"Best Outcome, Best Experience"
- Clinical Quality - Assure Best Outcomes
- Service Quality - Create Seamless Service; Excel in Personalised Care
Singapore General Hospital is committed to deliver the best possible experience and clinical outcomes for our patients. As a testimony to our ongoing efforts, we are pleased to share pertinent data and information collected from surveys and studies regarding our patients' experience and clinical outcomes, benchmarked against our counterparts in healthcare locally or internationally where appropriate and available.
A)
Delivering Responsive Care
B)
Enhancing Our Patients’ Physical Ability To Function Independently
C)
Bringing Relief To Our Patients
D)
Providing Care That Is Safe
E)
Delivering Care That Is Effective
F)
Providing Care That Is Up-to-date With Current Medical Evidence Or Consensus
A) Delivering Responsive Care
A1. How Do Our Patients Rate Their Experience?
In an independent Patient Satisfaction Survey commissioned by the Ministry of Health in 2009, SGH ranked favourably among the various regional and tertiary public hospitals in Singapore. 78% of our patients expressed overall satisfaction and 84% said they would recommend the services of SGH to others, based on their perceptions on the following nine quality service attributes:
I. Facilities
II. Care coordination
III. Knowledge and skills of doctors
IV. Care and concern by doctors
V. Knowledge and skills of nurses
VI. Care and concern by nurses
VII. Knowledge and skills of allied health professionals
VIII. Care and concern by allied health professionals
IX. Clear explanation by staff on the procedures and care
Overall Satisfaction at the Public Hospitals (2005-2009)
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Would you recommend the hospital to others? (2005-2009)
Source: MOH
Note: Figures are rounded off
B) Enhancing Our Patients’ Physical Ability To Function Independently
B1. Are Our Stroke Patients Functionally More Independent After Receiving Medical Rehabilitation?
After receiving medical rehabilitation at our hospital, our stroke patients on average had an improvement of 3.7%, 24% and 16.6% in their Cognitive, Motor and Total Functional Independence Measure (FIM) scores respectively. The Functional Independence Measure (FIM) is a comprehensive assessment of disability and independence based on activities such as feeding, grooming, dressing, toileting, mobility, communication, social interaction, problem-solving and memory.
Source: Dept of Rehabilitation Medicine, SGH (Data from Jan 2006 to June 2008)
References:
1. Ng YS, Jung H, Tay SS, Bok CW, Chiong Y, Lim PA. Results From a Prospective Acute Inpatient Rehabilitation Database: Clinical Characteristics and Functional Outcomes using the Functional Independence Measure. Ann Acad Med Singapore. 2007 Jan;36(1):3-8
B2. Are Total Knee Replacement Surgeries Working For Our Patients?
Patients with diseased and painful knee are sometimes offered a knee replacement surgery that replaces the joint surfaces with implants in order to relieve pain and improve function. Our patients reported on average an improvement of 40.1% at six months and 48% at two years respectively after the operation in terms of knee pain, stability and level of functional capabilities.
Source: Department of Orthopaedic Surgery, SGH
C) Bringing Relief To Our Patients
C1. How Much Relief Can We Offer Our Patients With Haemorrhoids?
Haemorrhoids (also known as piles) are swollen veins in the rectum and anus that can often cause pain and bleeding. After a stapled haemorrhoidectomy surgery, none of our patients experienced persistent anal pain, 0.2% had residual disease that required further surgery or outpatient intervention, and 1.1% developed anal stricture. Our results appear generally more favourable against our counterpart in New Zealand offering the procedure.
|
SN
|
Complications
|
SGH experience
(n = 6631)
|
New Zealand experience
(n = 738)
|
|
1
|
Persistent anal pain
|
0%
|
1.5%
|
|
2
|
Residual disease requiring surgery or outpatient intervention
|
0.2%
|
4.6%
|
|
3
|
Anal stricture
|
1.1%
|
1.1%
|
|
4
|
Urinary retention requiring catheterisation
|
2.6%
|
1.9%
|
|
5
|
Postoperative bleeding requiring hospitalization
|
4.2%
|
4.2%
|
Source: Dept of Colorectal Surgery, SGH
References:
1. Mehigan BJ, Monson JR, Hartley JE. Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomised controlled trial. Lancet. 2000 Mar 4;355(9206):782-5.
