Moving from specialist-led to generalist-led hospital care: propensity-matched analyses of clinical outcomes and survey of patient care experiences
Abstract
Introduction: In this study, we aimed to compare the clinical outcomes of patients who received care under a new generalist-led hospital care model — the Integrated General Hospital (IGH) — with those receiving care under the usual specialist-led hospital model, and to examine patients’ care experiences of the IGH model. Methods: A retrospective propensity-matched analysis comparing attendees of IGH (n = 2,127) and usual care attendees at a different hospital (n = 2,127) was conducted between 1 January 2019 and 31 August 2019. Clinical outcomes included length of stay, 30-day readmission, inpatient mortality and mortality within 30 days of discharge. In addition, a patient survey on IGH care experiences (n = 270) was conducted between 7 October 2019 and 12 April 2021. A two-sample t-test or chi-square test was used to compare the matched samples. For time-to-event variables, a Cox proportional hazards model was used to estimate the hazard ratio with 95% confidence intervals. Results: After propensity-matching, statistically significant differences were found between the IGH and usual care groups for length of stay (P = 0.003), inpatient mortality (P = 0.007) and mortality within 30 days of discharge (P = 0.014), but not for 30 day readmission (P = 0.456). The hazard ratio for 30-day readmission was 0.94 (P = 0.46) and for mortality within 30 days of discharge was 0.51 (P = 0.01). Survey responses on IGH care found the care experiences were generally positive, particularly in terms of provider–patient communication and perceived staff teamwork. Conclusion: Initial analysis of the IGH model was associated with better clinical outcomes in some respects compared with the usual care model. Patient care experiences of IGH were also favourable. An ongoing prospective study will explore the longer-term clinical impact of the IGH care model, including the effect on postdischarge care and care continuity.
Related
- Impact of Neuromuscular Blocking Agents on Hospital Outcomes in Mechanically Ventilated Patients With Sepsis: Propensity Score Analyses of A Nationwide Sepsis Cohort
- A Novel Informatics-Driven Model for Proactive Radiation Safety Management: Lessons from a Tumor Specialist Hospital in China.
- Vibration‐Controlled Transient Elastography (VCTE)‐Based Prevalence and Assessment of Hepatic Steatosis and Fibrosis in a UK Tertiary Hospital‐Based Specialist Weight Management Service: A Real‐World Evaluation
- Pressure injuries as adverse events in the context of patient’s safety during 2013–2020 in a specialist hospital: A retrospective study
- Preoperative sustained C-reactive protein elevation shortens patient survival after liver resection for perihilar cholangiocarcinoma : A retrospective cohort study with propensity score analyses
BibTeX
@article{yeeweilim2026moving,
title = {{Moving from specialist-led to generalist-led hospital care: propensity-matched analyses of clinical outcomes and survey of patient care experiences}},
author = {Yee Wei Lim, PhD and Sin Hui Neo, MSc and Ee Lin Kimberly Teo, BSc and Cherylanne Tan, BSc and Lin Siew Chong, MSc and Anjali Bundele, MPH and Jennifer Sumner, PhD},
journal = {Singapore Medical Journal},
year = {2026},
month = sep,
doi = {10.4103/singaporemedj.smj-2023-092},
url = {https://doi.org/10.4103/singaporemedj.smj-2023-092},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Moving from specialist-led to generalist-led hospital care: propensity-matched analyses of clinical outcomes and survey of patient care experiences
AU - Yee Wei Lim, PhD
AU - Sin Hui Neo, MSc
AU - Ee Lin Kimberly Teo, BSc
AU - Cherylanne Tan, BSc
AU - Lin Siew Chong, MSc
AU - Anjali Bundele, MPH
AU - Jennifer Sumner, PhD
PY - 2026
DA - 2026/09/01
JO - Singapore Medical Journal
DO - 10.4103/singaporemedj.smj-2023-092
UR - https://doi.org/10.4103/singaporemedj.smj-2023-092
AB - Introduction: In this study, we aimed to compare the clinical outcomes of patients who received care under a new generalist-led hospital care model — the Integrated General Hospital (IGH) — with those receiving care under the usual specialist-led hospital model, and to examine patients’ care experiences of the IGH model. Methods: A retrospective propensity-matched analysis comparing attendees of IGH (n = 2,127) and usual care attendees at a different hospital (n = 2,127) was conducted between 1 January 2019 and 31 August 2019. Clinical outcomes included length of stay, 30-day readmission, inpatient mortality and mortality within 30 days of discharge. In addition, a patient survey on IGH care experiences (n = 270) was conducted between 7 October 2019 and 12 April 2021. A two-sample t-test or chi-square test was used to compare the matched samples. For time-to-event variables, a Cox proportional hazards model was used to estimate the hazard ratio with 95% confidence intervals. Results: After propensity-matching, statistically significant differences were found between the IGH and usual care groups for length of stay (P = 0.003), inpatient mortality (P = 0.007) and mortality within 30 days of discharge (P = 0.014), but not for 30 day readmission (P = 0.456). The hazard ratio for 30-day readmission was 0.94 (P = 0.46) and for mortality within 30 days of discharge was 0.51 (P = 0.01). Survey responses on IGH care found the care experiences were generally positive, particularly in terms of provider–patient communication and perceived staff teamwork. Conclusion: Initial analysis of the IGH model was associated with better clinical outcomes in some respects compared with the usual care model. Patient care experiences of IGH were also favourable. An ongoing prospective study will explore the longer-term clinical impact of the IGH care model, including the effect on postdischarge care and care continuity.
SN - 0037-5675
SN - 2737-5935
ER -