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This is the presentation by Dr. Hung-Bin Tsai to introduce the hospitalist program in National Taiwan University Hospital at International Hospital Medicine Forum of Hospital Medicine 2014.
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Dr. Hung-Bin TsaiDivision of Hospital Medicine, Department of
Traumatology, National Taiwan University HospitalMarch 25, 2014
Hospital Medicine Around the World- Taiwan Experience
Special Interest Forum 2014
National Health Insurance in Taiwan (TNHI)
Started on March 1, 1995
Spend 6.6% GDP for health in 2011.
Compulsory social health insurance program for all citizens from birth
Health Insurance IC Card
Second Generation National Health Insurance System
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Payment System of TNHI Healthcare institutions signed contracts with the BNHI:
92.47% Early years : “fee-for-service”
→ spiraling growth of medical cost
Pay-for-performance system (first introduced in 2001) breast cancer therapy, diabetes, asthma and hypertension treatment
Global Budget Payment System
Taiwanese version of the Diagnosis Related Groups (Tw-DRGs) adopted 111 DRGs into practice for the first year (2010) and would take 5
years to phase in the complete system (more than 500)
The Hospitalist Program in National Taiwan University Hospital (NTUH)
Founded in Oct. 2009 Current 8 Hospitalists Teaching: yes Services offered:
Medical management of multimorbid patients Consultative services Co-management of surgical patients Palliative care Medical education to nurse practitioners & nurses Quality improvement Information technology Integrated post-discharge transitional care (PDTC)
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Current situation of Hospital Medicine in Taiwan
Leading hospitalist program in Taiwan: NTUH, since Oct 2009.
Hospitalist program for 2-year young VS obligation for primary care: Chang-Gang Medical Center, since 2006
ED observation units model: Chi Mei Medical Center in Southern Taiwan,
since Aug 2012.
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Potential implications of Hospital Medicine in the development of best practice models in Taiwan.
Co-management for surgical patients
Reduce weekend effect of adverse outcome for weekend admission patients
Post-discharge transitional care
Palliative care for multimorbid aged patients
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J Hosp Med 2011;378-382
Higher clinical severities of patients in hospitalist-run vs. Internalist-run ward
Hospitalist-run vs. Internalist-run Ward:[After Propensity score matching]
Less LOS for 6 days
Less admission cost per patient: 3,590 USD
Less paid by NHI per patient: 3,202 USD
Risk Factors for 30-day readmission:
Intern Med J 2011 Jul 25.
- CCI - Cancer - LOS - Anemia
NTUH Hospitalist program reduce weekend effect of adverse outcome
(Propensity score matching)
Weekday admission (n =496)
Weekend admission
(n=496)
P value
Age (yr) 70.1 15.6 70.0 15.8 0.930 a
Male gender 249 (50.2) 251 (50.6) 0.899 b
Chronic disease CCI, unadjusted 2.6 2.5 2.5 2.4 0.432 a
ED triage level 0.703 b
1-2 256 (51.6) 262 (52.8) 3-5 240 (48.4) 234 (47.2) BI at admssion 53.9 36.9 51.3 36.5 0.276 a
Malignancy 103 (20.8) 109 (22.0) 0.699 b
Outcomes ICU admission 9 (1.8) 5 (1.0) 0.299 b
CPR event 1 (0.2) 3 (0.3) 0.374 b
DNR consent 97 (19.6) 94 (19.0) 0.872b
Hospital mortality 42 (8.5) 40 (8.1) 0.818b
BMC Med. 2011 Aug 17;9:96.PLoS One 2013
Post-discharge Transitional Care (PDTC)Can Reduce Readmission Rate and Mortality
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Pearls of PDTC:8AM-8PM Call Center + Follow-up clinic in hospitalist-run ward2 case managers to make phone callsFollowed on post-discharge 1,7,14,30 days
Our Challenges
What are the needs to run local programs and chapters of Hospital Medicine?
To redesign clinical schedule (need time for academic work) - Pair hospitalists, 2 wards by 4 teams 8a-6p for 7 or 14 days - Each team care 18 patients by 1 doc & 2 NPs
To relieve night shift burden - on duty 6 nights per month - we need moonlighters/nocturist!
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Our Challenges What is the potential role of SHM in terms of
teaching, research and networking?1.One of the successful hospitalist programs in North-
East Asia.2.We wound design more detailed post-discharge
transitional care model to link intermediate care (post-acute care)
3.To compare different interprofessional coordinated care models in USA, EU, Asia.
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Suggestions to improve the international section and the HMX community
Regional annual experts meeting for consensus of best practice model in hospital medicine.
Encourage short-term (6 month to 1 year) exchange program for fellows to learn different models in healthcare system (such as palliative care).
To compare the burn-out index of hospitalists in different healthcare systems.
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Acknowledgement:NTUH hospitalists provided holistic, integrated, non-border and trusted (HINT) services in Taiwan
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Hot-blooded Hospitalists
Thanks for your attention!
My Official E-mail: [email protected]
If you talk to a man in a language he understands, that goes to his head.
If you talk to him in his language, that goes to his heart.
~Nelson Rolihlahla Mandela