Effectiveness of Short-Term Interdisciplinary Intervention on Postacute Patients in Taiwan

Journal of Clinical Gerontology and Geriatrics

Jseng

et al. 2012

a b s t r a c tPurpose: This prospective study aims to determine predictive factors for patients to be discharged to home after receiving post-acute care (PAC) services and to improve the case-finding criteria for PAC services in Taiwan. Methods: Elder patients admitted to Taichung Veterans General Hospital for treatment of an acute illness were assessed by simplified comprehensive geriatric assessment (CGA) and clinical evaluation. Patients with functional recovery potential were transferred to community hospitals for further PAC service. Discharging status from a PAC unit to a home or long-term care facility was recorded. Results: From patients were recruited. 40 patients didn't receive complete PAC service and the remaining 83 patients completed the program. Among the 83 patients that completed the program, 56 patients (67.5%) were discharged to home and 27 patients (32.5%) were transferred to long-term care facilities. The Barthel index (BI) before receiving PAC was low (35.0 AE 21.34) and all patients had below average nutrition. Using multiple logistic regression analysis, patients receiving prior orthopedic surgery, living with other people and in a malnourished state were more likely to be discharged to home after receiving PAC service. Conclusion: Two-thirds of PAC patients can be safely discharged to home after receiving PAC services. Patients who live with other people, have prior orthopedic surgeries, and have good nutritional status represented predictive factors for returning home safely.

Section: Introductionmentioning

confidence: 99%

Predictive factors for patients discharged after participating in a post-acute care program

Lee

Journal of Clinical Gerontology and Geriatrics

Jseng

et al. 2012

“…In addition to, inpatient and outpatient services in tertiary medical centers, the Veteran Affairs System also successfully developed the community hospital-based post-acute care service program in Taiwan. This program clearly demonstrated the clinical benefits of post-acute care services to promote short-term functional recovery 11,12) as well as long-term survival benefits 13) . In traditional health care service system, the lack of post-acute care service is a major gap of continuing health care system in Taiwan and it may be similar among countries in eastern Asia.…”

Section: Current Status Of Geriatric Services In Taiwanmentioning

confidence: 84%

Developing Geriatric Services in Taiwan

Peng

Chen

2012

J Korean Geriatr Soc

Self Cite

Taiwan is aging fast, and so are neighborhood countries in eastern Asia. The rapid demographic transition triggers the need of developing elder-friendly health care system. However, developing geriatric services in eastern Asia was not as successful as western countries due to various reasons. In Taiwan, the development of geriatric services has been highly supported by the Veteran Affairs Commission in the past few years. Outpatient and inpatient geriatric services, as well as the post-acute care services have been successfully developed. The success of developing geriatric services in Taiwan was related to the development of geriatric specialty training program, which provided well-trained geriatricians for institutes to start new services. The success of specialty training programs also extended into clinical geriatric researches, especially the health service researches that proved the clinical benefits of outpatient, inpatient, post-acute and long-term care services with active participation of geriatricians. This review summarized the development of geriatric services and clinical geriatric researches in Taiwan in recent years.

“…11 The Taiwanese Veterans Affairs Commission started the first community hospital-based PAC program in 2007, which showed that a 4-week, CGA-based interdisciplinary PAC program successfully improved functional recovery and significantly reduced 12-month mortality. 11,22 However, the overall needs of PAC services from tertiary medical centers in Taiwan remained unclear.…”

Section: Discussionmentioning

confidence: 99%

Screening postacute care needs of hospital inpatients in Taiwan: A hospital-based study

Chou

Liang

Journal of Clinical Gerontology and Geriatrics

et al. 2012

Self Cite

a b s t r a c tPurpose: To evaluate the postacute care (PAC) needs of elderly patients in a tertiary teaching hospital. Methods: All elderly veterans admitted to a tertiary medical center were screened for their needs for PAC services from May 1 to October 31, 2009. Case managers evaluated the inclusion/non-inclusion criteria while visiting patients before their discharge. Comprehensive geriatric assessment (CGA) was performed before their transfer, if they agreed to receive the PAC service in addition to the complete medical history review. Results: Overall, 409 elderly patients (96.8% male; mean age ¼ 80.4 AE 5.4 years) meeting the inclusion/ exclusion criteria were screened, and 103 (25.2%) had PAC service needs. All patients diagnosed with central nervous system and musculoskeletal conditions displayed a significant decrease (93.1 AE 10.8 to 43.6 AE 33.3, p < 0.001; 90.9 AE 14.6 to 40.4 AE 23.1, p < 0.001) in Barthel Index (BI), and were more likely to require PAC (41.1%, p ¼ 0.001 and 55.3%, p < 0.001). Most patients with PAC needs had multiple complex needs, including mobility problems (97.7%), risk of malnutrition (90.7%), polypharmacy (74.4%), cognitive impairment (53.5%), pain problems (41.9%), sleep problems (39.5%), urinary incontinence (32.6%), and depression (14.0%). Conclusion: One-quarter of the elderly veterans admitted to the tertiary medical center, especially patients with central nervous system and musculoskeletal conditions, required PAC. Furthermore, the presence of multiple complex care needs among these patients strongly supported the suggestion that PAC services should be provided through a multidisciplinary approach.