Impact of team-based community healthcare on preventable hospitalisation: a population-based cohort study in Taiwan

Abstract

ObjectivesThe objective of this study was to explore the impact of Taiwan’s Family Practice Integrated Care Project (FPICP) on hospitalisation.DesignA population-based cohort study compared the hospitalisation rates for ambulatory care sensitive conditions (ACSCs) among FPICP participating and non-participating patients during 2011–2015.SettingThe study accessed the FPICP reimbursement database of Taiwan’s National Health Insurance (NHI) administration containing all NHI administration-selected patients for FPICP enrolment.ParticipantsThe NHI administration-selected candidates from 2011 to 2015 became FPICP participants if their primary care physicians joined the project, otherwise they became non-participants.InterventionsThe intervention of interest was enrolment in the FPICP or not. The follow-up time interval for calculating the rate of hospitalisation was the year in which the patient was selected for FPICP enrolment or not.Primary outcome measuresThe study’s primary outcome measures were hospitalisation rates for ACSC, including asthma/chronic obstructive pulmonary disease (COPD), diabetes or its complications and heart failure. Logistic regression was used to calculate the ORs concerning the influence of FPICP participation on the rate of hospitalisation for ACSC.ResultsThe enrolled population for data analysis was between 3.94 and 5.34 million from 2011 to 2015. Compared to non-participants, FPICP participants had lower hospitalisation for COPD/asthma (28.6‰–35.9‰ vs 37.9‰–42.3‰) and for diabetes or its complications (10.8‰–14.9‰ vs 12.7‰–18.1‰) but not for congestive heart failure. After adjusting for age, sex and level of comorbidities by logistic regression, participation in the FPICP was associated with lower hospitalisation for COPD/asthma (OR 0.91, 95% CI 0.87 to 0.94 in 2015) and for diabetes or its complications (OR 0.87, 95% CI 0.83 to 0.92 in 2015).ConclusionParticipation in the FPICP is an independent protective factor for preventable ACSC hospitalisation. Team-based community healthcare programs such as the FPICP can strengthen primary healthcare capacity.

Primary care team and its association with quality of care for people with multimorbidity: a systematic review

“…The traditional PCTs included 8 models in 8 articles [ 34 – 38 , 42 , 45 , 50 ]. In this model, primary care physicians and nurses/medical assistants (care managers) were the main members.…”

“…Three studies reported results of hospitalizations, mortality, and illness burden (Table 2 ). One study reported statistically significant lower hospitalization for COPD/asthma (OR = 0.91, 95%CI = 0.87–0.94) and diabetes or its complications (OR = 0.87, 95% CI = 0.83–0.92) [ 38 ]. Another two studies both reported no significant difference in the reduction in all-cause hospitalizations [ 37 ] or the number of hospital admissions/outpatient attendances or the number of deaths [ 45 ].…”

Relationships Between Bronchodilators, Steroids, Antiarrhythmic Drugs, Antidepressants, and Benzodiazepines and Heart Disease and Ischemic Stroke in Patients With Predominant Bronchiectasis and Asthma

“…The diabetes P4P program for caring patients with diabetes alone and diabetes with comorbid hypertension and hyperlipidemia from a single payer in Taiwan could help the BCAS cohort to improve the health behavior and food habits including poor dietary practices, physical inactivity, and cigarette smoking ( 13 , 33 , 34 ). The lifestyle measures that are recommended to lower HDS including salt restriction, alcohol limitation, body reduction, cessation of smoking, diet adaptation, and exercise adoption.…”

“…The lipid guidelines for high risk patients recommended pragmatic goals for low density lipoprotein-cholesterol (LDL-C) of <70 mg/dL (<100 mg/dl, 2000-2009) for those at highest HDS (31,32). A P4P programme is a management strategy that encourages healthcare providers to deliver high quality of care, and helps the BCAS cohort with these comorbidities to receive the management under these guidelines such as HbA1c < 7.0%, BP < 140/90 mmHg, and LDL-C < 100 mg/dL (33)(34)(35).…”

Beyond the Disease – History of the House for Patients with Chagas Disease and Heart Failure of Pernambuco (Casa do Portador de Doença de Chagas e Insuficiência Cardíaca de Pernambuco)/PROCAPE-UPE/Brazil

“…In face of the complexity of Chagas disease, with its social, economic, and psychological implications, the team felt the need to transcend the strictly biomedical approach into a more complete care, meaning a whole health care performed by a multidisciplinary team, which to the current day has been scientifically proven as the best option when caring for chronic patients. 1 In this perspective, the need to evaluate the patient as a whole was already clear, with the challenge of adopting the biopsychosocial model of care: It proposes a view of much more than a sick organ but also the person, his or her history, family, and socioeconomic context. For this, a group of professionals that helped increase the perception of various aspects of the reality of an individual was needed.…”