Mobile Inpatient Care @ Home Sandbox To Expand To More Public Hospitals To Cover More Medical Conditions

Paediatrics and rehabilitation medicine are among the new conditions included in the expanded MIC@Home Sandbox.

1. 7 August 2023 – More patients will be able to receive hospital-type care in the comfort of their home with the expansion of the Mobile Inpatient Care-at-Home (MIC@Home) pilot to more public healthcare institutions. The pilot will bolster future hospital planning and add bed capacity buffer for the healthcare system. In addition, MIC@Home will serve as a means to provide appropriate care for the patient in a more comfortable environment without sacrificing care outcomes.

2. First launched in April 2022, the MIC@Home pilot offers patients the option to be cared for in their own home instead of in a hospital ward. This pilot is managed by MOH Office for Healthcare Transformation (MOHT) and supported by MOH’s MIC@Home Regulatory and Financing Sandbox. Selected patients with conditions classified under general medicine, such as skin infections, urinary tract infections and congestive heart failure with fluid overload, can be admitted to a “virtual” ward where they have round-the-clock access to care delivered by a team of healthcare professionals via teleconsultations and home visits, until they are deemed fit for discharge. The care they receive, as well as resulting outcomes, are expected to be non-inferior to that in hospitals. Care escalation protocols, including transfers back to hospital, could be triggered if the patient’s condition deteriorates. MIC@Home patients can receive subsidies and funding that will simulate MediShield Life and MediSave coverage for an equivalent hospital admission.

Expansion of MIC@Home to more conditions, across more hospitals

3. Following the pilot implementation at hospitals under the National University Health System (NUHS), Singapore General Hospital (SGH) and Khoo Teck Puat Hospital (KTPH) in April 2022, MIC@Home has now been expanded to four more hospitals, namely: Changi General Hospital (CGH), KK Women’s and Children’s Hospital (KKH), Sengkang General Hospital (SKH) and Tan Tock Seng Hospital (TTSH).

4. Apart from general medicine, suitable patients from selected speciality including paediatric medicine, obstetrics and gynaecology, rehabilitation medicine, and elective surgeries can now be admitted to MIC@Home. As of June 2023, around 1,000 patients have benefitted from the programme, resulting in an estimated savings of 7,000 bed days.

5. One notable addition to MIC@Home is the enrolment of children and women into the KKH@Home specialist programme. Children with common conditions, such as dengue fever, skin infections, eczema and urinary tract infection, as well as women with gynaecological conditions, and skin and wound infections, can now also be cared for at home instead of being admitted to hospital.

6. Associate Professor Mark Koh, Clinician Lead for KKH@Home, as well as Head and Senior Consultant, Department of Dermatology, KKH said, “Using remote, real-time technology for vital signs monitoring in home care has added benefits like reduced anxiety levels, minimised risk of exposure to other infections, and streamlined hospital workflows, all leading to better patient outcomes. It is particularly beneficial for children, who may feel anxious in a hospital environment. There are cost and time savings, with greater convenience and less disruption to busy schedules for those who are working. Doctors and nurses are also able to still identify and respond to changes in patients’ condition in a timely manner.”

7. Another recent specialist care inclusion is rehabilitation medicine cases from TTSH, such as patients undergoing intensive therapy sessions with physiotherapists and occupational therapists in the hospital wards. Adj Asst Prof Endean Tan, Clinical Director of MIC@Home (TTSH) and Senior Consultant at the Department of General Medicine, said: “The goal of rehabilitation is to build patients’ strength and function so that they may continue to live meaningfully in the community. Bringing this care into patients’ own homes will not only enable them to recover in a familiar environment but allow caregivers to be more involved in the recovery journey”.

8. SKH@Home also commenced operations recently with the initial focus to recruit suitable patients from the Emergency Department (ED) to reduce the wait time for a bed. Said Adj Asst Prof Jean Lee, Director, Transitional Care and Community Medicine and Senior Consultant, Emergency Department at Sengkang General Hospital, and SKH@Home Clinician Lead: “Patients who are assessed to have stable medical conditions could have their treatment started promptly at ED and continued at home, where they can recover in the comfort of a familiar setting.”