2. Hill A. Stapled haemorrhoidectomy-no pain, no gain? N Z Med J. 2004 Oct 8;117(1203):U1104. Review.
3. Ravo B, Amato A, Bianco V et. al. Complications after stapled hemorrhoidectomy: can they be prevented? Tech Coloproctol. 2002 Sep;6(2):83-8.
4. Ch'ng S, Hulme-Moir M. New Zealand's early experience in stapled haemorrhoidopexy. N Z Med J. 2006 Mar 10;119(1230):U1880.
5. KH Ng, KS Ho, BS Ooi, CL Tang, KW Eu. Experience of 3711 stapled hemorrhoidectomy operations. British Journal of Surgery 2006;93:226-230.
C2. Doctor, My Finger Is Stuck In A Bent Position!
Trigger finger is a condition that causes finger stiffness and pain and the finger may “get stuck” in a bent position and have to be straightened with the help of the other hand. A surgery to release the finger tendon may be necessary when conservative treatments fail. Our success rate and complication rate appear favourable to those reported by other hospitals in Japan, Norway and the United States offering the procedure.
|
Country
|
Success rate
|
Complication rate
|
No. of patients
|
Year of publication
|
|
Singapore General Hospital
|
100%
|
1%
|
373
|
2007
|
|
Japan
|
100%
|
13%
|
105
|
2005
|
|
Norway
|
94%
|
not reported
|
72
|
2003
|
|
USA
|
97%
|
3%
|
59
|
1997
|
References:
1. M-H. Lim, K. -K. Lim, M. Z. Rasheed, S. Narayanan, A. Beng -Hoi Tan. Outcome of open trigger digit release. Journal of Hand Surgery (European Volume, 2007) 32E: 4: 457–459
2. Moriya K, Uchiyama T, Kawaji Y. Comparison of the surgical outcomes for trigger finger and trigger thumb: preliminary results. Hand Surgery, Vol. 10, No. 1 (July 2005) 83–86
3. Finsen V, Hagen S (2003). Surgery for trigger finger. Hand Surgery, 8:201–203.
4. Turowski GA, Zdankiewicz PD, Thomson JG. The results of surgical treatment of trigger finger. J Hand Surg 1997;22A:145–149
C3. How Are Newborns Who Were Delivered Slightly Earlier Than Expected Doing?
Infants borne prematurely between 34 and 37 weeks gestation are often less matured (physiologically and metabolically) and are more prone to develop complications associated with prematurity. A four-year audit of deliveries managed in SGH shows that our rates of immediate complications of prematurity and our utilization of neonatal intensive care by late preterm newborns compares favourably with those reported in published research studies by our counterparts in the United States.
Rates of immediate complications of prematurity
|
Outcome During Initial Birth Hospitalization
|
Late Preterm Morbidity
(Singapore General Hospital)
|
Late Preterm Morbidity
(Reported Studies)
|
|
No.
|
Percentage
|
No.
|
Percentage
|
|
Feeding difficulties
|
131
|
24%
|
29
|
32%
|
|
Hypoglycaemia
|
36
|
7%
|
14
|
16%
|
|
Jaundice
|
192
|
34%
|
49
|
54%
|
| Temperature Instability |
5
|
1%
|
9
|
10%
|
| Apnoea (35 to <37 wk) |
6
|
1%
|
4
|
1%
|
|
Respiratory distress (35 to<37 wk)
|
134
|
24%
|
26
|
29%
|
|
Received mechanical ventilation
|
2
|
0%
|
1103
|
3 %
|
Utilization of neonatal intensive care by late preterm newborns
|
Gestational Age (Weeks)
|
SGH
|
Reported study from USA
|
|
34
|
26.8%
|
88%
|
|
35
|
14.1%
|
54%
|
|
36
|
6.2%
|
25%
|
|
37
|
3.3%
|
12%
|
|
>38
|
1.5%
|
2.6%
|
References:
1. Martin JA, Hamilton BE, Sutton PD, ventura SJ, Menacker F, Munson ML. Births: final data for 2003, Natl Vital Stat Rep.2005;54(2):1-116
2. Wang ML, Dorer DJ, Fleming MP, Catlin EA. Clinical outcomes of near-term infants. Pediatrics.2004;114:372-6
3. Henderson-Smart DJ, The effect of gestational age on the incidence and duration of recurrent apnoea in newborn babies. Aust Paediatr J. 1981;17:273-6
4. Gilbert WM, Nesbitt TS, Danielsen B. The cost of prematurity: quantification by gestational age and birth weight. Obstet Gynecol.2003;102:488-92
5. Escobar GJ, Greene JD, Hulac P, et al. Rehospitalisation after birth hospitalization: patterns among infants of all gestations. Arch Dis Child.2005;90:125-131
D) Providing Care That Is Safe
D1. What Is The Risk Of Our Patients Experiencing A Fall?
