Abstract
Background: Yishun Health (YH), a Regional Population Health System (RPHS) under National Healthcare Group caring for 330,000 residents in northern Singapore, developed the Unified Care Model (UCM) and its subsidiary Lifelong Care (LC) and Episodic Care (EC) models to guide development of its future-state Service Delivery Subsystem. YH’s Governance and Leadership Subsystem focused on development of the UCM Performance Framework (UCMPF) and a systemic Needs-Based Population Segmentation Model for LC and EC resident/patient populations, enabling performance measurement of LC and EC and in turn RPHS performance management.
UCMPF was designed to enable measurement of whole health system performance using a “dual logic” approach i.e., (1) “horizontal logic” within LC and EC programs and services comprising input, process, output, and outcome indicators, and (2) “vertical logic” where the outcomes of LC and EC services at the microsystem level were aggregated into mesosystems and macrosystem levels. Use of UCMPF enabled more effective rationalization and alignment of performance indicators. Systemic measurement, reporting and regular clinician and operational team usage of LC and EC indicators were hypothesized to drive care integration, improve health outcomes, and accelerate health system transformation.
Methods: Systemic Integrated Care Dashboards (SICD) were conceptualized to mirror the “dual logic” of UCMPF, automating performance measurement trending for all LC and EC populations segments and at various system levels.
Data engineering performed extensive patient data extractions, transformation, and loading. Data cleaning and processing included tagging patients to LC and EC population segments, assigning Clinician ID, computing LC and EC indicators based on definitions in UCM policies.
Oracle Data Visualisation Tools were used to create a set of interactive SICD equipped with customised user access to ensure data security and filters i.e. population segments, Diagnosis-Related Group, Clinician ID, and subspecialty, allowing users to efficiently visualize and compare LC and EC performance indicators.
Results: Five levels of performance management dashboards were progressively rolled out to LC and EC teams throughout 2023 (SICD Phase One):
-Individual Clinician Patient Dashboard (“Patient Outcome/Action Lists")
-Clinical Service Dashboard (“Clinical Lead/Care Team Action Lists”)
-Clinical Department Dashboard (Clinician Performance Management)
-Medical Board Dashboard (LC and EC Population Segment Performance Management)
-Senior Management Dashboard (Overall Health System Performance Management)
These dashboards provided better systemic visualisation of performance measurement, catalysed improvement and care integration activities i.e. LC population segment-based performance management conversations focusing on Emergency Department, Specialist Outpatient Clinic, inpatient utilization, services gaps, shared care processes between primary care and hospital care; analysis of variations in radiology orders within the same DRG for different EC segment and clinicians, trending of hospital workload and average length of inpatient stay across different segments prompting EC process standardization.
Discussion/Conclusion: SICD features clearer visualization of healthcare organisational performance data at different levels of the health system, facilitating better performance monitoring, fostering greater accountability, and a data-driven culture for continuous services evaluation and improvement. Flexibility and customization options in SICD allow for more responsive performance reporting and management that can support evolving challenges and priorities. SICD enhances systemic healthcare performance measurement and RPHS performance management.