Supporting Covid-19 patients at home

9. During the pandemic, CGH, KTPH, NUH and SGH ran Covid-19 “virtual wards” that allowed about 700 Covid-19 infected patients to recover at home safely, thus collectively saving KTPH, NUH and SGH over 5,000 bed days between September to December 2021. As we move towards endemicity in April 2023, these Covid-19 “virtual wards” will be incorporated into MIC@Home as a use case due to ceasing of Covid-19 funding from MOH.

Wearable devices and non-contact devices to support patients at home

10. The expansion of the MIC@Home care model pilot implementation with more patient profiles paves the way for the adoption of promising technological solutions, for more seamless care. New capabilities such as remote monitoring for paediatric cases including wearable devices for children as young as 6 years old are being explored. With this, care teams can closely monitor patients’ conditions and work alongside patients’ families to track patients’ needs.

11. Beyond the conventional vital signs monitoring technologies, there has been some development in the remote-photoplethysmography (rPPG) and thermo-imaging space. These technological enhancements have enabled non-contact devices to monitor the patient’s vital signs such as heart rate, temperature and even respiratory rate.

12. MOHT has been working with MOH and Synapxe on a technology adoption and governance framework to guide the development and implementation of technology enablers for this care model. This is to ensure that patient information can be transmitted securely and seamlessly for patient monitoring and care delivery.

Delivering effective care to patients at home

13. Studies of similar models overseas has demonstrated that MIC@Home can help reduce hospitalisation costs by decreasing overhead costs, shortening in-hospital stays, reducing readmissions, improving resource utilisation, and improving patient outcomes.

14. To this end, MOH and MOHT will continue to rigorously evaluate the MIC@Home programme to work towards mainstreaming of the programme. The success of MIC@Home will simplify how patients can access quality medical care and treatment at home for a range of conditions.

15. Said Mr Lai Yi Feng, Assistant Director and Project Lead at MOHT: “We believe that MIC@Home, as a care delivery model, can help address the fast-growing healthcare needs in Singapore. Given the pilot findings obtained so far, we are also optimistic that it might even cost less compared to existing hospital-based care. There are also aspirations to include patients with a higher clinical severity of presenting medical conditions and who require a higher acuity of care in the future. To be able to mainstream this care model, however, we will require regulatory and financing policy redesign that fundamentally redefines the mission and scope of “home-based care services”. With the expansion in scope and reach for the Sandbox, MOHT hopes to maximise the learning and curation of implementation and policy strategies that could be put in place as the care model is progressively scaled-up after the current Sandbox concludes in 2024.”

Future aspirations and possibilities for MIC@Home

16. The three earlier pilot sites at NUHS, SGH and Yishun Health have demonstrated early proof of concept results. There is potential for the model to provide a sustainable alternative to traditional hospital care.

17. Alexandra Hospital Deputy Director of Nursing Janet Lam, Head Nurse for NUHS@Home, said: “With nearly three years of experience in caring for patients at home, we have really seen the benefit of patients being able to receive treatment and recover in the comfort of their homes and surrounded by family. We have also grown into a cohesive team of healthcare staff who are now skilled at delivering such care for patients at home. As we grow our service to enable more patients in the west of Singapore be cared for at home, we are actively recruiting more nurses, allied health professionals and doctors to join our team.”

18. MIC@Home will continue to partner stakeholders to improve patient experiences and outcomes, and reduce cost to payers and the healthcare system. The care model is also designed to ease the burden on hospitals and healthcare facilities in the long run, particularly in terms of physical resources like bed capacity. It can serve as an alternative mode of inpatient care delivery, helping hospitals to right-site and manage patient loads more effectively. This could be especially crucial during peak times or emergencies like a pandemic, where healthcare resources may be strained.

¹ The care model is designed to ease the burden on hospitals and healthcare facilities, particularly in terms of physical resources like bed capacity. It can serve as an alternative mode of inpatient care delivery, helping hospitals to right-site and manage patient loads more effectively. This could be especially crucial during peak times or emergencies like a pandemic, where healthcare resources may be strained.

² Hospitals under the National University Health System include the National University Hospital, Ng Teng Fong General Hospital and Alexandra Hospital.