A Novel Integrated Geriatric Services Hub for Frailty Identification and Comprehensive Management of Community-Dwelling Older Adults in Singapore: Impact on Health Service Utilization.

Abstract

Background: Healthcare systems need to address the high healthcare use of frail older adults. The Geriatric Services Hub (GSH) is a novel program in Singapore that delivers frailty screening, comprehensive geriatric assessment and coordinated care for community-dwelling older persons with bio-psycho-social needs. We aimed to evaluate the effects of the GSH on healthcare use.

Methods: We compared healthcare utilization of 634 GSH participants with 634 unique propensity score-matched non-GSH community-dwelling older adults at 12 months before and after GSH enrolment. Baseline matching covariates included demographics, socioeconomic status, disease burden, calendar quarter of enrolment, and past healthcare utilization. We did exact matching on frailty categories (Clinical Frailty Score (CFS) score 4, 5, and 6-7). Difference-in-differences technique was used to derive effect estimates.

Results: After propensity score matching, baseline covariates were adequately balanced. Healthcare utilization declined in both groups after GSH enrolment. Relative to the comparators and after accounting for pre-enrolment differences, participation in the GSH was associated with greater primary care (mean difference: 0.06, 95% CI-0.64 to 0.77) and specialist outpatient clinic visits (mean difference: 0.42, 95% CI -0.29 to 1.13), and fewer emergency department visits (mean difference: -0.18, 95% CI -0.69 to 0.34). However, these effects did not reach statistical significance. While number of hospitalizations did not differ between the groups, cumulative length of stay differed by 1.15 bed-days and was not statistically significant. No statistically significant differences were observed within CFS groups.

Conclusion: GSH was not associated with significant reductions in healthcare use in the first year of enrolment. Higher utilization of primary care and specialist outpatient clinic services could reflect the increased identification of care needs with the potential to reduce unnecessary healthcare use such as emergency department visits. Prospective studies with a longer follow-up would ascertain if the GSH translates to reduced healthcare utilization as hypothesized.