Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.
Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
Clin Interv Aging. 2024 Aug 15;19:1437-1444. doi: 10.2147/CIA.S457281. eCollection 2024.
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.
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.
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).
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.
家庭医疗综合计划（HMIP）是台湾家庭医疗保健（HHC）的一种新模式，于 2016 年启动，旨在提高护理质量。然而，该计划对 HHC 患者健康结果和医疗资源利用的影响尚不清楚。因此，我们进行了这项研究以阐明这一点。
作者利用台湾全民健康保险研究数据库，确定了 2015 年 1 月至 2017 年 12 月期间接受 HMIP 和未接受 HMIP 的 HHC 患者。采用回顾性队列研究设计。采用便利抽样选择符合纳入标准的患者：参加 HHC 计划且具有完整分析数据的患者。
本研究共纳入 4982 名 HMIP 组和 10447 名非 HMIP 组的 HHC 患者。HMIP 组和非 HMIP 组的平均年龄分别为 77.6 岁和 76.1 岁。与非 HMIP 组相比，HMIP 组 HHC 的总医疗费用较低，门诊就诊次数和医疗费用较低，急诊就诊医疗费用较低，住院次数较少，死亡率较低（34.6%比 41.2%，p<0.001）。
HMIP 是提高 HHC 患者护理质量和降低医疗资源利用的有前途的模式。虽然这表明非 HMIP 模式应该被取代，但重要的是要注意，非 HMIP 和 HMIP 模式目前并存。HMIP 可能为其他国家在改善自身 HHC 系统的护理质量和降低医疗资源利用方面提供重要参考。
