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Poster Abstracts

Building an Integrated Home-based Medical Care services across the whole life course in Taiwan

Author:

Chih-yuan Shih

Taipei City Hospital, TW
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Abstract

Introduction:

National health insurance administration (NHIA) in Taiwan initiated the integrated Home-Based Medical Care (iHBMC) program since March 2016. This program composed of three stages of care, including home-based primary care (HBPC, stage 1) for homebound patients with healthcare needs, home-based primary care plus (HBPC plus, stage 2) to provide additional skilled nursing care, and home-based palliative care (HBPalC, stage 3) for terminally ill patients. Taipei City Hospital (TCH) is a public community hospital and the first hospital to establish iHBMC services in Taiwan.

Description of practice change implemented:

1.Comprehensive and longitudinal home healthcare

2.Transdisciplinary team-based care

3.Coordination with personal services and social care

Aim:

1.Improving the health care of patients who have difficulties to access medical care due to disabilities or disease characteristics.

2.Encouraging health care services to link to community networks and reducing avoidable emergency department visits and hospitalizations.

3.Solving the problem of current fragmented home healthcare services.

Target population:

1.Patients who lived at home and had health care needs

2.In addition, patients should have difficulties to access medical care due to disabilities or disease characteristics

Timeline:

January 2015: Initiating Home-Based Palliative Care in Taipei City Hospital

March 2016: Launching the new integrated Home-Based Medical Care services

Highlights:

The physicians were required to provide home visit at least once every three months for each patient. 24 hours a day, 7 days a week telephone consultation by physicians and nurses should be available. Taipei City Hospital iHBMC services offered a wide range of newly developed services, including tele-dermatology consultation, point-of-care ultrasound and mobile eye and dental care services. A total of 2799 patients, aged ≥18 years, were admitted to iHBMC at the end of 2017. Of these, the median age was 86 years and 54.4% were female patients. Nearly one third of the iHBMC patients (31.8%) receiving nasogastric tube feeding, and the highest rate was noted among stage 2 patients (66.3%). In Stage 1, 2 and 3 of iHBMC patients, the one year mortality rate was 18.6%, 30.6% and 75.5%, respectively.

Sustainability:

The iHBMC services were covered by National Health Insurance in Taiwan.

Transferability:

Taiwan had provided universal health coverage (99.9% of the population) through a single payer National health Insurance system. Therefore, this model of iHBMC could be transferred to other areas in Taiwan.

Conclusions:

Home-Based Medical Care is a crucial service to diminish health inequalities for the disabled and homebound patients. There are some key essentials in Taipei City Hospital’s iHBMC services: “Accompany from life to death”, “Culture of communication”, “Continuous care” and “Transdisciplinary teamwork”.

Lessons learned:

Integrated Home-Based Medical Care was a type of high-value health care services. Patients receiving iHBMC service was a majorly older adults with high mortality rate. Palliative care should be integrated through the whole life course of care. Besides, recognizing terminally-ill patients earlier and conducting a family meeting to establish the agreement of care goals were crucial.

How to Cite: Shih C-yuan. Building an Integrated Home-based Medical Care services across the whole life course in Taiwan. International Journal of Integrated Care. 2021;21(S1):176. DOI: http://doi.org/10.5334/ijic.ICIC20172
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Published on 01 Sep 2021.

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