Impact of value-driven care initiatives on clinical quality indicators in children admitted with community-acquired pneumonia in Singapore

INTRODUCTION: Healthcare policymakers are focusing increasingly on value-driven care (VDC) models that aim to improve the quality of care and outcomes. We aimed to study the impact of community-acquired pneumonia (CAP) VDC initiatives on the trends in clinical quality indicators over a 7-year period (2018-2024). METHODS: Children admitted with CAP from January 2018 to December 2024 to KK Women's and Children's Hospital, Singapore, were included. We adopted a multifaceted approach to improving clinical quality indicators (length of stay [LOS] ≤5 days, no 30-day complications, no 30-day readmissions and no inpatient mortality) and the Clinical Quality Index (CQI)-the proportion of patients who meet all four clinical quality indicators. RESULTS: The total number of CAP admissions varied across the years (P < 0.05), with the highest number recorded in 2024 (n = 3197). The vast majority (68.7%) were of preschool age (<5 years). Viral CAP was the most common category, except in 2024 when a surge in CAP due to Mycoplasma pneumoniae was observed. The baseline CQI of 84% in 2018 (pre-VDC) increased to 90.3% in 2024 (P < 0.001). This was primarily driven by the improvement in LOS. The LOS (mean ± standard deviation) decreased from 3.65 ± 3.83 days in 2018 to 2.94 ± 2.00 days in 2024 (P < 0.001). CONCLUSION: This study highlights the positive impact of CAP VDC initiatives on key clinical quality indicators in children admitted with CAP over a 7-year period. The VDC model is scalable, and a similar multifaceted approach may be applied to VDC models for other acute and chronic conditions.