Studies reveal that 1 in 3 elderly people experience a fall at least once a year and this risk increases 2-3 times when hospitalised, presumably as a result of their poorer physical and cognitive ability to prevent a fall. A fall experienced by sick patients tends to result in more serious complications such as fractures and/or lacerations. Most hospitals regard fall prevention as one of their highest safety priority for patients nowadays. The risk of our geriatric patients experiencing a fall is 1.54 per 1000 days of hospital stay and our hospital-wide fall rate is 1.09 per 1000 days of hospital stay. Our fall rate is 3-4 times lower compared to the average hospital in the United States or United Kingdom.
|
Hospital / Setting
|
Inpatient fall rate per 1000 patient days |
Year |
|
Singapore General Hospital
|
1.09 (Hospital Wide)
|
2008
|
|
1.54 (Geriatric Department)
|
2008
|
|
United Kingdom
|
4.80
|
2005 - 2006
|
|
United States
|
3.38
|
2002 - 2003
|
Source: Division of Nursing, SGH
References:
1. National Institute for Clinical Excellence (NICE). Clinical practice guideline for the assessment and prevention of falls in older people. November 2004.
2. Healey F, Scobie S, Oliver D, Pryce A, Thomson R, Glampson B. Falls in English and Welsh hospitals: a national observational study based on retrospective analysis of 12 months of patient safety incident reports. Qual Saf Health Care 2008;17(6):424-30.
3. Hitcho EB, Krauss MJ, Birge S, Claiborne Dunagan W, Fischer I, Johnson S, et al. Characteristics and circumstances of falls in a hospital setting: a prospective analysis. J Gen Intern Med 2004;19(7):732-9.
D2. What Is The Risk Of Severe, Uncontrolled Bleeding After Tonsillectomy?
A tonsillectomy is a surgery undertaken to remove tonsils that are prone to recurrent infections. A potentially serious complication of this surgery is severe, uncontrolled bleeding over the wound site after the operation. Since 2007, none of our patients experienced severe, uncontrolled bleeding that required to be stopped in the emergency operating theatre under general anaesthesia.
D3. What Is The Chance Of Keyhole Cholecystectomy Being Converted To Open Cholecystectomy?
Open cholecystectomy is the traditional abdominal surgery to remove the gallbladder through a wide incision of about 10cm. Laparoscopic or keyhole cholecystectomy is now the first-choice of treatment for gallstones but when potentially serious complications such as bile duct injuries or uncontrolled bleeding occurs, the surgeon may need to convert to open cholecystectomy to effectively manage the complications.
Source: Dept of Quality Management, SGH
D4. What Is The Risk Of Our Patients On Mechanical Ventilation Developing Pneumonia?
Ventilator-associated pneumonia (VAP) refers to lung infection that occurs in patients on mechanical ventilation for more than 48 hours. Patients on mechanical ventilation are usually managed in the Intensive Care Unit (ICU). With appropriate care and evidence-based interventions, it is possible to reduce the chance of ventilator-associated pneumonia in these patients.
Ventilator-Associated Pneumonia Rate Per 1000 Ventilator-Days
|
Setting
|
SGH
(2008)
|
U.S National Healthcare
Safety Network
(2006-2007)
|
|
Surgical ICU
|
4.4
|
5.3
|
|
Medical ICU
|
0.5
|
2.5
|
References:
1. Jonathan RE, Kelly DP, Mary LA, Margaret AD, Daniel AP, Teresa CH. National Healthcare Safety Network (NHSN) Report, data summary for 2006 through 2007, issued November 2008. Am J Infect Control.2008; 36:609 -26
D5. What Is The Risk Of Our Patients Acquiring An Infection Caused By Methicillin-Resistant Staphylococcus Aureus (MRSA)?
