Clinical Research Directory

Place-based Care (PBC) at SingHealth Community Hospitals represents a significant evolution of these approaches, addressing the limitations of fragmented care by integrating social prescribing with structured transitional care. Within community hospital settings, PBC encompasses five core domains: coordinated specialist outpatient follow-ups, linkage to community resources, medication adherence support, primary care transition planning, and caregiver education and self-care empowerment. This integrated model shifts the conventional discharge process from a primarily episodic and medically driven approach to a comprehensive, person-centred care pathway that incorporates both clinical and social assessment, coordinated care planning, supported transition, and structured follow-up. By embedding social prescribing within the continuum of care, PBC aims to improve both clinical outcomes and patient experience during vulnerable transition periods.