Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan.
J Am Geriatr Soc. 2023 May;71(5):1526-1535. doi: 10.1111/jgs.18232. Epub 2023 Jan 27.
In Taiwan, the National Health Insurance Administration initiated the integrated home-based medical care (iHBMC) program in 2016 to improve accessibility to health care for homebound patients. This study aimed to describe the characteristics of older people receiving iHBMC services in Taiwan as well as the relationship between patient characteristics and survival.
All older adults registered in the iHBMC application dataset were enrolled between March 1, 2016, and December 31, 2018. Data on social determinants of health (income level, residential area), functional status, consciousness status, nasogastric tube or urinary catheter placement, and major diseases were retrieved from the database. Data on the frequency of multidisciplinary team members' visits were collected. The survival rate was investigated using the Kaplan-Meier method. A Cox proportional hazards univariate regression was conducted to analyze factors influencing survival rates.
A total of 41,079 patients aged ≥65 years were enrolled in iHBMC services. The results showed that the one-year survival rates were 72.1%, 67.4%, and 14.7% in the home-based primary care (HBPC), home-based primary care plus (HBPC-Plus), and home-based palliative care (HBPalC), respectively. Nearly two-thirds of the HBPC-Plus patients underwent nasogastric tube placement. The Cox proportional hazards univariate regression analysis showed that a low urbanization level, a low income level, a low functional status, and an impaired consciousness status were significant predictors of poor survival after adjustment for confounding variables.
Older adults receiving iHBMC services had a high mortality rate. The high rate of feeding tube use indicated that education and support for both clinical practitioners and family caregivers regarding careful hand feeding are warranted. There was a relationship between low income levels and poor survival in rural areas. Further research on whether social care could impact prognosis should be considered.
在中国台湾地区，全民健康保险署于 2016 年启动了整合居家医疗照护（iHBMC）计划，以改善居家患者的医疗可及性。本研究旨在描述中国台湾地区接受 iHBMC 服务的老年人的特征，以及患者特征与生存之间的关系。
所有于 2016 年 3 月 1 日至 2018 年 12 月 31 日期间登记在 iHBMC 应用程序数据集中的老年人均被纳入研究。从数据库中检索了社会决定因素（收入水平、居住区域）、功能状态、意识状态、鼻胃管或导尿管置管、以及主要疾病的数据。收集了多学科团队成员访问的频率数据。使用 Kaplan-Meier 法调查了生存率。采用 Cox 比例风险单因素回归分析了影响生存率的因素。
共有 41079 名年龄≥65 岁的患者接受了 iHBMC 服务。结果显示，居家初级照护（HBPC）、HBPC 加护（HBPC-Plus）和居家缓和医疗照护（HBPalC）的一年生存率分别为 72.1%、67.4%和 14.7%。HBPC-Plus 患者中近三分之二接受了鼻胃管置管。Cox 比例风险单因素回归分析表明，在调整混杂因素后，低城市化水平、低收入水平、低功能状态和意识状态受损是生存不良的显著预测因素。
接受 iHBMC 服务的老年人死亡率较高。使用饲管的比例较高表明，临床医生和家庭照顾者都需要接受精心喂养的教育和支持。农村地区收入水平低与生存不良之间存在关联。应进一步研究社会关怀是否会影响预后。
