Search

Purpose: 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 on health outcomes and medical resource utilization in HHC patients remain unclear. Thus, we conducted this study to clarify it. Patients and Methods: The authors 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 retrospective cohort study design was used. Convenience sampling was employed to select patients who met the inclusion criteria: being part of the HHC program and having complete data for analysis. Results: A total of 4982 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background. Prior studies have shown that sleep disturbances are related to falling and its risk factors, such as poorer cognition, depression, and physical function. However, little is know about the gender-specific associations between falling and sleep duration. Methods. Study participants were from the annual Health Examination for the Elderly Program in the National Taiwan University Hospital (135 women and 121 men, mean age 72.2 years). Self-reported sleep duration was grouped into three categories: less than 5.5-7.9, and 8 or more hours. Short sleep duration was defined as sleep duration less than 5 hours. Falling during the previous 12 months was ascertained by self-report questionnaire. The association of sleep duration with falling was examined by using multiple logistic regression. We approximated risk ratio (RR) of falls from the adjusted odds ratio (OR) after correction of falls incidence in the previous year. Results. Sleep duration was inversely associated with falling among women. After adjusting for multiple confounding factors including use of antihypertensives and psychotropic medications, the OR of falls for each hour decrease in sleep duration was 1.95 (95% confidence interval [CI] 1.24-3.06). Moreover, women with sleep deprivation had a greater odds of falls within the last year than those with longer sleep durations. The estimated RR of falls comparing women with short sleep duration (sleep Conclusion. Sleep deprivation is independently associated with falls in women but not in men. Short sleep duration may be an indicator to identify women at risk for falling. Key Words: Sleep duration--Falls--Cross-sectional study. doi: 10.1093/gerona/glp143