Interdisciplinary collaboration and computer-assisted home healthcare referral in the emergency department: a retrospective cohort study

Hsu, Shu-Lien; Tsai, Kang‐Ting; Tan, Tian-Hoe; Ho, Chung‐Han; Yang, Pei-Chi; Hsu, Chien‐Chin; Lin, Hung‐Jung; Hung, Shang-Ping; Huang, Chun‐Yen

doi:10.1007/s40520-022-02109-9

Cited by 7 publications

(11 citation statements)

References 13 publications

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“…The second stage is known as home-based primary care plus, aims to provide additional skilled nursing care to homebound patients [7,10]. Nurse visits are added to physician visits in this stage [7,10]. The third stage is home-based palliative care, which aims to provide end-of-life care for patients diagnosed with serious illnesses [10].…”

Section: Study Design Setting and Participantsmentioning

confidence: 99%

“…This change aims to encourage physicians to provide care outside of hospitals, expand options for seeking medical assistance, and promote changes in patients' health-seeking behavior [6,7]. The HMIP model integrates health literacy, rehabilitation, home-based medical care, home-based nursing, community palliative care, and end-of-life care, while building community resources networks and providing high-quality community care services [6].…”

Section: Introductionmentioning

confidence: 99%

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Impact of the Home-based Medical Integrated Program on Health Outcomes and Medical Resource Utilization in Taiwan

Ho,

Wang,

Weng

et al. 2023

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Background The home-based medical integrated program (HMIP) is a novel model for home healthcare (HHC) in Taiwan, initiated in 2016 to enhance care quality. However, the outcomes of this program remain unclear. Thus, we conducted this study to clarify it. Methods We utilized the Taiwan National Health Insurance Research Database to identify HHC patients who received HMIP and those who did not between January 2015 and December 2017. A comparison was made between the two groups in terms of outcomes over a one-year follow-up period. Results A total of 4,982 HHC patients in the HMIP group and 10,447 patients in the non-HMIP group were identified for this study. The mean age in the HMIP group and non-HMIP group was 77.6 years and 76.1 years, respectively. Compared with the non-HMIP group, the HMIP group had lower total medical costs for HHC, fewer outpatient department visits and lower medical costs, lower medical costs for emergency department visits, fewer hospitalizations, and a lower mortality rate (34.6% vs. 41.2%, p < 0.001). Conclusion The HMIP is a promising model for improving care quality and reducing medical resource utilization in HHC patients. While this suggests that the non-HMIP model should be replaced, it’s important to note that both non-HMIP and HMIP models currently coexist. The HMIP may serve as an important reference for other nations seeking to improve care quality and reduce medical resource utilization in their own HHC systems.

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Section: Study Design Setting and Participantsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of the Home-based Medical Integrated Program on Health Outcomes and Medical Resource Utilization in Taiwan

Ho,

Wang,

Weng

et al. 2023

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“…Since 2017, the CMMC initiated HHC and has provided continuous and holistic care to its patients [12]. The HHC in CMMC includes not only the patients in need after hospital discharge but also those who are directly discharged from the ED [7]. We included all patients who received HHC between August 1, 2019, and July 31, 2021, in this study (Figure 1).…”

Section: Study Design Setting and Participantsmentioning

confidence: 99%

“…The aim of HHC is for aging in place as well as reducing ED visits and hospitalization [6]. ED visits during HHC are indicators of negative outcomes [2,7,8], which increases the burden on families and medical insurance. Previous studies reported that approximately 20-30% of patients who receive HHC may visit the ED or get hospitalized [8,9].…”

Section: Introductionmentioning

confidence: 99%

Prediction of emergency department visits in home healthcare patients: a case-control study in Taiwan

