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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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Geriatric Education and Research Institute, Singapore 768024, Singapore
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Panaxea, 1098 XH Amsterdam, The Netherlands
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Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
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Center for Economic and Social Research, University of Southern Carolina, Los Angeles, CA 90089, USA
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Research for Impact, Singapore 159964, Singapore
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Tsao Foundation, Singapore 168730, Singapore
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Health Services & Systems Research, Duke-NUS, Singapore 169857, Singapore
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Author to whom correspondence should be addressed.
Academic Editor: Paul B. Tchounwou
Int. J. Environ. Res. Public Health 2021, 18(21), 11160; https://doi.org/10.3390/ijerph182111160
Received: 5 October 2021 / Revised: 21 October 2021 / Accepted: 22 October 2021 / Published: 24 October 2021
(This article belongs to the Section Health Care Sciences & Services)
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). View Full-Text
Keywords: Patient-Centered Medical Home; primary care; innovation; implementation; complex needs; adoption; assimilation Patient-Centered Medical Home; primary care; innovation; implementation; complex needs; adoption; assimilation
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MDPI and ACS Style

Lim, Z.Z.B.; Mohamed Kadir, M.; Ginting, M.L.; Vrijhoef, H.J.M.; Yoong, J.; Wong, C.H. Early Implementation of a Patient-Centered Medical Home in Singapore: A Qualitative Study Using Theory on Diffusion of Innovations. Int. J. Environ. Res. Public Health 2021, 18, 11160. https://doi.org/10.3390/ijerph182111160

AMA Style

Lim ZZB, Mohamed Kadir M, Ginting ML, Vrijhoef HJM, Yoong J, Wong CH. Early Implementation of a Patient-Centered Medical Home in Singapore: A Qualitative Study Using Theory on Diffusion of Innovations. International Journal of Environmental Research and Public Health. 2021; 18(21):11160. https://doi.org/10.3390/ijerph182111160

Chicago/Turabian Style

Lim, Zoe Z.B., Mumtaz Mohamed Kadir, Mimaika L. Ginting, Hubertus J.M. Vrijhoef, Joanne Yoong, and Chek H. Wong 2021. "Early Implementation of a Patient-Centered Medical Home in Singapore: A Qualitative Study Using Theory on Diffusion of Innovations" International Journal of Environmental Research and Public Health 18, no. 21: 11160. https://doi.org/10.3390/ijerph182111160

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