Achievements in Reducing the Hospitalization Rate of Home Care Patients in a Regional Hospital in Taiwan

Introduction

Community care is currently actively being promoted to implement long term care in Taiwan. Home health care is an indispensable part of it; besides, it is also long term care under the health insurance payment. Most of the service cases are elderly, multiple chronic diseases cause physical dysfunction, and disease diagnosis.

Method

This study adopts the research design of medical history retrospective, with descriptive statistical analysis. The object of the study was a total of 326 patients who have received care from a home care center affiliated to a regional hospital from 2018 to 2019. The data is collected by a structured questionnaire, inclusive of age, gender, discharge disease diagnosis, self-care ability, type of intubation, wound condition, main caregiver at home, number of readmissions, readmission diagnosis, number of days in hospital. After collecting the questionnaire, we work with physiotherapists, occupational therapists and dietitians to discuss follow-up care plans in cross-disciplinary cooperation, and to teach caregivers related disease care skills, nutrition guidance, passive movement in bed, assist in getting out of bed, and visit the ward during hospitalization to maintain contact with clinical nurses [1, 2].

Results

The average age of the patients in this study was 89 years old. Most of the discharged diseases were diagnosed with pneumonia and heart failure. In the part of self-care ability, the ADL (Barthel Index for Activities of Daily Living) score is 100 points, indicating that the patient can take care of himself completely. The IADL scale (Lawton And Brody Instrumental Activities of Daily Living) has a full score of 8, indicating that the patient can be independent in daily life [3].

The highest ADL score of all patients in this study was 24 points. Among them, self-care ability was completely dependent on caregivers, accounting for 94.2%. The highest score in the IADL is 3, of which 91% are dependent on caregivers in daily life [4]. The main caregivers are foreign caregivers accounting for 48%, followed by family caregivers accounting for 35% and domestic caregivers accounting for 17%. During the hospitalization, the home nurse maintains continuous contact with the clinical nurse and the personal supervisor, and assists the patient to get out of bed at least twice a day through cross-field care guidance and back smash at least three times.

The caregiver assists the patient to perform upper limb exercises twice a day, raises the head of the bed 30 to 45 degrees for the bedridden patient, records the diet and guides food preparation. The hospitalization rate dropped from 10.98% to 7.7% from 2018 to 2019.

Conclusion

Home-care patients are mainly elderly, severely disabled, and intubated. They need long-term care to maintain their health. The role of the main caregiver at home is very important as well.

They often encounter the problem of caregiver rotation. Insufficient care skills have led to a high rate of hospitalization.

It is recommended to use actual health education guidance, caregivers to respond to the teaching instantly, in addition to guiding foreign care workers or nursing skills, and family members to learn care skills together. Active solicitude during hospitalization is also very important to win the trust from patients, as well as continuous contact with clinical nurses and individual supervisors. Care will not be interrupted, and the quality of care is also improved through the study.