The Impact of Integrated Home-Based Primary Care on Continuity and Outcomes of Care Among the Community Homebound Older Adults in Taiwan.

IF 2.8 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Medical Care Pub Date : 2025-09-01 Epub Date: 2025-06-26 DOI:10.1097/MLR.0000000000002183

Meng-Tse Li, Yu-Chi Tung, Kuan-Liang Kuo

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引用次数: 0

Abstract

Objectives: The homebound older adults are often at risk of poor care outcomes due to disability and limited access to health care. Home health care services have been developed to improve various outcomes of care. Since the initiation of the integrated home-based primary care (iHBPC) program in Taiwan, this study aimed to evaluate the effect of the iHBPC program on continuity and outcomes of care among the homebound older adults.

Methods: Electronic medical records of all homebound older adults receiving home health care services from March 1, 2016 to April 30, 2022, in a hospital system in Taiwan were analyzed. Continuity and outcomes of care 12 months before and after participation in the iHBPC program were observed and compared with the control group by the propensity score matching method. Multivariate generalized estimating equation regression with the difference-in-difference method was performed after adjustment for patient characteristics to evaluate the impact of the iHBPC program on the number of physicians seen, emergency department visits, hospitalizations, and inpatient days.

Results: A total of 912 patients were included. After propensity score matching, the intervention group participating in the iHBPC program for 12 months decreased the number of physicians seen, emergency department visits, hospitalizations, and inpatient days compared with the control group.

Conclusions: The iHBPC program under Taiwan's universal health care system improved continuity and outcomes of care for the homebound older adults by enhancing the accessibility, comprehensiveness, and coordination of health care. The promotion of this feasible and effective policy is anticipated to create additional benefits in the future.

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综合居家初级照护对台湾社区居家长者照护的延续性及结局之影响。

目的：由于残疾和获得卫生保健的机会有限，居家老年人往往面临护理结果不佳的风险。发展了家庭保健服务，以改善各种护理结果。摘要本研究旨在探讨综合居家初级照护（iHBPC）计划对居家长者照护的延续性及结果之影响。方法：对台湾某医院系统2016年3月1日至2022年4月30日接受居家保健服务的所有居家老年人的电子病历进行分析。通过倾向评分匹配法观察参加iHBPC计划前后12个月的护理连续性和结果，并与对照组进行比较。在调整患者特征后，采用差中差法进行多元广义估计方程回归，以评估iHBPC计划对就诊医生数量、急诊就诊次数、住院次数和住院天数的影响。结果：共纳入912例患者。倾向评分匹配后，与对照组相比，参与iHBPC项目12个月的干预组就诊次数、急诊次数、住院次数和住院天数均有所减少。结论：台湾全民健保制度下的iHBPC计划，透过提高健保的可及性、全面性和协调性，改善居家老人照护的延续性和效果。推广这一可行和有效的政策预计将在未来创造更多的利益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Medical Care 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.20

自引率

3.30%

发文量

228

审稿时长

3-8 weeks

期刊介绍： Rated as one of the top ten journals in healthcare administration, Medical Care is devoted to all aspects of the administration and delivery of healthcare. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of healthcare. This timely journal reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services.