Potential of Interface Care Models to Deliver More Appropriate Care to Patients With Acute Medical Illness

Potential of Interface Care Models to Deliver More Appropriate Care to Patients With Acute Medical Illness in Singapore and Decrease Utilisation of Acute Care Bed-days

Every country in the world is experiencing growth in both the size and the proportion of older persons. As a result of the changes, the profile and needs of people with medical illnesses have evolved. How care is delivered to patients has to keep pace with these changes, or patients will experience poor care at high cost and not have their needs met. A new model of care has emerged to meet these challenges: Acute Medical Unit. Despite considerable investment and popularity of this model, questions remain: (i) Who benefits most from this care model? (ii) How may these models be most effectively implemented for the best results? (iii) How effective are these models? Singapore is well-placed to answer these questions with its national healthcare system and excellent research institutions. The investigators plan to study how effective the model is by comparing patients with similar profiles exposed to both these care models compared to how hospital care is usually provided, looking for four differences: (i) how long patients stay in hospital, (ii) how often they use the emergency department (iii) quality of health (iv) cost. Additionally, the investigators seek to characterise patterns of health needs for this group of patients.

Study Overview

• Status: Recruiting
• Conditions: Pneumonia; Falls Injury; Chronic Obstructive Pulmonary Disease (COPD); Infection; Falls; Hospitalization in Acute Care; Acute Exacerbation of Asthma; UTI - Urinary Tract Infection; URTI - Viral Upper Respiratory Tract Infection

• Study Type: Observational
• Enrollment (Estimated): 220

Contacts and Locations

• Study Contact: Name: John TY Soong, PhD; Phone Number: +6567727678; Email: John_soong@nuhs.edu.sg

Study Locations

• Singapore
  • Singapore, Singapore, 119228
    • Recruiting
    • National University Hospital
    • Contact: John TY Soong, PhD; Phone Number: +6567727678; Email: John_soong@nuhs.edu.sg
    • Principal Investigator: John TY Soong, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

The study population will consist of adult patients admitted to the National University Hospital (NUH), Singapore, for acute medical conditions. Participants will be recruited either from the Acute Medical Unit (AMU) or directly to the General Ward (GW) following presentation to the Emergency Department. Patients represent a typical mix of acute medical admissions seen in a tertiary hospital setting, including infection-related illnesses, falls with disequilibrium, and acute exacerbations of chronic diseases such as Chronic Obstructive Pulmonary Disease (COPD).

Description

Inclusion Criteria:

• AMU inclusion criteria - admission from ED to AMU directly
• Control group inclusion criteria - admission from ED to GW directly
• Acute medical illnesses that includes infection-related conditions, falls-disequilibrium, and acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD).

Exclusion Criteria:

• Below 21 years old
• Patients undergoing active chemotherapy
• Patients with active pregnancy
• Patients admitted less than 24 hours
• Cerebrovascular disease requiring thrombolysis or intravascular intervention

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Acute Medical Unit (AMU) Patients; Patients admitted to the AMU from the Emergency Department (ED) or specialist clinics as their first admission ward. The AMU provides rapid assessment and early intervention to improve efficiency of care. Participants will primarily include adults with acute medical illnesses such as infection-related conditions, falls/disequilibrium, or acute exacerbation of COPD.
General Ward (GW) Control Patients; Patients admitted directly from the ED to General Wards under the Division of Advanced Internal Medicine. Patients will be matched to the AMU group by diagnosis group, age, gender, illness severity, comorbidities, frailty, and functional status to minimize confounding factors.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean acute care bed-days utilised	Average total days of acute hospital stay, including the index episode, for each patient. Measures efficiency of hospital care between AMU and GW groups.	Up to 6 months following discharge

