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Early Implementation of a Patient-Centred Medical Home in Singapore: A Qualitative Study Using Theory of Diffusion of Innovations

Published in the International Journal of Environmental Research and Public Health, this study explores the ground-up implementation of a patient-centred medical home (PCMH) in Singapore by describing change strategies as well as discussing initial experiences and perceptions.

In-depth interviews were conducted with 22 key informants from three groups: the implementers, their implementation partners, and other providers.

"Diffusion of innovation" emerged as an overacrching theory to contextualise PCMH in the early stages of its implementation. Three core "innovations" differentiated the PCMH from usual primary care: (i) team-based and integrated care; (ii) empanelment; and (iii) shared care with other general practitioners.

Change strategies employed to implement these innovations included repurposing pre-existing resources, building partnerships to create supporting infrastructure and pathways in the delivery system, and doing targeted outreach to introduce the PCMH.

Initial experiences and perceptions were characterised by process to "adopt" and "assimilte" the innovations, which were identified as challenging because of less predictable, self-organising behaviours by multiple players. To work with the inherent complexity and novelty of the innovations, time, leadership, standardised methods, direct communication, and awareness-building efforts are needed.

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