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

Zoe Zon Be Lim, Mumtaz Mohamed Kadir, Mimaika Luluina Ginting, Hubertus Johannes Maria Vrijhoef, Joanne Yoong and Chek Hooi Wong
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Zoe Zon Be Lim: Geriatric Education and Research Institute, Singapore 768024, Singapore
Mumtaz Mohamed Kadir: Geriatric Education and Research Institute, Singapore 768024, Singapore
Mimaika Luluina Ginting: Geriatric Education and Research Institute, Singapore 768024, Singapore
Hubertus Johannes Maria Vrijhoef: Panaxea, 1098 XH Amsterdam, The Netherlands
Joanne Yoong: Geriatric Education and Research Institute, Singapore 768024, Singapore
Chek Hooi Wong: Geriatric Education and Research Institute, Singapore 768024, Singapore

IJERPH, 2021, vol. 18, issue 21, 1-20

Abstract: 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).

Keywords: Patient-Centered Medical Home; primary care; innovation; implementation; complex needs; adoption; assimilation (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (2)

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