore.