creating age-friendly health care through innovation …. ming-yueh cho… · creating age-friendly...
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Creating Age-friendly Health Care
through Innovation and Partnership
Ming-Yueh Chou, MD
Director, Division of Geriatric Integrated Care, Center for Geriatrics and Gerontology
Kaohsiung Veterans General Hospital, Taiwan
The world is rapidly aging
Japan
Korea
Germen
Italy
France
UK
US
Taiwan
Highly Specialized Professionals
Traditional/Fragmented Services
4
Not Ideally Designed
for older persons
Taiwan’s Framework of
Age-friendly Hospital
the WHO age-friendly principles
the WHO HPH model
the Vancouver Island Health Authority’s Elder-Friendly
Hospital Initiative
It consists of vision, values, missions,
and strategies on four dimensions
- management and policy
- communication and services
- care processes
- physical environment
社區式長照機構式照護日間照護服務
Health Care system in Taiwan
Geriatric
Syndrome
Fraily/Sarcopenia
Acute care Post-Acute Care Long-term
care
Community
care
Intermediate Care
Home Care
Institutionalized
Care
Day care
Stroke
Fragile fracture
CHF
Frail older people
Integration from Acute to Chronic Care
Acute Care Chronic Care
Kaohsiung Veterans General Hospital
A tertiary medical center
1414 beds
OPD: 108,000 visits per month
65-y-o : 38.8%
ED: 7159 visits per month
65-y-o : 27.2%
Admission: 3375 per months
65-y-o : 42.6%
Intermediate Care
Community
Education
Long-Term Care
Established in 2004
Core Value：
- Integrated Services、Team Work、Respect Life
Mission：
– Provide Good Quality Care
for Older Persons
– Develop a Good Team Work
– Be an Excellent Training Center
for Geriatric Medicine
Center for Geriatrics and Gerontology
Taiwan’s Framework of
Age-friendly Hospital
Strategy 1： Management policy
1.1 Developing an age-friendly policy
1.2 Organizational support
1.3 Continuous monitoring and improvement
Promote Geriatric
Medicine
Value the care for older
persons
Build up Geriatric
Medicine Building
Expend Geriatric
Medicine
Age-Friendly Environment
Our Management Policy
Geriatric Medical
Building
Taiwan’s Framework of
Age-friendly Hospital
Strategy 2：Communication and services
2.1 Communication
2.2 Services
All healthcare professionals,
hospital staff and volunteers
Continuing Education Programs
Doctors Nurses health care staff Volunteers
To empathy elderly’s situation
Older Persons Simulation
Experience
• More than 60 hours per year
• Including age-friendly principle, health promotion,
integrated services, gender, and so on.
• Should attend at least 2 hours per year
Continuing Education Programs
Taiwan’s Framework of
Age-friendly Hospital
Strategy 3： Care processes
3.1 Patient assessment
3.2 Intervention and management
3.3 Community partnership and continuity of care
The Complex Needs for ED
To solve the problems
of frequent ED visits
and unnecessary stay
To cooperate with ED
CGA in the ED
Project in the Emergency Department
急診頻診30天內至急診≧3次
1.2次
4.9次
0
1
2
3
4
5
6
介入前 介入後
超時滯留滯留6小時仍無判科
33.4小時
93.3小時
0
20
40
60
80
100
介入前 介入後
急診頻診 30天內至急診≧4次
超時滯留 滯留6小時仍無判科
International Journal of Gerontology (2012) 6:131-133
Project in the Emergency Department
Integrated Service in ED
Newspaper in Jan 2016
VGHKS is the first one
to integrate geriatric
medicine to ED
Integrated Service in Orthopedic Ward
Integrated Service in Orthopedic Ward
Pre-OP Post-OP Rehabilitation
Delirium Prevention
Program
Combing Care
Intermediate Care
Integrated Service with Psychiatrists
3 D: Delirium, Depression, Dementia with BPSD
Combing Care model
More physical condition: Geriatric ward
More psychiatric condition: Psychiatric ward
Fall
Clinics
(CGA)
Integrated Outpatient Services
Post-CVD Bone
Health Metabolic
Clinics
每年總看診次數 13.318.7
23.9
10.215.1
19.6
0
25
D=內科+家醫科 C=D+外科+精神科 B=所有科別
每
年
看
診
次
數
前一年 後一年
13.318.7
23.9
10.215.1
19.6
0
25
D=內科+家醫科 C=D+外科+精神科 B=所有科別
每
年
看
診
次
數
前一年 後一年內科+家醫科
每年總藥費(元)
12,885,189 14,797,211 15,577,219
13,601,22612,992,93010,961,3290
20,000,000
D=內科+家醫科 C=D+外科+精神科 B=所有科別
20,000,000
0
14.9%*↓
減少192萬
前一年看診 本院內科+家醫科 總看診次數>4次&
月藥品項數≧5項
N=700
9,946 13,192 16,533
13,47310,6537,7860
24,000
D=內科+家醫科 C=D+外科+精神科 B=所有科別
24,000
0
21.7%*↓
每年總藥品項數
84.897.1
107.2
68.4 82.4 80.5
0
120
D=內科+家醫科 C=D+外科+精神科 B=所有科別
0
120
*：p<0.001
19.4%*↓
27
The Effectiveness of CGA-based clinics
內 科醫師 神經科醫師 復健科醫師 精神科醫師 家醫科醫師
臨床藥師 營養師 社會工作師 物理治療師 職能治療師
高齡醫學 個管師
老年醫學 專科醫師群
護理師 出服個管師
受訓醫師
老年醫學專科醫師群
參與學生 藥師PGY 營養師PGY 社工實習生 實習醫師 PGY醫師 護生 新進護理人員
Multidisciplinary Team works
所有的社區居民（500名）
三位專職個管師，每季進行周全性老年評估
醫師定期檢視及衛教、訪視
關懷活動，提昇長輩身心健康
急診
高齡醫學門診
醫師診治 視病況需要住院治療
持續社區
健康管理 聯繫個管師
聯繫個管師 特需社區長輩
Health Management in the community
Taiwan’s Framework of
Age-friendly Hospital
Strategy 4： Physical environment
4.1 the common principles of Universal Design
4.2 transport
4.3 Simple and easily readable signage
Our New Building for Geriatric Medicine
Integrated with Geriatric Medicine, Psychiatric Medicine, Rehabilitation Medicine, Neurologic Medicine
Open in November 2014
Integrated Clinic Area
Ward for Geriatric Medicine
33
Ward for Geriatric Medicine
Ward for Geriatric Medicine
第一警戒區
病房及廁所門口
廁所
第一警戒區
病房及廁所門口
廁所
第一警戒區
病房及廁所門口
廁所
第二警戒區
病房門口
第二警戒區
病房門口
第二警戒區
病房門口
病房每台電腦、行動護理車警示系統連線
病房每台電腦、行動護理車警示系統連線
當患者出現在預防區，跳出警示視窗，並發出音樂聲當患者出現在預防區，跳出警示視窗，並發出音樂聲
Ward for Geriatric Medicine
Ward for Geriatric Medicine
38
Project from Ministry of Health and Welfare, 2013
Help 15 hospitals to
provide integrated care for
older persons
• Age-Friendly Hospitals
• Integrated Outpatient
Services
• Team Care
Guidance for Integrated Care
Services for Older Persons
Thank You !