in order to balance medical resources and reduce the burden of health insurance, Taiwan Province began to plan levels of care, emphasizing the vertical integration of services between hospitals at different levels in various regions and community medical groups, so that the medical ecology will return to balance, and the ward services in hospitals will also begin to face reform. In Taiwan Province, integrated medicine, that is, specialized Hospital medicine, is the solution to the super-old society. Since 22, Taiwan Province Chang Gung Memorial Hospital began to have the concept of emergency evacuation ward, which became the basis of integrated medical care. Later, in 29, Dr. Ke Wenzhe formally established integrated medical ward service in National Taiwan University Hospital to improve the quality of basic care. Up to now, 19 hospitals have integrated medical wards. As of February, 219, the Taiwan Association of Hospital Medicine has been established, with 18 certified integrated medical specialists, and has started follow-up training and participated in international seminars.
Four models that integrated medical doctors in Taiwan Province can do
A. Specialized
Integrated medical doctors are doctors who focus on taking care of inpatients. In the aging society, patients with multiple diagnoses are the mainstream, which will make it difficult to admit patients under the system of highly sub-specialization. However, for those with common diagnoses, integrated medical doctors can take care of doctors who integrate general internal medicine knowledge as the first line, and try to sort out the common diagnostic tools of various specialists as a systematic evaluation, such as POCUS (Point-of-Care Ultrasound), without being bound by too many sub-specialties, and integrated medical doctors can improve the whole person.
B. quality
which specialist is the best person to take care of general medical diseases such as pneumonia and urinary tract? In Taiwan Province, the answer is to integrate medical practitioners. Based on the statistics of Taiwan Province from 21 to 214, patients with common diseases such as pneumonia, urinary tract infection and chronic obstructive pulmonary disease were compared under the care of integrated medical doctors and non-integrated medical doctors.
The mortality rate of pneumonia in hospital is obviously improved under the care of integrated medical specialties, especially the patients with integrated medical specialties are actually more seriously ill. For example, among pneumonia patients, the proportion of * * * disease is less than that of patients with critical illness (18.6% vs. 15.2%), stroke (11.5% vs.9.6%), diabetes (22.2% vs. 19.5%) and low-income households (4.8% vs.2.6%).
under the system of integrated specialist care, there will be no problem of weekend effect caused by the traditional duty in sub-specialist wards because of the continuation of shift system and appropriate manpower.
C. Labor
Burnout and professional psychological injuries (pressured into situations that violate their beliefs) are killers that threaten the health of medical staff and patients at present. Integrate medical doctors to focus on the care of inpatients and improve the shift system in wards reasonably.
D. Smart medical treatment By integrating medical doctors to focus on holistic care and comprehensive communication of inpatients, the economic burden and communication cost in all aspects can be effectively reduced! Improve the quality of in-patient medical care and patient satisfaction, towards the implementation of integrated holistic care, and provide integrated outpatient care for multiple chronic patients. In addition to treating multiple diseases that are difficult to return to the department, you can also treat cases with definite diagnosis, and you can also treat cases that require surgical operation but are accepted by the surgical department as the backing of the regional network.
the role of Community hospital as an integrated medical care ward emphasizes acute aftercare (PAC). With the aging of the population, patients often face the end of the course of acute illness in acute medical treatment, but the patients are still in a state of disability. The goal of acute aftercare is similar, and the system varies from country to country. Since 1984, the DRG payment for hospitalization in the United States has been fully implemented, and the acute aftercare institutions have flourished. In the United Kingdom, the concept of intermediate care has been adopted. In 214, the Taiwan Province Health Insurance Department began to pilot the Post-acute care, PAC) for stroke. The PAC program will be expanded in 217 to include the diagnosis of stroke, burns, traumatic nerve injury, fragile fracture and heart failure.
In Taiwan Province, PAC plans to introduce a nursing team to make a personalized treatment plan, including rehabilitation within a time limit and cross-team integration of care and rehabilitation. The cross-team includes medical treatment, nursing, physical therapy, functional therapy, speech/swallowing therapy, psychotherapy, social worker, nutrition, medical consultation, health education, prevention and treatment of complications, and regular assessment of functional recovery within 2 to 3 weeks. In this way, the burden of family and social care is greatly reduced, and the allocation efficiency of the original acute medical care is also strengthened, which is seamlessly integrated with long-term care services to achieve a win-win goal.
integrating medical services to reduce the rate of patients' readmission
At the end of 29, National Taiwan University Hospital also tried to integrate the attending physician system in medical departments in line with the world trend and the reduction of medical manpower. During the implementation of the inpatient attending physician system in National Taiwan University Hospital, in order to compensate for the continuity after discharge, an integrated system of follow-up care within 3 days after discharge was implemented, including pre-discharge preparation, post-discharge follow-up, special line open consultation, integrated outpatient service and other services, in order to improve the stability of patients after discharge and reduce the rate of re-hospitalization.
during the implementation period from December 29 to mid-May 21, the first two months were the observation period, * * * 94 patients were admitted, and the last four months were the implementation period, * * * 214 patients were admitted. When the case was closed on the 3th, 52 people were unplanned readmitted, 5 people lost their follow-up and 3 people died unexpectedly. Before and after the implementation of the case, the number of patients cared for by the attending physician in the integrated medical department decreased within 3 days after discharge and after the intervention of discharge follow-up (25.5% vs.14.6%, P = .21 by log-rank test).
it is concluded that in the implementation of the integrated medical attending physician system, the 3-day follow-up system after discharge may be helpful to the change or recurrence of patients' symptoms after discharge, especially in the case of readmission. In the future, according to the current plan, I hope to promote home video care tracking, home monitoring and data processing system after discharge, and expand the service for discharged patients.
how does integrated care medicine connect with hospice care?
To evaluate the Palliative Performance Index (PPI Score) of patients with severe illness and terminal illness, those who are qualified will be referred to hospice care, providing physical care and symptom control, emphasizing the psychological and spiritual holistic care of patients, including psychological and spiritual support of family members, and the extension of follow-up care will also cover grief counseling of family members.
Woman Photo Created by Tirachardz Topics: PAC Project, POCUS, Holiday Effect, Holistic Care, Specialized Hospitalization, Integrated Medical Department, Community Hospital.