Expanding the Target Population of Post-Acute Care and Establishing a Community-Based Integrated Care Model

  The National Health Insurance Administration (NHIA) announced that the amended Integrated Post-Acute Care (PAC) Project will be implemented as of July 1, 2017. The amendment will expand the scope of the target population from stroke patients and burn patients to patients with traumatic nerve injuries, fragility fractures, and heart failure, as well as frail elderly patients. The NHIA also introduced a home-based integrated PAC model to encourage more medical institutions to establish service teams made up of experts with different backgrounds and from different institutions so that patients can return to community healthcare.

  In 2014, the National Health Insurance (NHI) began launching the Integrated PAC Project. In the early stage of this project, a trial run was conducted on stroke, which has more comorbidities and affects more patients. Medical centers assist with referring patients to receive care service from a PAC team at community hospitals nearest to the patients' places of residence. Following acute treatment, the patients are hospitalized for rehabilitation care. Burn patients were incorporated in September 2015, and a daytime care model for inpatient rehabilitation was introduced. Since the project was implemented, it has attracted participation by 176 hospitals nationwide forming 38 hospital teams. More than 4,000 patients were enrolled in 2016; 87.6% of the patients showed significant improvement in overall functioning, and their average Barthel Index score has improved from 39.1 to 63.4, that is from heavy dependence to capable of initial self-care. 88% of the patients successfully returned to their homes and communities; the satisfaction rate was 88.6%, and the re-hospitalization rate and emergency rate were also reduced (30-day readmission rate: PAC group=15.2%, Control group=31.2%; 30-day emergency rates: PAC group=11.6%, Control group=15.8%), indicating preliminary effectiveness. Subsequently, the NHIA engaged in discussions with professional medical teams to collectively formulate plans for expansion.

  After the acute phase, patients who are evaluated by medical teams as having positive rehabilitation potential will receive cross-hospital discharge preparation service and function evaluation. They will then be transferred to hospitals with PAC teams near their places of residence. During the treatment period, the patients will receive intense rehabilitation and integrated care according to the individualized treatment program devised by the PAC team. The care service will encompass medical, nursing, medication use, physical, occupational, speech-language rehabilitation, social worker, nutritional, case management and health education, comorbidities, complication prevention and handling procedure services. Patients' functional improvements are assessed by the team on a regular basis every two to three weeks. At the time of completion, patients are provided with a consultation hotline, home-based care instructions, subsequent rehabilitation therapy recommendations, and, if necessary, referrals to community medical resources (e.g. referrals to community medical groups or to teams of home-based medical care integrated projects), or social resource services. Depending on the evaluation results, the team will contact long-term care institutions or refer patients to social welfare institutions.

  To facilitate objective evaluation of stroke PAC effectiveness, the NHIA commissioned academic scholars to conduct a study titled "Functional Outcome, Subsequent Healthcare Utilization and Mortality for Stroke Post-Acute Patient in Taiwan: A Nationwide Propensity Score-Matched Study." The study has been approved for publication in the Journal of the American Medical Directors Association, and the results will be published within the next one to two months.

  After the expansion of the target population in July this year, the NHIA expects to care for approximately 17,000 patients every year. Except for the original medical costs, which are included in the hospital global budget, the additional costs incurred for this project, including the home-based model, case evaluations, incentives for encouraging cross-hospital referrals, case management and health education, and quality incentive measures, are expected to amount to NT$150 million.

  For quality assurance, when hospital teams submit application for new diseases, the medical personnel in charge must undergo professional training before case enrollment. NHIA will announce a list of qualifying hospitals on its website for public reference. NHIA anticipates increasing the scope of the target population for post-acute care so that patients with temporary

  disabilities can return home fully recovered, or successfully settle themselves in long-term care institutions. By doing so, subsequent family care, medical costs, and social expenses can be reduced, thus creating a win-win situation.

  • Date:2017-06-27