Abstract
Background: Yishun Health (YH), a regional population health system in Singapore, has expanded its role beyond healthcare provision to collaboratively care for more than 330,000 residents in Northern Singapore with community partners. This prompted transformation towards a more person-centred Unified Care Model (UCM), delivering care through its subsidiary integrated Lifelong Care (LC) and Episodic Care (EC) models.
Experience is a critical component of the “Quadruple Aim”, a framework for measuring whole health system outcomes. Accordingly, YH developed UCM Performance Framework (UCMPF) that includes measurement of resident health experience as one of our whole system performance indicator.
Conventional tools to measure experience revolves around patient experience in healthcare settings. Resident’s health experience in the community has not been sufficiently evaluated. There is also lack of validated measurement tools that aggregate measures of person-centred health experiences in the community with experiences in healthcare settings.
Methods: Development of our Resident Health Experience Tool (RHET) was informed by comprehensive literature review of items related to experience of health and healthcare system. Based on person-centeredness, comprehensiveness, actionability and alignment with our UCMPF, we shortlisted 12 items grouped into 3 subscales of experience, i.e. community, LC and EC systems, respectively. The experience dimensions included availability and affordability of services and resources, usefulness of services, quality of service delivery, services integration, affiliation with healthcare providers and environmental determinants. RHET was piloted using YH Population Health Survey (PHS2022). Data was analysed using statistical procedures such as one-way ANOVA, exploratory factor analysis, Pearson’s correlation for convergent validity analysis and internal consistency to establish validity and reliability.
Results: Weighted analysis of PHS2022 data from 2499 participants from Singapore’s North population showed that the Overall Resident Health Experience Score was 54.0%, with contributory Community Experience Score, LC Experience Score and EC Experience Score at 23.1%, 69.7% and 69.3% respectively (higher scores indicate more positive experiences). Experience of healthy living in the community, and LC and EC experience, emerged as three latent factors based on break point of Scree plot and interpretability of factors, accounting for 63.6% of data variance, validating the same 3 domains we identified from literature. Each factor had good internal reliability, as did the overall score (Cronbach’s Alpha=0.80). The 12-items also showed significant positive correlation with Altarum Consumer Engagement score which assessed health engagement of residents.
Conclusion: Preliminary data indicated that RHET met most psychometric criteria for assessment measures, although further investigation is required for validation. Our RHET Scores facilitates the evaluation of resident’s health experiences in both the community and in healthcare service delivery systems. RHET Scores can help inform and improve the quality of services for population health and hospital systems, thereby accelerating attainment of person-centric, integrated and value driven care.