Nosocomial infections by antibiotics resistant bacteria are related to the provision of healthcare itself due to the high usage of antibiotics and close contact with other patients, healthcare workers and/or contaminated environmental surfaces. Multi-pronged measures are put in place by our hospital to minimize the risk to our patients. From year 2000 to 2008, the incidence rate has seen a successful and sustained reduction.
Incidence Rate Of Nosocomial MRSA Infections Per 1000 Patient-Days
|
SGH
|
2000
|
2001
|
2002
|
2003
|
2004
|
2005
|
2006
|
2007
|
2008
|
|
Incidence rate of nosocomial MRSA infections (per 1000 patient-days)
|
1.3
|
1.2
|
1.0
|
0.9
|
0.7
|
0.8
|
0.7
|
0.6
|
0.6
|
Source: Department of Infection Control
Reference:
1. Aires de Sousa, M., and H. de Lencastre. 2004. Bridges from hospitals to the laboratory: genetic portraits of methicillin-resistant Staphylococcus aureus clones. FEMS Immunol. Med. Microbiol. 40:101–111.
2. Chen YY, Chou YC, Chou P. Impact of nosocomial infection on cost of illness and length of stay in intensive care units. Infect Control Hosp Epidemiol. 2005 Mar;26(3):281-7.
D6. What Is The Risk Of Our Patients Developing a Post-Injection Joint Infection?
Joint aspirations and injections are common medical procedures used for both diagnosis and treatment. The fluid aspirated can be sent for laboratory tests to help aid diagnosis, at the same time reducing joint swelling. Joint injection is also an effective way of delivering medication to an affected area and is used in patients with arthritis (e.g. rheumatoid arthritis or osteoarthritis) or rheumatism. A rare, but serious complication of joint aspiration and injection is joint infection after the procedure. The reported incidence of post-injection joint infection is 1:3000 – 1:50000 according to large reported series, mainly from the United States. A clinical audit was conducted by the SGH Department of Rheumatology and Immunology on all joint aspirations/injections performed by the department from November 2003 to December 2004. None of our patients developed joint infection within 2 months after the procedure, which is consistent with the reported rates from the medical literature.
References:
1. Charalambous CP, Tryfonidis M, Sadiq S, Hirst P, Paul A. Septic arthritis following intra-articular steroid injection of the knee - a survey of current practice regarding antiseptic technique used during intra-articular steroid injection of the knee. Clin Rheumatol. 2003 Dec;22(6):386-90.
D7. What Is The Risk of Excessive Post-operative Bleeding After Transurethral Resection Of The Prostate (TURP)?
Aging men with non-cancerous enlargement of the prostate gland frequently experience difficulty with passing urine and they may require a surgery known as transurethral resection of the prostate. The table below shows the proportion of patients with excessive post-operative bleeding and required blood to be transfused to them as well as the length of hospital stay required on average for the surgery. Our rates appear favourable when compared to results from a survey study done in Britain.
|
SN
|
Performance indicators
|
SGH (n=455)
|
Britain (n=120)
|
|
1
|
Blood transfusion after the operation
|
6.5%
|
7.5%
|
|
2
|
Average length of stay in hospital for these patients
|
2.6 days
|
4.6 days
|
Reference:
1. Fowler C, McAllister W, Plail R, Karim O, Yang Q. Randomised evaluation of alternative electrosurgical modalities to treat bladder outflow obstruction in men with benign prostatic hyperplasia. Health Technol Assess. 2005 Feb;9(4):iii-iv, 1-30.
D8. What Is The Risk Of Excessive Bleeding After A Kidney Biopsy?
