Introduction: Population ageing is one of humanity's greatest challenges in the 21st century, which will undoubtedly put increased health, economic and social demands on all countries. In Singapore, an integrated approach is being undertaken by the various government agencies to manage the ‘silver tsunami’. From the healthcare front, a central body—the Agency for Integrated Care (AIC)—has been set up to facilitate and coordinate care services so that patients can be cared for at the most appropriate settings.
Aim: To discuss the concept and principles of care coordination in Singapore context and its impact on aged care landscape.
Results: One of the projects undertaken by AIC is the Aged Care Transition (ACTION) Project. Piloting at five acute hospitals in Singapore, ACTION is a 4-year, 22-million project funded by the government. The aim of Aged Care Transition (ACTION) Team is to help patients make an important transition from hospital into their home or community. This is done by streamlining and coordinating care services thereby optimizing outcomes throughout and following an episode of illness. With trained care coordinators at these pilot sites, the project helps to establish a line of open communication as well as point of contact amongst acute setting, AIC Headquarters and the community service providers. It is also through this project that the effectiveness of care coordination (in the form of unplanned readmissions and attendances at A&E) as well as areas of improvement in both acute and community setting are identified and intervened.
Conclusion: The preliminary findings of ACTION shows that this new initiative helps to reduce average length of stay (ALOS) in acute settings, foster interagency collaboration and improve access to services for patients.