Evaluation of caregiver stress under Medical Home – A Hospital at Home service integrating care towards the Unified Care Model

Background: Medical Home (MH) is a Hospital-at-Home (HaH) service model by Yishun Health (YH) delivering multi-disciplinary care for patients requiring acute medical care in their homes. Yishun Health (YH) is a regional hospital system caring for 300,000 people in the north of Singapore that has embarked on a multi-year, whole regional health system transformation to improve outcomes. Care and services delivery transformation to enable greater person-centeredness and value-driven integration of care is based on the Unified Care Model (UCM) and its two subsidiary Episodic and Lifelong Care Models. A Population Health Survey conducted by YH in 2022 had also revealed that close to half of the caregivers living in the northern population served by YH reported caregiving-related needs that may require our help. MH is a critical component to enable YH’s ongoing remodeling of Episodic Care to meet residents’ needs during episodes of acute medical crisis and has been hypothesized to improve patient experience as well as reduce care giver burden. Methods: A mixed-method quasi-experimental study designed to recruit 125 eligible patients under MH, and 125 eligible patients who underwent usual hospital care under control group (CG) is currently ongoing. A preliminary analysis of the caregiver stress measured at admission, discharge and 90-days post-discharge from MH or the hospital was conducted for 125 MH patients and 125 controls. Caregiver was defined as the main spokesperson in charge of patient’s care, excluding domestic helper. Caregiver stress was measured using the Zarit Caregiver Burden Interview Short Form (ZBI-12). Results: Caregivers in both groups had similar age, gender, ethnicity, marital status and education level. A larger proportion of MH caregivers are working full time (MH 68.2% vs CG 50%; p0.033) while a larger proportion of CG caregivers has domestic helpers who live in with patients (MH 6.8% vs CG 44%; p<0.05). MH and control group caregivers had similar ZBI-12 scores on admission (MH: 12.35 vs CG: 12.56; p0.893) and discharge (MH: 10.57 vs CG: 12.06; p0.379). MH caregivers had a significantly lower ZBI-12 score compared to CG caregivers at 90-days post-discharge, (MH: 7.17 vs CG: 10.94; p0.019), indicating lower caregiver stress. Conclusions: MH service model is a value driven HaH alternative to Inpatient Care and supports YH’s ongoing remodeling of care process towards the Episodic Care Model. Caregivers of patients served by MH experienced significantly lower caregiver stress even at 90 days post discharge, despite a lower proportion having domestic helpers. More studies should be done to further evaluate the factors associated with caregiver stress and how a HaH service like MH can support and benefit more caregivers. Systemic scaling up of MH may help address and improve the extent of caregiving-related needs reported by YH’s northern population.