Potential of Interface Care Models to Deliver More Appropriate Care to Patients With Acute Medical Illness

NCT07536035 | Recruiting

• 1 other identifier: MOH-001435-00
• Study Type: observational
• Target: 220
• Locations: 1 country
• Sites: 1

Brief Summary

Every country in the world is experiencing growth in both the size and the proportion of older persons. As a result of the changes, the profile and needs of people with medical illnesses have evolved. How care is delivered to patients has to keep pace with these changes, or patients will experience poor care at high cost and not have their needs met. A new model of care has emerged to meet these challenges: Acute Medical Unit. Despite considerable investment and popularity of this model, questions remain: (i) Who benefits most from this care model? (ii) How may these models be most effectively implemented for the best results? (iii) How effective are these models? Singapore is well-placed to answer these questions with its national healthcare system and excellent research institutions. The investigators plan to study how effective the model is by comparing patients with similar profiles exposed to both these care models compared to how hospital care is usually provided, looking for four differences: (i) how long patients stay in hospital, (ii) how often they use the emergency department (iii) quality of health (iv) cost. Additionally, the investigators seek to characterise patterns of health needs for this group of patients.

Conditions

Falls Injury; Falls; Hospitalization in Acute Care; Chronic Obstructive Pulmonary Disease (COPD); Infection; Acute Exacerbation of Asthma; Pneumonia; UTI - Urinary Tract Infection; URTI - Viral Upper Respiratory Tract Infection

Keywords

Acute Medical Unit; Acute Medicine; Interface Care; Clinical effectiveness; Cost effectiveness; prospective observational; matched controlled

Outcome Measures

Primary Outcomes (1)

• Mean acute care bed-days utilised

  Average total days of acute hospital stay, including the index episode, for each patient. Measures efficiency of hospital care between AMU and GW groups.

  Up to 6 months following discharge

Secondary Outcomes (9)

• Patient Outcomes - Health-related Quality of Life (EQ-5D-5L)

  Baseline (Day 0, at discharge), 3 months post-discharge, and 6 months post-discharge

• Patient Outcomes - Patient Activation Measure (PAM-13)

  Baseline (Day 0, at discharge) and 6 months post-discharge

• Patient Outcomes - World Health Organisation Five Wellbeing (WHO-5)

  Baseline (Day 0, at discharge), 3 months post-discharge, and 6 months post-discharge

• Patient Outcomes - Patient Health Questionnaire (PHQ-9)

  Baseline (Day 0, at discharge) and 6 months post-discharge

• Patient Outcomes - Functional Dependence (Barthel Index)

  Baseline (Day 0, at discharge) and 6 months post-discharge

Other Outcomes (1)

• Cost-effectiveness

  Up to 6 months from discharge

Study Arms (2)

Acute Medical Unit (AMU) Patients

Patients admitted to the AMU from the Emergency Department (ED) or specialist clinics as their first admission ward. The AMU provides rapid assessment and early intervention to improve efficiency of care. Participants will primarily include adults with acute medical illnesses such as infection-related conditions, falls/disequilibrium, or acute exacerbation of COPD.

General Ward (GW) Control Patients

Patients admitted directly from the ED to General Wards under the Division of Advanced Internal Medicine. Patients will be matched to the AMU group by diagnosis group, age, gender, illness severity, comorbidities, frailty, and functional status to minimize confounding factors.

Eligibility Criteria

• Age: 21 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

The study population will consist of adult patients admitted to the National University Hospital (NUH), Singapore, for acute medical conditions. Participants will be recruited either from the Acute Medical Unit (AMU) or directly to the General Ward (GW) following presentation to the Emergency Department. Patients represent a typical mix of acute medical admissions seen in a tertiary hospital setting, including infection-related illnesses, falls with disequilibrium, and acute exacerbations of chronic diseases such as Chronic Obstructive Pulmonary Disease (COPD).

You may qualify if:

• Acute medical illnesses that includes infection-related conditions, falls-disequilibrium, and acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD).

You may not qualify if:

• Below 21 years old
• Patients undergoing active chemotherapy
• Patients with active pregnancy
• Patients admitted less than 24 hours
• Cerebrovascular disease requiring thrombolysis or intravascular intervention

Sponsors & Collaborators

• National University Hospital, Singapore: lead
• Duke-NUS Graduate Medical School: collaborator

Study Sites (1)

National University Hospital

Singapore, 119228, Singapore

RECRUITING

Related Publications (5)

• Lateef A, Lee SH, Fisher DA, Goh WP, Han HF, Segara UC, Sim TB, Mahadehvan M, Goh KT, Cheah N, Lim AYT, Phan PH, Merchant RA. Impact of inpatient Care in Emergency Department on outcomes: a quasi-experimental cohort study. BMC Health Serv Res. 2017 Aug 14;17(1):555. doi: 10.1186/s12913-017-2491-x.

  PMID: 28806942 BACKGROUND

• Balakrishnan T, Teo PSE, Lim WT, Xin XH, Yuen BH, Wong KS. Acute Medical Ward for better care coordination of patients admitted with infection - evidence from a tertiary hospital in Singapore. Acute Med. 2017;16(4):170-176.

  PMID: 29300795 BACKGROUND

• Reid LE, Dinesen LC, Jones MC, Morrison ZJ, Weir CJ, Lone NI. The effectiveness and variation of acute medical units: a systematic review. Int J Qual Health Care. 2016 Sep;28(4):433-46. doi: 10.1093/intqhc/mzw056. Epub 2016 Jun 16.

  PMID: 27313174 BACKGROUND

• Soong JTY, Bell D, Ong MEH. Meeting today's healthcare needs: Medicine at the interface. Ann Acad Med Singap. 2022 Dec;51(12):787-792. doi: 10.47102/annals-acadmedsg.2022196.

  PMID: 36592147 BACKGROUND

• Roseveare C. Acute medicine and general practice: a key interface in managing emergency care pressures. Br J Gen Pract. 2014 Mar;64(620):122-3. doi: 10.3399/bjgp14X677392. No abstract available.

  PMID: 24567628 BACKGROUND

MeSH Terms

Conditions

Pulmonary Disease, Chronic Obstructive; Infections; Pneumonia; Urinary Tract Infections

Condition Hierarchy (Ancestors)

Lung Diseases, Obstructive; Lung Diseases; Respiratory Tract Diseases; Chronic Disease; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Respiratory Tract Infections; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases

Central Study Contacts

John TY Soong, PhD

CONTACT

+6567727678; John_Soong@nuhs.edu.sg

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: January 25, 2026
• First Posted: April 17, 2026
• Study Start: September 30, 2024
• Primary Completion (Estimated): May 31, 2026
• Study Completion (Estimated): May 31, 2026
• Last Updated: April 17, 2026

Record last verified: 2025-09

Locations

SG (1)