{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:10:43Z","timestamp":1791976243221,"version":"4.4.0"},"reference-count":35,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>During COVID-19, Singapore simultaneously experienced a dengue outbreak, and acute hospitals were under pressure to lower bed occupancy rates. This led to new models of care to treat patients with acute, low-severity medical conditions either at home, in a hospital-at-home (HaH) model, or in a clinic-style setting sited at the emergency department in an ambulatory care team (ACT) model, but a reliable cost analysis for these models is lacking.<\/jats:p><\/jats:sec>Objective<\/jats:title>To compare personnel costs of HaH and ACT with inpatient care.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>In this economic evaluation study, time-driven activity-based costing was used to compare the personnel cost of inpatient care with treating dengue via HaH and treating chest pain via ACT. Participants were patients with nonsevere dengue and chest pain unrelated to a coronary event admitted via the emergency department to the internal medicine service of a tertiary hospital in Singapore.<\/jats:p><\/jats:sec>Exposures<\/jats:title>HaH for dengue and ACT for chest pain.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>A process map was created for the patient journey for a typical patient with each condition. The amount of time personnel spent on delivering care was estimated and the cost per minute determined based on their wages in 2022. The total cost of care was calculated by multiplying the time spent by the per-minute cost of the personnel resource and summing all costs.<\/jats:p><\/jats:sec>Results<\/jats:title>Compared with inpatient care, HaH used 50% less nursing time (418 minutes, 95% uncertainty interval [UI], 370 to 465 minutes) but 80% more medical time (303 minutes, 95% UI, 270 to 338 minutes) per case of dengue. If implemented nationally, HaH would save an estimated 56\u202f828 SGD per year (95% UI, \u2212169\u202f497 to 281\u202f412 SGD [US $41\u202f856; 95% UI, \u2212$124\u202f839 to $207\u202f268]). The probability that HaH is cost saving was 69.2%. Compared with inpatient care, ACT used 15% less nursing time (296 minutes, 95% UI, 257 to 335 minutes) and 50% less medical time (57 minutes, 95% UI, 46 to 69 minutes) per case of chest pain. If implemented nationally, ACT would save an estimated 1\u202f561\u202f185 SGD per year (95% UI, 1\u202f040\u202f666 to 2\u202f086\u202f518 SGD [US $1\u202f149\u202f862; 95% UI, $766\u202f483 to $1\u202f536\u202f786]). The probability that ACT is cost saving was 100%.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This economic evaluation found that the HaH and ACT models decreased the overall personnel cost of care. Reorganizing hospital resources may help hospitals reap the benefits of reduced hospital-acquired infections, improved patient recovery, and reduced hospital bed occupancy rates.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.34936","type":"journal-article","created":{"date-parts":[[2023,9,22]],"date-time":"2023-09-22T15:31:02Z","timestamp":1695396662000},"page":"e2334936","source":"Crossref","is-referenced-by-count":11,"title":["Economic Evaluation of Novel Models of Care for Patients With Acute Medical Problems"],"prefix":"10.1001","volume":"6","author":[{"given":"Orlanda Q. 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