These MOHT-coordinated pilots are supported by the Ministry of Health (MOH), and implemented as part of a regulatory and financing sandbox. Under this sandbox, patients will receive programme subsidies similar to the healthcare financing coverage for a standard hospital admission.
The Sandbox was first announced in Parliament during the Ministry of Health Committee of Supply Debate in March 2022. Pilots were soft-launched in April 2022 and are set to conclude by March 2024.
The Sandbox aims to:
- provide care of comparable and increased resource efficiency relative to usual inpatient care, without compromising safety.
- study suitable medical conditions which could be included under the programme, and develop relevant regulatory requirements for the services.
Hospitals participating in the Sandbox will be able to trial and implement the new care model and integrate it with their existing processes. This makes it easier for subsequent service ramp-up and mainstreaming into existing practices. This model provides patient-centred and appropriate hospital care for a select group of hospital patients. It will be delivered by hospital-led clinicians and partners and augmented by telehealth and other supportive modalities of care.
A patient’s journey through MIC@Home
Suitable patients may be referred to MIC@Home programmes from the emergency departments, hospital ward or from community nurses or doctors. The programme will be offered to patients as an alternative to being hospitalised.
A nurse meets the patient at his/her own home, setting up medication and equipment for treatment such as infusion stand and devices for teleconsultation and remote monitoring if needed. Nurses from hospitals or private partners like Speedoc, will visit the patient up to several times a day to administer drip-based medication or draw blood for testing. The care team will review patients daily either by teleconsultation or by home visits.
Physiotherapists can also visit patients at home if required. New medications are delivered to patients at home. The team is also available 24/7 for teleconsultation, should the patient encounter urgent medical issues. During care under MIC@Home, the care team will also evaluate the patient’s understanding of their own condition, medication and home environment during a visit, and also plan for follow-up post-discharge care. When a patient’s condition has improved and no longer require daily treatment, they will be discharged from the programme.
Dr Low Lian Leng, Director, Population Health and Integrated Care Office, SGH added: “We have been able to identify suitable selected patients from our emergency department and inpatient wards who can be safely managed in the home setting through a combination of in-person home visits and close virtual telehealth monitoring. Patient satisfaction is high as they can recover in a familiar home environment while the SGH team remains accessible to them. MIC@Home has helped to save bed stays for the hospital and allowed the hospital to care for sicker patients.”
Enabling recovery at home – during the COVID-19 pandemic
Prior to the COVID-19 Delta wave, KTPH, NUH, and SGH were running their proof-of-concepts pilots, supported by evaluation funding from MOHT. Thus, during the Delta and Omicron surges these hospitals were able to quickly set up their COVID Virtual Wards to serve COVID patients. This allowed about 700 COVID infected patients to safely recover at home, thus collectively saving KTPH, NUH and SGH over 5,000 bed days between September to December 2021.
Future of MIC@Home
Studies in established models in Australia[3], Europe and the United States, have shown that MIC@Home models can have equivalent clinical outcomes as ward hospitalisation. Importantly, patients recovering at home report sleeping better, eating better, walking around more, and perceive their recovery to be quicker.
Healthcare professionals can build close rapport with patients over home visits and assess their conditions in their home environment. Medical care plans can also be personalised and tailored to the patient’s lifestyle and environment.
Like, SGH, the experience for NUHS and Yishun Health has been similarly positive.
Said Dr Stephanie Ko, Lead Clinician for NUHS@Home, and Consultant, Division of Advanced Internal Medicine, Department of Medicine, National University Hospital (NUH): “Our vision for NUHS@Home is to provide patients who want to be at home rather than a hospital an option to receive the care that they require. Within their home environment, patients tend to eat better, sleep better and walk around more – all of which help with their road to recovery. Our doctors and nurses can also assess patients within their home environment and better personalise treatment plans. And with the advances in technology and development of home delivery and home services, we have an opportunity to develop this way of caring for our patients.”
Dr Boh Toon Li, Lead Clinician and Principal Investigator at Yishun Health Medical Home said: “We have received positive feedback from both patients and caregivers on this service. In addition to understanding more about the patient’s medical condition, caregivers also gain knowledge and confidence to better care for their loved ones.”
Mr Lai Yi Feng, Senior Manager and Project Lead of MIC@Home at MOH Office for Healthcare Transformation (MOHT) sums it up: “As the provision of healthcare continues to shift from hospital to the home and the community, structural change and reorganisation of care delivery is pivotal. The early success of MIC@Home garnered interest to ensure its ethical, safety and regulatory standards, so that it can be recognised and scaled, as an equivalent form of inpatient care provision.”
Tech-enabling MIC@Home
Technology is a key enabler that makes MIC@Home possible. Mr Alan Goh, Assistant Chief Executive, Platform Services, Integrated Health Information Systems (IHiS), shared: “Our network of integrated systems serve as a good foundation to enable holistic care of patients. In this new pilot, we will harness a myriad of smart solutions to support the on-site and remote care for patients, including smart medical devices, apps for vital signs monitoring and teleconsultations. The solutions will include smart dashboards with decision support to the care providers, and provide alerts on anomalous health indicators. Following learnings from the pilot, IHiS will also work with our healthcare partners in forward IT planning to mainstream these services through technology.”
Patient profiles are available for media interviews. Please contact Ms Shamana Menon (MOHT).
[2] In emergency and critical care medicine, clinical acuity refers to the severity of a hospitalized patient's illness and the level of attention or service he/she will need from professional staff.