Jian

Tsai

et al. 2022

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Background: Home healthcare (HHC) is an important care choice for elderly people with disabilities; however, the risk factors for emergency department (ED) visits, a poor outcome index, remain unclear. Therefore, we conducted this study to clarify it. Methods: We conducted a case-control study from a medical center in Taiwan by identifying HHC patients between Aug 1, 2019, and July 31, 2021. Age, sex, iatrogenesis, underlying comorbidities, and ED visit data were collected. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of ED visits. Results: We identified 240 patients, including 133 patients with and 107 patients without ED visits, for this study. The mean ages were 83.9 and 83.3 years and females accounted for 71% and 60.9% of patients without and with ED visits, respectively. Multivariable logistic regression analyses showed that urinary catheters (adjusted odds ratio [aOR]: 5.84; 95% confidence interval [CI]: 1.48−23.01, p = 0.012) and peptic ulcer disease (PUD)/gastroesophageal reflux disease (GERD) (aOR: 2.27; 95% CI: 1.12−4.61, p = 0.023) were independent predictors of ED visits. Stratified analyses according to sex and age showed that PUD/GERD and dyslipidemia were significant predictors of ED visits in female patients. Conclusions: This study identified independent predictors of ED visits in HHC patients. Our results provide an important reference for the early prevention, recognition, and adjustment of care plans for at-risk patients. Further studies recruiting more patients and external validation are warranted.

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“…In response to these challenges, the Chi Mei Medical Center (CMMC) established a geriatric ED in 2019 to enhance the quality of care for older ED patients [8]. Various geriatric care protocols have been implemented and published, encompassing hospice and palliative care, geriatric syndrome screening, medication reconciliation, delirium screening, treatment, and referrals for home healthcare [9][10][11][12][13][14]. Within this context, we developed a novel computer-assisted model for TFU and conducted this study to elucidate its impact on the Asian population.…”

Section: Introductionmentioning

confidence: 99%

Implementation of a novel computer assisted telephone follow-up model for older patients after emergency department discharge in an Asian population

Lee,

Ho,

Tan

et al. 2023

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Background While the impact of telephone follow-up (TFU) for older emergency department (ED) patients is controversial, its effects on the Asian population remain uncertain. In this study, we evaluated the effectiveness of a novel computer assisted TFU model specifically for this demographic. Methods At a Taiwanese tertiary medical center, we developed a TFU protocol that included a referral and case management system within the ED hospital information system. We provided TFU to older discharged patients between April 1, 2021, and May 31, 2021. We compared this cohort with a non-TFU cohort of older ED patients and analyzed demographic characteristics and post-ED discharge outcomes. Results The TFU model was successfully implemented, with 395 patients receiving TFU and 191 without TFU. TFU patients (median age: 76 years, male proportion: 48.9%) differed from non-TFU patients (median age: 74 years, male proportion: 43.5%). Compared with the non-TFU cohort, the multivariate logistic regression analysis revealed that the TFU cohort had a lower total medical expenditure < 1 month (adjusted odds ratio [AOR]: 0.32; 95% CI: 0.21 − 0.47 for amounts exceeding 5,000 New Taiwan Dollars), and higher satisfaction (AOR: 2.80; 95% CI: 1.46 − 5.36 for scores > 3 on a five-point Likert Scale). However, the TFU cohort also had a higher risk of hospitalization < 1 month (AOR: 2.50; 95% CI: 1.31 − 4.77) compared to the non-TFU cohort. Conclusion Computer-assisted TFU appears promising. Further research involving a larger number of patients and validation in other hospitals is necessary to bolster the evidence and extend the findings to a broader context.

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Interdisciplinary collaboration and computer-assisted home healthcare referral in the emergency department: a retrospective cohort study

Cited by 7 publications

References 13 publications

Impact of the Home-based Medical Integrated Program on Health Outcomes and Medical Resource Utilization in Taiwan

Impact of the Home-based Medical Integrated Program on Health Outcomes and Medical Resource Utilization in Taiwan

Prediction of emergency department visits in home healthcare patients: a case-control study in Taiwan

Implementation of a novel computer assisted telephone follow-up model for older patients after emergency department discharge in an Asian population

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