Aim: This study aimed to appropriately establish a healthcare program in Thailand that acquired ISO 9001 certification; QC14J0022 (the International Organization for Standardization, ISO) improved problems and inspected the program’s effectiveness. Furthermore, we are making this ISO health promotion widely available in Asian countries and are making an international contribution. Method: We implemented a 9-month health program in Klongyong and a 6-month health program in Nikhompattana, Rayong, Thailand. This program assessed findings from pedometry, anthropometry, physical fitness, and brain function tests. Results: In Klongyong, the average number of walking and exercise steps was 3471.3, and in Nikhompattana, the average number of walking and exercise steps was 4695.5. The pre- and post-health program results in Klongyong showed significant differences in blood pressure, hand grip strength, the 10-meter obstacle walk and the 6-minute walk. In Nikhompattana, there were significant differences in hand grip strength and sit-and-reach flexibility as well as the brain function tests. The pre- and post-health program results in Klongyong and Nikhompattana showed significant differences in the total number of “forgets”. Conclusions: The findings from before and after the health program in Nikhompattana suggest that the increased physical activity during the course of the program may have led to improved brain function results.

Chemotherapy is one modality for cancer treatment and customarily delivered in a hospital. Ambulatory home-based chemotherapy was initiated in the 1970s in Western countries (DeMoss, 1980). Today, this healthcare service system is implemented worldwide, based on findings demonstrating its effectiveness, safety, cost savings, convenience, patient satisfaction and improved quality of life. Additionally, this approach reduces the length of hospital stay and the risk of hospital-acquired infections (Keshvani et al., 2019).The equipment used for home chemotherapy administration is either an electronic or a non-electronic infusion device. The elastomeric infusion pump is a non-electronic device that requires no programming and is suited for the home setting owing to its small size, light weight, safety, accuracy, comfort, simplicity of use, ease of fluid filling and lack of maintenance cost (Broadhurst, 2012).Chemotherapy infusion is driven by pressure created by the stretched elastomeric membrane; the flow rate is generated by the pressure gradient across the flow restrictor and the fluid viscosity (Skryabina & Dunn, 2006). Moreover, the patient's body temperature, type

474 Background: The cost of cancer treatment has increased significantly in recent decades, and highest costs incurred in the last 6-months of life. Patients’ health insurance status is a factor influencing to cost of care in different from individuals’ ability to access hospital care. 80% of Thai people use the Thailand’s Universal Coverage Scheme (UCS), about 15% use the Civil Servants Medical Benefit Scheme (CSMBS). Only CSMBS can reimburse all costs of in-patient care, but UCS had to co-pay at some cost. All health scheme is equality accessibility to palliative care. Early integrated palliative care services improve the GU malignancy patients care experience, decreases healthcare utilization, and improved quality of life. Study aim was to examine Hospital-based palliative care interventions in GU malignancy patients may reduce costs. Methods: A retrospective claims database in Ramathibodi Hospital was analyzed, that included cancer patients had a medical claim for death between Jan 1, 2016 - Dec 31, 2020. Our study compared cost in patients receiving palliative care (PC) and patients receiving usual care. Costs were determined by summing paid amounts on all hospital services used within the last 6, 3 and 1 months before death, including cancer-related inpatient service, emergency room visits, cancer-related outpatient services and other hospital services with cancer diagnosis. Results: Of the 1,772 cancer patients who died, 289 (16.3%) integrated treated with PC matched to 1,483 (83.7%) were usual care patients. 107 Genitourinary Malignancies patients including 44 TCC, 36 Prostate, 22 RCC and 2 Testicular cancer, that 22 (20.6%) integrated treated with PC. Median age was 72.4 years. Patients categorized as CSMBS 48% and UCS 44.4%. The PC group had $10,244.1 (+/- 8,705.6) in last 3 months hospital costs that significantly less than in usual care $(17,174.3 +/-14,262.5) (P= 0.032) that PC group had significant reductions in medications, laboratory, and intensive care unit costs compared with usual care patients. Direct costs of inpatient care in the last 3 months of life for patients were lower in patient who received earlier PC that patients who received PC consults < 90 days was $9,728.8 (+/- 1,044.5) and patients received PC consults < 30 days cost was $12,517.7 +/- 1,476. Patients in SSS and UCS had a significantly saving cost when they received PC consultation, P=0.032. However, there was no difference in CSMBS. Conclusions: Integrated palliative care in caring GU malignant patients associates with significant hospital cost savings. Insurance status not limited in access to palliative care consultation, but influences in cost of end-of-life care.