A generalist-led care, the Integrated General Hospital (IGH) care model, demonstrates a numerically lower number of deaths and clinical outcomes comparable to a specialist-led care, the usual care model, as shown in a Singapore study. Patient care experiences with IGH are also positive.
“[O]ur study found that the IGH care model was associated with a lower risk of mortality, although there was no statistically significant difference in readmission risk between the IGH and usual care groups,” said the researchers, who led a propensity-matched analysis comparing attendees of IGH (n=2,127) and of usual care at a different hospital (n=2,127) between 1 January 2019 and 31 August 2019.
Clinical outcomes assessed were as follows: length of stay, 30-day readmission, inpatient mortality, and mortality within 30 days of discharge. A patient survey on IGH care experiences was also conducted in 270 participants between 7 October 2019 and 12 April 2021.
Furthermore, the research team compared the matched samples using a two-sample t-test or chi-square test. They also estimated the hazard ratio (HR) with 95 percent confidence intervals (CIs) using a Cox proportional hazards model for time-to-event variables.
Clinical outcomes were similar between the IGH and usual care groups for length of stay (6.4 vs 5.7 days; p=0.003), inpatient mortality (25 [1 percent] vs 48 [2 percent]; p=0.007), mortality within 30 days of discharge (21 [1 percent] vs 40 [2 percent]; p=0.014), and 30-day readmission (294 [14 percent] vs 311 [15 percent]; p=0.456). [Singapore Med J 2026;67:552-558]
The HR for 30-day readmission was 0.94 (95 percent CI, 0.80‒1.10; p=0.46), while that for mortality within 30 days of discharge was 0.51 (95 percent CI, 0.30‒0.87; p=0.01).
The numerically lower number of deaths in the IGH group could have been driven by a “more holistic generalist approach to patient management, where the care team makes a bigger effort to address patients’ health and nonhealth needs,” the researchers said.
“Another possible reason is the linking of acute and rehabilitative care, where IGH therapists provided more frequent rehabilitation with longer duration of sessions,” they added
Favourable experience
Furthermore, patient experience with IGH care was generally positive based on survey responses, especially with regard to provider‒patient communication and perceived staff work.
One patient stated that the doctors and nurses “were very good, had good communication,” and another said, “[T]here is no miscommunication between me and the doctors.”
These findings contribute to the ongoing debate on generalist- vs specialist-led care, according to the researchers. [Singapore Med J 2019;60:3-8]
In 2013, the Royal College of Physicians recommended more generalists (ie, advanced internal medicine physicians) and fewer specialists (ie, physicians with subspecialty training) in hospitals. [https://www.rcp.ac.uk/resources/future-hospital-commission/]
“Similar opinions have been expressed in Singapore. In the past few decades, specialist care has been the mainstay in hospitals. Investment in specialist training and infrastructure has been larger than in generalist and primary care,” the researchers said.
“As the number of patients with multimorbidity increases, the generalist approach of IGH might be worth developing further,” they added.
Furthermore, IGH care could improve care continuity and reduce the “siloed care experience” when several specialists manage patients. [N Engl J Med 2008;358:1064-1071; BMJ 2003;327:1219-1221; Eur J Intern Med 2022;98:47-52; J Gen Intern Med 2018;33:1848-1850]
“Hospital-based generalist-led integrated care for multimorbid patients could be an approach worth further exploration to complement ongoing efforts to provide more holistic care for patients in Singapore,” the researchers said.