Healthcare service utilization in the first year after admission into home medical care among elderly patients in Singapore

Figures & data

Table 1. Socio-demographic, clinical and functional characteristics of study population at time of admission (N = 1,060)

Characteristics	N (%)
Socio-demographic characteristics
Age
>70 years	937 (88.4)
≤70 years	123 (11.6)
Gender
Male	374 (35.3)
Female	686 (64.7)
Ethnicity
Chinese	825 (77.8)
Malay/Indian/Eurasian	235 (22.2)
Marital status
Single	46 (4.3)
Married	369 (34.8)
Divorced	20 (1.9)
Widowed	625 (59.0)
Religion
Buddhist	358 (33.8)
Taoist	218 (20.6)
Christian	213 (20.1)
Muslim	168 (15.8)
Hindu	26 (2.5)
No religion	44 (4.2)
Others	33 (3.1)
Eldershield/IDAPE^*
Eligible for claims	879 (82.9)
Eligible but not claiming	656 (74.6)
Housing type
1–3 rooms HDB flat	332 (31.3)
4 rooms HDB flat	352 (33.2)
5 rooms HDB flat	181 (17.1)
Private/landed property	195 (18.4)
Living arrangement
Alone	19 (1.8)
With spouse	79 (7.5)
With children	233 (22)
With spouse and children	565 (53.3)
Others	164 (15.5)
Primary caregiver
Foreign domestic worker (FDW)	617 (58.2)
Spouse/children/others	443 (41.8)
Total monthly income range
PA/MFEC^**	27 (2.5)
≤$2000	235 (22.2)
$2001–$3000	128 (12.1)
>$3000	149 (14.1)
Uncertain^***	521 (49.2)
Source of income (savings)
Yes	48 (4.5)
No	1,012 (95.5)
LOS (days)
Geometric mean LOS (inter-quartile range) in days	200.3 (613.5)
Clinical characteristics
Co-morbid conditions
Chronic lung disease	116 (10.9)
Dementia	507 (47.8)
Heart failure	222 (20.9)
Hemiplegia	277 (26.1)
Hypertension	695 (65.6)
Ischemic heart disease	394 (37.2)
Myocardial infarction	82 (7.7)
Peptic ulcer disease	213 (20.1)
Peripheral vascular disease	104 (9.8)
Stroke	694 (65.5)
Diabetes mellitus
None	631 (59.5)
Without end organ damage	285 (26.9)
With end organ damage	144 (13.6)
Renal disease
None	861 (81.2)
Mild	69 (6.5)
Moderate	49 (4.6)
Severe	81 (7.6)
Charlson co-morbidity index
Mild (1–3)	569 (53.7)
Moderate (4–6)	352 (33.2)
Severe (≥7)	139 (13.1)
Other past medical history
Parkinson’s disease	126 (11.9)
Fractures	357 (33.7)
Arthritis	165 (15.6)
Thyroid disease	84 (7.9)
Falls	343 (32.4)
Depression	321 (30.3)
Pressure ulcers
Pressure ulcers (yes)	392 (37.0)
Pressure ulcers, mean (SD)	0.75 (1.36)
Oral cavity
Oral mucous lesions	644 (60.8)
Edentulous	615 (58.0)
Possess dentures	159 (15.0)
Swallowing
Unable	525 (49.5)
Cough/choke	81 (7.6)
Able without difficulty	454 (42.8)
Mode of feeding
Oral	540 (50.9)
Naso-gastric tube (NGT)	489 (46.1)
Percutaneous endoscopic gastrostomy (PEG)	31 (2.9)
Per rectal exam
Faecal impaction	249 (23.5)
Blood	3 (0.3)
Normal soft stools	387 (36.5)
Empty rectum	302 (28.5)
Not done	104 (9.8)
Others	15 (1.4)
Abbreviated mental test score
Cognitive impaired (score <7 out of 10)	682 (81.5)
Functional characteristics
Bowels
Incontinent	835 (78.8)
Occasional accident (<1/week)	46 (4.3)
Continent	179 (16.9)
Bladder
Incontinent or catheterised	857 (80.8)
Occasional accident (max 1 per 24 h)	45 (4.2)
Continent for over 7 days	158 (14.9)
Grooming
Needs help	929 (87.6)
Independent (face/ hair/ teeth/ shaving)	131 (12.4)
Toilet use
Dependent	862 (81.3)
Need help but can do something	122 (11.5)
Independent	76 (7.2)
Feeding
Unable	792 (74.7)
Needs help	137 (12.9)
Independent	131 (12.4)
Transfer
Unable	635 (59.9)
Major help	170 (16.0)
Minor help	169 (15.9)
Independent	86 (8.1)
Mobility
Immobile	860 (81.1)
Wheel chair dependent	19 (1.8)
Walks with the aid of untrained person	96 (9.1)
Independent	85 (8.0)
Dressing
Dependent	863 (81.4)
Needs help	113 (10.7)
Independent	84 (7.9)
Stairs
Unable	994 (93.8)
Needs help	37 (3.5)
Independent up and down	29 (2.7)
Bathing
Dependent	989 (93.3)
Independent	71 (6.7)
Barthel index (BI)
Totally dependent (BI = 0)	599 (56.5)
Not totally dependent (BI > 0)	461 (43.5)
Mobility aids used during assessment
None	552 (52.1)
Walking frame	88 (8.3)
Wheel–chair	350 (33.0)
Quad stick	19 (1.8)
Walking stick	8 (0.8)
Other	43 (4.1)

