DOI: 10.4103/singaporemedj.smj-2025-222 ISSN: 0037-5675

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

Biju Thomas, Meng Dao Jeremy Ho, Ching Yee Sim, Bee Keow Goh, Yi Hua Tan, Zi Xean Khoo, Yong Hong Ng, Kok Wee Chong, Yoke Hwee Chan, Koh Cheng Thoon, Alex T Sia, Kok Ann Amos Lim, Yeow Yang John Wong, Sashikumar Ganapathy, Xue Fen Valerie Seah, Chia Yin Chong
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Abstract

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.

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