Eliciting Patient Preferences for the Hospital at Home Programme in Singapore; A Discrete Choice Experiment

Hospital overcrowding in Singapore has reached a critical level, primarily owing to an ageing population and an increased demand for medical services. Alternative care models such as hospital-at-home (H@H) programmes have been introduced to address this issue, utilising telehealth and home-based care. We conducted a choice experiment to determine the most preferred characteristics of a hospital-at-home programme in Singapore.

A desktop review, interviews with clinicians and an expert panel helped to decide on the attributes and levels of the choice sets. The attributes were the type of care team, communication method, care providers, out-of-pocket costs, additional services, and place of return to the hospital if needed. We obtained information from adult Singaporeans (age > 21 years) admitted to a hospital within the past 2 years using an online panel. The design was a fractional factorial study. A pilot study and a redesign helped to refine the choice experiment. The survey used two unlabelled alternatives.

The total study sample consisted of 602 respondents. The respondents did not have a particular preference for the type of care team, communication method or additional services provider. However, there was a strong preference for having a doctor as part of the care team and being readmitted to a specific ward rather than the emergency department. The analysis of relative importance revealed that out-of-pocket costs (71%) and the composition of care providers (12%) were the most significant attributes in decision-making. We found an anticipated adoption rate of H@H was over 83% compared with inpatient care.

Clinically eligible patients in Singapore are highly likely to accept the H@H care model. An approved private provider could provide the service without reducing patient satisfaction and trust.