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.

1. 1
Dr. Hung-Bin Tsai
Division of Hospital Medicine, Department of
Traumatology, National Taiwan University Hospital
March 25, 2014
Hospital Medicine Around the World
- Taiwan Experience
Special Interest Forum 2014

2. 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 System2

3. 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)

4. 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) 4

5. 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.
5

6. 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
6

7. 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

8. Risk Factors
for 30-day
readmission:
Intern Med J 2011 Jul 25.
- CCI
- Cancer
- LOS 
- Anemia

9. 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

10. BMC Med. 2011 Aug 17;9:96.
PLoS One 2013
Post-discharge Transitional Care (PDTC)
Can Reduce Readmission Rate and Mortality
10
Pearls of PDTC:
8AM-8PM Call Center + Follow-up
clinic in hospitalist-run ward
2 case managers to make phone calls
Followed on post-discharge
1,7,14,30 days

11. 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!
11

12. 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.
12

13. 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. 13

14. Acknowledgement:
NTUH hospitalists provided holistic, integrated, non-border
and trusted (HINT) services in Taiwan
14
Hot-blooded Hospitalists

15. Thanks for your attention!
My Official E-mail: hbtsai@ntuh.gov.tw
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