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In Singapore, FAs are defined as patients with three or more inpatient admissions in 12 months.
FAs are high-cost patients with an average cost per patient approaching SG 000.9 Interestingly, a cumulative direct cost of 30 000 Canadian dollars (SG 260) marks the top 5% of healthcare resource users in Ontario, Canada.10 Taking a population health approach, the Ministry of Health (MOH) Singapore has created six regional health systems (RHSs) in 2011, each being responsible to integrate care for a specific geographic region.
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Like most countries in the developed world, the main cost driver of healthcare in Singapore is inpatient care.8 Reducing unnecessary readmissions and providing care at the most appropriate setting is the focus of health systems reforms aimed at reining in escalating healthcare costs.
The ability to predict future high-cost users in the following 12 months will allow time for intervention by targeted transitional care programmes aimed at modification of behavioural risk factors, addressing social and functional care needs, with potentially large benefit.
So far, most models are derived using administrative data and perform poorly in predicting 30-day readmission risk, with only six studies reporting a C-statistic 0.7.6 To date, no published literature has investigated the effect of severity during acute illness, such as the treatment with high-risk medications and requirement for dialysis during the hospitalisation episode, on readmission risk.
11 variables were observed as significant predictors and included in the final regression model.
The strongest independent predictor was treatment with antidepressants in the past 1 year (adjusted OR 2.51, 95% CI 2.26 to 2.78).
The model's performance of our predictive model was evaluated using a 10-fold cross-validation.