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient Outcomes - Health-related Quality of Life (EQ-5D-5L)	Patients rate 5 areas - mobility, self-care, usual activities, pain/discomfort, and anxiety/depression on a 5-level scale from 1 (no problems) to 5 (extreme problems). Scores are combined into an overall health index, where higher scores indicate worse health status. This captures the patient's overall quality of life over the follow-up period.	Baseline (Day 0, at discharge), 3 months post-discharge, and 6 months post-discharge
Patient Outcomes - Patient Activation Measure (PAM-13)	Patients answer 13 questions on a 4-point scale from "strongly disagree" to "strongly agree," with a "not applicable" option. Raw scores are converted to a 0-100 scale, where higher scores indicate greater engagement in self-care. Scores classify patients into four levels: Level 1 = disengaged, Level 2 = gaining confidence, Level 3 = taking action, Level 4 = confident and maintaining self-management.	Baseline (Day 0, at discharge) and 6 months post-discharge
Patient Outcomes - World Health Organisation Five Wellbeing (WHO-5)	Patient answers five questions that assess mood, energy, and interest in daily life over the past two weeks, scored 0 (at no time) to 5 (all of the time). The total score (0-25) is multiplied by 4 to create a 0-100 scale, where higher scores indicate better wellbeing.	Baseline (Day 0, at discharge), 3 months post-discharge, and 6 months post-discharge
Patient Outcomes - Patient Health Questionnaire (PHQ-9)	PHQ-9 includes 9 items scored 0 (not at all) to 3 (nearly every day), total 0-27; higher scores indicate more severe depressive symptoms.	Baseline (Day 0, at discharge) and 6 months post-discharge
Patient Outcomes - Functional Dependence (Barthel Index)	Measures independence in 10 daily activities, scored 0 (fully dependent) to 100 (fully independent). Higher scores indicate greater ability to perform daily activities without assistance.	Baseline (Day 0, at discharge) and 6 months post-discharge
System Outcomes - Number of Emergency Department (ED) visits	Number of ED visits recorded in hospital records within 6 months. Higher counts reflect greater acute care needs.	Baseline (Day 0, at discharge) and 6 months post-discharge
System Outcomes - Specialist Outpatient Clinic visit	Number of outpatient specialist visits, as recorded in hospital system.	Baseline (Day 0, at discharge) and 6 months post-discharge
System Outcomes - Polyclinic Visits	Number of visits to public polyclinics captured through health records	Baseline (Day 0, at discharge) and 6 months post-discharge
System Outcomes - Hospital Admissions	Number of inpatient hospital admissions during follow-up, excluding the index admission.	6 months post-discharge

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cost-effectiveness	Estimate the change to 'total costs' and the change to 'health benefits' as measured by Quality Adjusted Life Years (QALYS) from a decision to adopt AMU as compared to the 'existing acute care chain' in Singapore	Up to 6 months from discharge

Collaborators and Investigators

• Sponsor: National University Hospital, Singapore
• Collaborators: Duke-NUS Graduate Medical School

Publications and helpful links

General Publications

• Lateef A, Lee SH, Fisher DA, Goh WP, Han HF, Segara UC, Sim TB, Mahadehvan M, Goh KT, Cheah N, Lim AYT, Phan PH, Merchant RA. Impact of inpatient Care in Emergency Department on outcomes: a quasi-experimental cohort study. BMC Health Serv Res. 2017 Aug 14;17(1):555. doi: 10.1186/s12913-017-2491-x.
• Balakrishnan T, Teo PSE, Lim WT, Xin XH, Yuen BH, Wong KS. Acute Medical Ward for better care coordination of patients admitted with infection - evidence from a tertiary hospital in Singapore. Acute Med. 2017;16(4):170-176.
• Reid LE, Dinesen LC, Jones MC, Morrison ZJ, Weir CJ, Lone NI. The effectiveness and variation of acute medical units: a systematic review. Int J Qual Health Care. 2016 Sep;28(4):433-46. doi: 10.1093/intqhc/mzw056. Epub 2016 Jun 16.
• Soong JTY, Bell D, Ong MEH. Meeting today's healthcare needs: Medicine at the interface. Ann Acad Med Singap. 2022 Dec;51(12):787-792. doi: 10.47102/annals-acadmedsg.2022196.
• Roseveare C. Acute medicine and general practice: a key interface in managing emergency care pressures. Br J Gen Pract. 2014 Mar;64(620):122-3. doi: 10.3399/bjgp14X677392. No abstract available.

Study record dates

Study Major Dates

• Study Start (Actual): September 30, 2024
• Primary Completion (Estimated): May 31, 2026
• Study Completion (Estimated): May 31, 2026

Study Registration Dates

• First Submitted: January 25, 2026
• First Submitted That Met QC Criteria: April 10, 2026
• First Posted (Actual): April 17, 2026

Study Record Updates

• Last Update Posted (Actual): April 17, 2026
• Last Update Submitted That Met QC Criteria: April 10, 2026
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Keywords: Acute Medicine; Cost effectiveness; prospective observational; Clinical effectiveness; Acute Medical Unit; Interface Care; matched controlled
• Additional Relevant MeSH Terms: Urogenital Diseases; Pathologic Processes; Male Urogenital Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Chronic Disease; Disease Attributes; Respiratory Tract Infections; Respiratory Tract Diseases; Lung Diseases; Lung Diseases, Obstructive; Pathological Conditions, Signs and Symptoms; Pulmonary Disease, Chronic Obstructive; Pneumonia; Infections; Urinary Tract Infections
• Other Study ID Numbers: MOH-001435-00

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: At the time of study planning, no identified repository existed for this data. Researchers are welcome to contact the Principal Investigator directly.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No