A kidney biopsy is a procedure in which a sample of kidney tissue is obtained for microscopic examination so as to diagnose, monitor or treat a kidney disease. Bleeding is the most common complication and affected patients may notice blood in their urine (gross haematuria) after the biopsy. The use of real-time ultrasound-guided percutaneous renal biopsy in our hospital setting has helped us minimise this risk at ≤ 2% from 2005 – 2009.
|
Year
|
No. of Patients With
Kidney Biopsy Performed
|
% of Patients with
Gross Haematuria Post-Biopsy
|
|
2005
|
200
|
2.0%
|
|
2006
|
337
|
1.8%
|
|
2007
|
243
|
0.8%
|
|
2008
|
248
|
1.6%
|
|
2009
|
209
|
1.0%
|
Source: Department of Quality Management, SGH
E) Delivering Care That Is Effective
E1. What Is The Success Rate Of Our Patients Who Underwent In-Vitro Fertilization (IVF)?
Approximately 10% of couples are unable to conceive after 1 year of unprotected intercourse. In-vitro fertilisation (IVF) is a method of treating infertility when other methods of achieving conception have failed. The egg cells are fertilised by sperm outside the woman's womb and is then transferred to the patient's uterus with the intent to establish a successful pregnancy. There are several factors that determine success and they include age, quality of the eggs and sperm, duration of the infertility, the health of the uterus, and the medical expertise. Our IVF success rate compares favourably to those reported by our counterparts from European countries and the United States.
IVF Success Rate
|
SN
|
Countries/Settings (Year)
|
Pregnancies per cycle
|
Pregnancies per transfer
|
|
1
|
European countries, 2003 (range)
|
20.1% to 34.1%
|
23.4% to 40.0%
|
|
2
|
United States, 2003
|
34.4%
|
Not available
|
|
3
|
Singapore General Hospital, 2005
|
35.2%
(n = 176)
|
38.3%
(n = 162)
|
Source: Department of Obstetrics & Gynaecology, SGH
References:
1. Van Voorhis, B.J., Clinical practice. In vitro fertilization. N Engl J Med, 2007. 356(4): p. 379-86.
2. Cohen, J., et al., The early days of IVF outside the UK. Hum Reprod Update, 2005. 11(5): p. 439-59.
3. Nyboe Andersen, A., et al., Assisted reproductive technology in Europe, 2003. Results generated from European registers by ESHRE. Hum Reprod, 2007: p. [Epub ahead of print].
4. 2003 Assisted reproductive technology (ART) report. Atlanta: Centers for Disease Control and Prevention, 2003, (Accessed 04 May, 2007, at http://www.cdc.gov/ART/ART2003/index.htm).
E2. Are Our Patients On Oral Anticoagulation Therapy Optimally Managed?
Oral anticoagulation therapy is used to ‘thin’ the blood to reduce the risk of blood vessel blockages in a wide variety of diseases involving the heart, lungs and brain. It is estimated that 5 million patients worldwide is on anticoagulation therapy. When a patient’s international normalized ratio (INR) is not within therapeutic range, he or she risks having either no therapeutic benefit or an increased risk of bleeding. Our doctors try their best to keep their patients’ INR within the therapeutic range and our results are favourable compared to our counterparts from Italy, Spain, Canada, France and the United States.
| Country/Setting |
% Patients' INR Within Therapeutic Range
|
No. of Patients Reviewed
|
|
Italy
|
69%
|
177
|
|
Singapore General Hospital, SGH
|
65%
|
228
|
|
Spain
|
64%
|
215
|
|
Canada
|
61%
|
145
|
|
France
|
58%
|
247
|
|
United States
|
57%
|
600
|
Source: Department of Haematology, SGH
References:
1. Yang, D.T., R.S. Robetorye, and G.M. Rodgers, Home prothrombin time monitoring: a literature analysis. Am J Hematol, 2004. 77(2): p. 177-86.
2. Ansell, J., et al., Descriptive analysis of the process and quality of oral anticoagulation management in real-life practice in patients with chronic non-valvular atrial fibrillation: the international study of anticoagulation management (ISAM). J Thromb Thrombolysis, 2007. 23(2): p. 83-91.
3. Samsa, G.P., et al., Quality of anticoagulation management among patients with atrial fibrillation: results of a review of medical records from 2 communities. Arch Intern Med, 2000. 160(7): p. 967-73.
E3. How Straight Are Our Computer-Assisted Minimally Invasive Total Knee Replacement Surgeries?