^* Interim disability assistance program for the elderly (IDAPE).

^** Public assistance/medical fee exemption card.

^*** Children/siblings or grandchildren were responsible for all medical related expenditure.

Table 2. Total number of encounters stratified by type and profession during first year of admission

Professional group	Encounters, N (%)
	Scheduled visits	Unscheduled visit	Phone calls	Total
Doctor	2,275 (30.8)	594 (50.1)	124 (2.1)	2,993 (20.6)
Nurse	4,494 (60.8)	587 (49.6)	5,806 (97.8)	10,887 (75.1)
Therapist	619 (8.4)	3 (0.3)	3 (0.1)	625 (4.3)
Total	7,388 (100)	1,184 (100)	5,933 (100)	14,505 (100)

Table 3. Overall trend of healthcare service utilization during first year of admission

	First quarter N = (1,060)	Second quarter (N = 756)	Third quarter (N = 599)	Fourth quarter (N = 512)
Patients discharged, n (%)	75 (7.1)	61 (5.7)	31 (2.9)	17 (1.6)
Patients died, n (%)	229 (21.6)	96 (9.1)	56 (5.3)	50 (4.7)
No. of days patients were in home care service in each quarter (Mean)	76	58	49	43
Total scheduled visits, n (Mean per quarter)	3,524 (3.32)	1,634 (1.54)	1,230 (1.16)	1,000 (0.94)
Total unscheduled visits, n (Mean per quarter)	543 (0.51)	283 (0.27)	183 (0.17)	175 (0.17)
Total phone calls, n (Mean per quarter)	2,808 (2.65)	1,436 (1.35)	952 (0.90)	737 (0.70)
Total doctor encounters, n (Mean per quarter)	1,755 (1.65)	498 (0.47)	409 (0.38)	331 (0.31)
Total nurse encounters, n (Mean per quarter)	4,855 (4.58)	2,707 (2.55)	1,842 (1.74)	1,483 (1.40)
Total therapist encounters, n (Mean per quarter)	268 (0.25)	145 (0.14)	115 (0.11)	97 (0.09)

Figure 1. Overall trend of healthcare service utilization during first year of admission.

Table 4. Mean visits density (visits per patient day per unique patient × 90 days) of healthcare service utilization during first year of admission

First admissions	First quarter	Second quarter	Third quarter	Fourth quarter
Scheduled visit density	4.5	1.8	0.9	0.9
Unscheduled visit density	0.9	0.0	0.0	0.0
Phone call density	4.5	1.8	0.9	0.9
Doctor encounter density	2.7	0.9	0.0	0.0
Nurse encounter density	7.2	3.6	1.8	1.8
Therapist encounter density	0.002	0.001	0.004	0.000

Table 5. Linear trend of healthcare service utilization during first year of admission

Type of healthcare service utilization	Incidence rate ratios per quarter (95% CI)	p-Value
Scheduled visits	0.77 (0.75–0.79)	<0.001
Unscheduled visits	0.82 (0.75–0.86)	<0.001
Phone calls	0.77 (0.74–0.81)	<0.001
Doctor encounters	0.64 (0.61–0.68)	<0.001
Nurse encounters	0.81 (0.78–0.83)	<0.001
Therapist encounters	0.61 (0.28–1.32)	0.21