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Prevalence of care fragmentation among outpatients attending specialist clinics in a regional hospital in Singapore: a cross-sectional study
  1. Manimegalai Kailasam,
  2. Wenjia Guo,
  3. Yin Maw Hsann,
  4. Kok Soong Yang
  1. Epidemiology, Ng Teng Fong General Hospital, Singapore
  1. Correspondence to Dr Manimegalai Kailasam; Kailasam_Manimegalai{at}


Objective To measure the extent of multispecialty care fragmentation among outpatients receiving specialist care and identify associated risk factors for fragmented care.

Design A retrospective cross-sectional study.

Setting Specialist outpatient clinics (SOCs) in a Singapore regional hospital.

Participants A total of 40 333 patients aged 21 and above with at least two SOC visits in the year 2016. Data for 146 792 physician consultation visits were used in the analysis and visits for allied health services and medical procedures were excluded.

Outcome measures The Fragmentation of Care Index (FCI) was used to measure care fragmentation for specialist outpatients. Log-linear regression with stepwise selection was used to investigate the association between FCI and patient age, gender, race and Most Frequently Visited Specialty (MFVS), controlling for number of different specialities seen.

Results About 36% experienced fragmented care (FCI >0) and their mean FCI was 0.70 (SD=0.20). FCI was found to be positively associated with age (p<0.001). Patients who most frequently visited Haematology, Endocrinology and Anaesthesiology specialities were associated with more fragmented care while those who most frequently visited Medical Oncology, Ophthalmology and Orthopaedics Surgery specialities were associated with less fragmented care.

Conclusion Multispecialty care fragmentation was found to be moderately high in the outpatient specialist clinics and was found to be associated with patients’ age and certain medical specialties. With an ageing population and a rising prevalence of multimorbidity, healthcare providers should seek to eliminate unnecessary referrals to reduce the extent of care fragmentation.

  • care fragmentation
  • multi-specialty care
  • specialist outpatient clinic

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  • Contributors KSY, MK and YMH conceived and designed the study, carried out tasks related to ethics approval and data acquisition. WG completed statistical analysis and interpreted the results. WG drafted the manuscript and MK, YMH revised the manuscript. KSY reviewed and approved the final draft as submitted.

  • Funding This work was supported by JurongHeath Fund Research and Development Grant.

  • Competing interests None declared.

  • Ethics approval The NHG Domain Specific Review Board (DSRB).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Statistical code and dataset are available upon reasonable request to the corresponding author.

  • Patient consent for publication Not required.