Using this new surgical technique, a shorter incision is required which results in smaller scars, less post-operative pain and a faster return to physical activity. The technique also improves the chance of our patients having the ideal mechanical axis (± 3 degrees) that improves the long term survival of the implanted artificial knee, reducing the need for future corrective surgeries. In SGH, 92% of our patients who underwent this surgery achieved the ideal alignment and this rate compares well with those reported by our counterparts in the United States and Germany.
|
SN
|
Hospital
|
Proportion of patients achieving the ideal mechanical axis
|
Year
|
| 1 |
Singapore General Hospital |
92%
|
2008
|
|
2
|
Duke University, USA
|
90%
|
2005
|
|
3
|
Detroit Medical Centre, USA
|
95%
|
2005
|
|
4
|
Feinberg School of Medicine, USA
|
94%
|
2005
|
|
5
|
University of Regensburg, Germany
|
95%
|
2008
|
|
6
|
St.Vincenz Hospital, Germany
|
79%
|
2005
|
References:
1. Berend ME, Ritter MA et al. Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res. 2004;428:26-34.
2. Andrew QD, Seng-JY et al. Computer-Assisted Minimally Invasive Total Knee Arthroplasty Compared with Standard Total Knee Arthroplasty A Prospective, Randomized, Study. J Bone Joint Surg Am. 2008; 90:2-9.
3. Michael B, Aaron H. Alignment in total knee arthroplasty-A Comparison of Computer-Assisted Surgery with the conventional technique. Clin Orthop Relat Res. 2005; 440:162–169.
4. Rolf GH, Martin S et al. Computer-Assisted Navigation Increases Precision of Component Placement in Total Knee Arthroplasty. Clin Orthop Relat Res. 2005; 433: 152–159.
5. Kevin CA, Knute CB et al. Computer Assisted Navigation in Total Knee Arthroplasty- Comparison with Conventional Methods. J of Arthroplasty. 2005; 20: No. 7 Suppl. 3.
6. Steve JK, Margot MD et al. Computer Assisted Navigation in Total Knee Arthroplasty- Improved Coronal Alignment. J of Arthroplasty.2005; 20:No. 7 Suppl. 3.
7. Tingart M, Luring C et al. Computer-Assisted Total Knee Arthroplasty versus the conventional technique: how precise is navigation in clinical routine? Knee Surg Sports Traumatol Arthrosc.2008 Jan ;( 1):44-50.
E4. What Is The Chance Of Our Patients Getting A Definitive Diagnosis After A Procedure Such As The Small Bowel Endoscopy?
Small bowel endoscopy is a new technique developed to visualize patients’ small intestines clearly to take tissue samples for definitive diagnosis. Our doctors were able to make a definitive diagnosis in 73% of patients who underwent the procedure and our rate appears comparable, if not better, than reported by other centers worldwide and is suggestive that the care is highly appropriate to patients’ medical needs. Our complication rate and time taken to perform the procedure appears to be lower and faster as well.
| SN |
Hospital/ Country
|
Diagnostic yield
|
Major complication rate*
|
Average time taken to complete procedure via oral route
|
Average time taken to comlete procedure via rectal route
|
Year reported
|
No. of patients in the reported series
|
|
1
|
Singapore General Hospital
|
73%
|
0%
|
48 mins
|
70 mins
|
2007
|
30
|
|
2
|
United States
|
43%
|
0.4%
|
93 mins
|
93 mins
|
2006
|
188
|
|
3
|
Japan
|
73%
|
1.1%
|
Not available
|
Not available
|
2004
|
123
|
|
4
|
Europe
|
72%
|
Not available
|
70 mins
|
90 mins
|
2005
|
62
|
|
5
|
New Zealand
|
70%
|
Not available
|
Not available
|
Not available
|
2008
|
Not available
|
* Major complications include bleeding and perforation
References:
1. H Yamamoto, Y Sekine et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointestinal Endoscopy Vol 53, No. 2, 2001
2. Ang D, Luman W et al. Early experience with double balloon enteroscopy: a leap forward for the gastroenterologist Singapore Med J 2007; 48(1):50
3. Shahab Mehdizadeh , Andrew Ross et al. What is the learning curve associated with double-balloon enteroscopy? Technical details and early experience in 6 U.S. tertiary care centers Gastrointestinal Endoscopy Volume 64, Issue 5, November 2006, Pages 740-750
4. http://www.waikatodhb.govt.nz/page/pageid/2145841997/Health_Innovation_Awards
5. Ell C; May A; Nachbar L et al.Push-and-pull enteroscopy in the small bowel using the double-balloon technique: results of a prospective European multicenter study. Ell C - Endoscopy - 01-JUL-2005; 37(7): 613-6
6. Hironori Yamamoto, Hiroto Kita et al. Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases. Clinical Gastroenterology and Hepatology Volume 2, Issue 11, November 2004, Pages 1010-1016
F) Providing Care That Is Up-to-date With Current Medical Evidence Or Consensus
F1. Are Our Diabetic Patients Receiving Care In Accordance With The Clinical Practice Guidelines?
