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Reading: Measuring the maturity of integrated care in Singapore with the SCIROCCO Exchange tool.

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Measuring the maturity of integrated care in Singapore with the SCIROCCO Exchange tool.

Authors:

Angeline Lim ,

Saw Swee Hock School of Public Health, National University of Singapore National Healthcare Group, SG
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Jason Chin Huat Yap

Saw Swee Hock School of Public Health, National University of Singapore, SG
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Abstract

Introduction: How have we progressed and where are the gaps of integrated care in Singapore? Social-health care provision in the context of an ageing population is critical in the city-state’s management of the unprecedented demand as the proportion of seniors with multiple complex medical needs has almost doubled in the past decade. The concept of integrated health and social care has been increasingly discussed due to its role in advancing the Quadruple Aims of healthcare. 

Aims & Methods: Using the SCIROCCO Exchange tool, this paper explores the maturity of the overall integration of Singapore’s health and social care system, identifies strengths and gaps and recommends follow-up actions. The SCIROCCO Exchange tool consists of 12 domains necessary for the provision of integrated care. A three-step mixed method Delphi study was used to derive expert consensus. At each iteration, participants rated each of the twelve domains of the SCIROCCO Exchange tool on a six-point ordinal and provided justifications for each rating. Criteria from the RAND UCLA appropriateness method and thematic analysis were adopted for the analysis. The six-point scale was tiered into maturity levels – “Initial”, “Progressing”, “Optimising” and “Uncertain”, based on the median and distribution of responses.

Findings: All 12 participants completed the study and reached agreement on the maturity level for most domains over three rounds of Delphi study.  The study found that five domains of integrated care are in “Initial” maturity level and five domains in “Progressing” maturity level. Participants had split responses in two remaining domains, viz Breadth of Ambition and Capacity Building.  For the former, the split responses suggested that participants adopted varying interpretations and expectations of integrated care, where the latter seemed to suggest the absence of a systematic building of capacity for integrated care, with social-health care remaining in silos. 

Conclusion: In participants’ justifications for their ratings, the absence of a systematic approach for integrated care was the most common subtheme across all dimensions.  Coordination is limited to programme- or disease-specific, due to operational challenges because of separate social-health ministries and limited digital infrastructure to support data-sharing.

Implications: Depending on the role they play in the provision of integrated care, participants appeared to have different responses because of different vantage points and interpretations of integrated care. The common subtheme of the felt absence of a systematic approach for integrated care is foundational and suggests where the current gaps are.

 

The findings reflect that there is a sequence to the domains, where certain domains are foundational to lead the progress of other domains. When the foundational domains are weak, the progress in other domains becomes limited.  The development of a population health roadmap which spans social-health care sectors could be favourable, as it would guide policymakers, healthcare and social care professionals to consider a systematic and strategic approach that could further strengthen the design and deployment of social-healthcare in Singapore.  Future thoughts on approaches to restructure the governance of social-health care agencies and citizens’ consultation on integrated care are warranted.

 

How to Cite: Lim A, Yap JCH. Measuring the maturity of integrated care in Singapore with the SCIROCCO Exchange tool.. International Journal of Integrated Care. 2022;22(S3):203. DOI: http://doi.org/10.5334/ijic.ICIC22099
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Published on 04 Nov 2022.

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