What exactly is acute aftercare doing?

I have mentioned the importance of "acute aftercare" in maintaining the health care system for the elderly, but it is understandable that it is still a very puzzling term for Taiwan Province Province. After all, in medical education in Taiwan Province Province, most of them only teach diseases and acute medical treatment itself, and pay little attention to the importance of chronic disease care and the recovery of physical and mental functions to the overall treatment of diseases, and it is not easy to understand what to do in acute aftercare. From 65438 to 0980, in order to effectively control medical expenses, the United States divided the treatment process of patients' diseases into stages. The hospitalized patients were discharged after their condition was stable and entered the stage of "subacute nursing". Treatment continues in the emergency bed, such as antibiotic treatment and postoperative recovery. The purpose of this design in the United States is to manage medical expenses. When patients live in emergency beds, the cost is very high. If we can transfer to a cheaper intensive care unit to complete the follow-up treatment in a relatively stable period (but the treatment has not yet been completed), the cost can be effectively controlled and the patient's treatment rights will not be affected. This model has effectively reduced the average hospitalization time and medical expenses of American patients. Therefore, from the beginning, the United States only introduced subacute nursing mode to four types of patients: hip fracture, stroke, brain injury and artificial joint replacement. So far, this nursing model has diagnosed forty or fifty diseases. In the United States, some problems were found after one or two decades, that is, it was difficult to define "subacute" that was not urgent in the first few days of hospitalization, so it was later called "post-acute care" to slightly reduce the controversy. A similar thing happened in Britain. During the period of 1980-2000, the number of beds and the average length of stay in Britain decreased significantly. In addition to the effectiveness of hospital management, it is also found that the chances of elderly patients staying in long-term care institutions have greatly increased, that is, the chances of returning to the community or their own homes have decreased, so the service model of "intermediate care" has been introduced. The concept of mid-term nursing in Britain is almost the same as that of acute late-stage nursing in the United States, but the reasons for making policies are slightly different. Different from the United States, the patients admitted to intermediate nursing units in Britain mainly need holistic nursing, while the conditions for entering acute late nursing in the United States are only specific disease diagnosis, which is very different in concept, but probably only in management methods. Even if we know the difference in terminology, what are patients doing when they enter mid-term care or acute late-stage care? In fact, acute aftercare is a multidisciplinary nursing model, which pays attention to holistic nursing. Although rehabilitation is very important, simply speaking, rehabilitation is a bit narrow. The following is a summary of the characteristics of acute aftercare service: whether it is the Anglo-American model or even the stroke model introduced by Taiwan Province Province, acute aftercare is basically the concept of caring about holistic nursing. Most cases requiring emergency post-care are elderly people. Because they suffer from a variety of chronic diseases, their body and mind deteriorate. When they suffer from a disease, they need a long recovery time. If they stay in the hospital, this recovery time will not be better. Instead, they must evaluate their needs as a whole, including chronic disease management, medication adjustment, nutritional support, physical function rehabilitation, psychological support and family support after discharge. For the medical system, these problems are a bit strange, because most doctors always think that as long as the patient's illness is treated well, the patient will gradually recover. However, it is often the patient who gets well, but gradually becomes bedridden. Therefore, after entering the acute stage, nursing is based on the needs of holistic nursing, and related treatment must be arranged according to the evaluation results after the overall evaluation. Because acute post-care pays attention to the comprehensive recovery of patients' physical and mental functions in disease treatment, it is difficult to be handled by a single specialty or a single medical specialty. Patients may have a lot of rehabilitation needs during treatment, but at the same time, the control of chronic diseases must also set new goals, reduce potential improper medication, evaluate cognitive function and depression, and so on. Therefore, it is necessary to integrate nursing teams to provide services together, not just by a single medical specialty. This part is not questioning the nursing ability of medical specialties, but that these patients are complex in nature, not simply disease treatment, and the finer the modern medical division of labor, the more difficult it is to cover everything, so it is necessary to integrate everyone's strength and work together. On the whole, physical therapy, personal care and nursing are the most important services in Britain, and medical services are absolutely necessary, but the proportion is relatively low. Because post-acute care focuses on the overall recovery of patients' physical and mental functions, the evaluation of treatment effect is different from that of general medical services. In general medical services, doctors pay attention to the patient's heartbeat, breathing, laboratory reports or X-ray reports as an evaluation of the progress of treatment, but acute late care focuses on the overall recovery of physical and mental functions and the degree of self-care ability. Therefore, the definition of treatment success is mostly based on the patient's "ability to restore independent life", rather than general clinical indicators. Acute late nursing is of great significance to complex elderly patients. Aside from the saving of medical expenses, it is more important to pay attention to the value of medical care itself on behalf of the medical system. The health status of patients is no longer viewed from the perspective of disease cure, but the recovery of physical and mental functions is taken as the measure of health status. This is a very important change, which can really improve the patient's condition and reduce the burden of family care at home. & lt This column reflects experts' views and does not represent our position >< The author has great wisdom of real anti-aging-medical argumentation and surpassing anti-aging & A record of China Journal of Medicine;