Diabetes is one of the major contributors to ill health and premature mortality worldwide. With timely and appropriate medical intervention, the risk of long-term diabetic complications e.g. heart attack, stroke, kidney failure may be minimized. Our rates of compliance to the Clinical Practice Guidelines are comparable to those reported by our Ministry of Health, the United Kingdom and the United States.
| Clinical assessments performed in a year |
UK National DM Audit(2006-2007) |
US HEDIS (2008) |
MOH(2007-2008) |
SGH (2008) |
| 1. One or more glycated haemoglobin test |
90% |
76-88% |
97% |
98% |
| 2. One or more blood pressure measurement |
93% |
N.A. |
91% |
87% |
| 3. One or more eye assessment |
68% |
34-63% |
56% |
N.A. |
| 4. One or more foot assessment |
75% |
N.A. |
56% |
N.A. |
| 5. One or more LDL-cholesterol test |
N.A. |
71-86% |
82% |
85% |
References:
1. MOH. Medisave for Chronic Disease Management Programme (CDMP) – The Second Year (Accessed on 01st Sep 09, at http://www.moh.gov.sg/mohcorp/uploadedFiles/Publications/Information_Papers/2009/OP%20on%20CDMP%202nd%20Year.pdf )
2. UK: National Diabetes Audit - Report for the audit period 2006-2007 (Accessed on 01st Sep 09, at http://www.ic.nhs.uk/webfiles/Services/NCASP/audits%20and%20reports/6851_Diabetes%20Exec%20Summary_FINALinclWales.pdf )
3. US HEDIS (Healthcare Effectiveness Data and Information Set)
(Accessed on 01st Sep 09, at http://www.ncqa.org/Portals/0/Newsroom/SOHC/SOHC_08.pdf)
F2. Are Our Patients With Hypertension Receiving Care In Accordance With The Clinical Practice Guidelines?
Hypertension is a common disease affecting 1 in 4 Singaporeans and increases their risk of heart attack, stroke and kidney failure. With timely and appropriate medical intervention, the risk of long-term complications of hypertension may be minimized. Our rates of compliance to the Clinical Practice Guidelines are close to those reported by our Ministry of Health.
| Clinical assessments performed in a year |
MOH (2007) |
SGH (2008) |
| 1. Two or more blood pressure measurements (to assess the response to treatment) |
69% |
58% |
| 2. One or more bodyweight measurement (to manage the overall risk of heart disease and stroke) |
88% |
75% |
References:
1. MOH. First year results of the Medisave for Chronic Disease Management Programme (CDMP)
(Accessed on 9th Jun 09, at http://www.moh.gov.sg/mohcorp/uploadedFiles/Publications/Information_Papers/2008/CDMP%20OP.pdf)
F3. Are Our Patients With Hypercholesterolemia Receiving Care In Accordance With The Clinical Practice Guidelines?
High levels of low density cholesterol contribute significantly to the risks of heart attack and stroke. With timely and appropriate medical intervention, the risk of long-term complications of hypertension may be minimized. Our rates of compliance to the Clinical Practice Guidelines are comparable to those reported by our Ministry of Health.
|
Clinical assessment performed in a year
|
MOH (2007)
|
SGH (2008)
|
|
One or more LDL-Cholesterol Test
(to assess the response to treatment)
|
77.8%
|
85.2%
|
References:
1. MOH. First year results of the Medisave for Chronic Disease Management Programme (CDMP)
(Accessed on 9th Jun 08, at http://www.moh.gov.sg/mohcorp/uploadedFiles/Publications/Information_Papers/2008/CDMP%20OP.pdf)