Early Implementation of a Patient-Centered Medical Home in Singapore: A Qualitative Study Using Theory on Diffusion of Innovations

Patient-Centered Medical Home (PCMH) has been found to improve care for complex needs patients in some countries but has not yet been widely adopted in Singapore. This study explored the ground-up implementation of a PCMH in Singapore by describing change strategies and unpacking initial experience...

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Autores principales:	Zoe Zon Be Lim, Mumtaz Mohamed Kadir, Mimaika Luluina Ginting, Hubertus Johannes Maria Vrijhoef, Joanne Yoong, Chek Hooi Wong
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	Patient-Centered Medical Home primary care innovation implementation complex needs adoption Medicine R
Acceso en línea:	https://doaj.org/article/7871adfd224f41ec96b1d6c0b28152f3
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spelling	oai:doaj.org-article:7871adfd224f41ec96b1d6c0b28152f32021-11-11T16:18:51ZEarly Implementation of a Patient-Centered Medical Home in Singapore: A Qualitative Study Using Theory on Diffusion of Innovations10.3390/ijerph1821111601660-46011661-7827https://doaj.org/article/7871adfd224f41ec96b1d6c0b28152f32021-10-01T00:00:00Zhttps://www.mdpi.com/1660-4601/18/21/11160https://doaj.org/toc/1661-7827https://doaj.org/toc/1660-4601Patient-Centered Medical Home (PCMH) has been found to improve care for complex needs patients in some countries but has not yet been widely adopted in Singapore. This study explored the ground-up implementation of a PCMH in Singapore by describing change strategies and unpacking initial experience and perception. In-depth interviews were conducted for twenty-two key informants from three groups: the implementers, their implementation partners, and other providers. “Diffusion of innovations” emerged as an overarching theory to contextualize PCMH in its early implementation. Three core “innovations” differentiated the PCMH from usual primary care: (i) team-based and integrated care; (ii) empanelment; and (iii) shared care with other general practitioners. Change strategies employed to implement these innovations included repurposing pre-existing resources, building a partnership to create supporting infrastructure and pathways in the delivery system, and doing targeted outreach to introduce the PCMH. Initial experience and perception were characterized by processes to “adopt” and “assimilate” the innovations, which were identified as challenging due to less predictable, self-organizing behaviors by multiple players. To work with the inherent complexity and novelty of the innovations, time, leadership, standardized methods, direct communication, and awareness-building efforts are needed. This study was retrospectively registered (Protocol ID: NCT04594967).Zoe Zon Be LimMumtaz Mohamed KadirMimaika Luluina GintingHubertus Johannes Maria VrijhoefJoanne YoongChek Hooi WongMDPI AGarticlePatient-Centered Medical Homeprimary careinnovationimplementationcomplex needsadoptionMedicineRENInternational Journal of Environmental Research and Public Health, Vol 18, Iss 11160, p 11160 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Patient-Centered Medical Home primary care innovation implementation complex needs adoption Medicine R
spellingShingle	Patient-Centered Medical Home primary care innovation implementation complex needs adoption Medicine R Zoe Zon Be Lim Mumtaz Mohamed Kadir Mimaika Luluina Ginting Hubertus Johannes Maria Vrijhoef Joanne Yoong Chek Hooi Wong Early Implementation of a Patient-Centered Medical Home in Singapore: A Qualitative Study Using Theory on Diffusion of Innovations
description	Patient-Centered Medical Home (PCMH) has been found to improve care for complex needs patients in some countries but has not yet been widely adopted in Singapore. This study explored the ground-up implementation of a PCMH in Singapore by describing change strategies and unpacking initial experience and perception. In-depth interviews were conducted for twenty-two key informants from three groups: the implementers, their implementation partners, and other providers. “Diffusion of innovations” emerged as an overarching theory to contextualize PCMH in its early implementation. Three core “innovations” differentiated the PCMH from usual primary care: (i) team-based and integrated care; (ii) empanelment; and (iii) shared care with other general practitioners. Change strategies employed to implement these innovations included repurposing pre-existing resources, building a partnership to create supporting infrastructure and pathways in the delivery system, and doing targeted outreach to introduce the PCMH. Initial experience and perception were characterized by processes to “adopt” and “assimilate” the innovations, which were identified as challenging due to less predictable, self-organizing behaviors by multiple players. To work with the inherent complexity and novelty of the innovations, time, leadership, standardized methods, direct communication, and awareness-building efforts are needed. This study was retrospectively registered (Protocol ID: NCT04594967).
format	article
author	Zoe Zon Be Lim Mumtaz Mohamed Kadir Mimaika Luluina Ginting Hubertus Johannes Maria Vrijhoef Joanne Yoong Chek Hooi Wong
author_facet	Zoe Zon Be Lim Mumtaz Mohamed Kadir Mimaika Luluina Ginting Hubertus Johannes Maria Vrijhoef Joanne Yoong Chek Hooi Wong
author_sort	Zoe Zon Be Lim
title	Early Implementation of a Patient-Centered Medical Home in Singapore: A Qualitative Study Using Theory on Diffusion of Innovations
title_short	Early Implementation of a Patient-Centered Medical Home in Singapore: A Qualitative Study Using Theory on Diffusion of Innovations
title_full	Early Implementation of a Patient-Centered Medical Home in Singapore: A Qualitative Study Using Theory on Diffusion of Innovations
title_fullStr	Early Implementation of a Patient-Centered Medical Home in Singapore: A Qualitative Study Using Theory on Diffusion of Innovations
title_full_unstemmed	Early Implementation of a Patient-Centered Medical Home in Singapore: A Qualitative Study Using Theory on Diffusion of Innovations
title_sort	early implementation of a patient-centered medical home in singapore: a qualitative study using theory on diffusion of innovations
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/7871adfd224f41ec96b1d6c0b28152f3
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Early Implementation of a Patient-Centered Medical Home in Singapore: A Qualitative Study Using Theory on Diffusion of Innovations

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