Home Healthcare Program Among Adults Aged 50 and Older: A RE-AIM Framework Evaluation Using 3-Year Real-World Data

Abstract

Home healthcare is a widely adopted health policy to address the needs of aging societies. This study examined Taiwan’s home healthcare policy as a case example, assessing its implementation through the five dimensions of the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Taiwan’s home healthcare policy, launched in 2016 as the “Integrated Home-Based Medical Care” (iHBMC) program, is reimbursed by the National Health Insurance. The study utilized data from the National Health Insurance Research Database and publicly available government sources. A total of 15,761 adults aged 50 years and above in the iHBMC program during its first year were identified, with 16% receiving home-based primary care (S1) and 84% receiving home-based advanced care (S2) (Reach). Prescriptions for chronic diseases and emergency department visits were significantly decreased among S1 and S2 patients after the iHBMC program (Effectiveness). Among all institutions delivering home healthcare, the majority were clinics (74%), followed by home nursing care agencies (18.3%) and hospitals (7.5%) (Adoption). Continuity of care was higher in S1 than in S2 (Implementation). More than 70% of participants engaged in the program for more than 6 months (Maintenance). These findings suggest the iHBMC program is feasible, improves healthcare utilization, and reduces hospital burden.

Keywords

home healthcare integrated home-based medical care (iHBMC)aging RE-AIM framework national health insurance research database

Get full access to this article

View all access options for this article.

References

Amjad

Carmichael

Austin

A. M.

Chang

C. H.

Bynum

J. P. W.

(2016). Continuity of care and health care utilization in older adults with dementia in fee-for-service medicare. JAMA Internal Medicine, 176(10), 1371–1378. https://doi.org/10.1001/jamainternmed.2016.3553

Arsenault-Lapierre

Henein

Gaid

Le Berre

Gore

Vedel

(2021). Hospital-at-home interventions vs in-hospital stay for patients with chronic disease who present to the emergency department: A systematic review and meta-analysis. JAMA Network Open, 4(6), e2111568. https://doi.org/10.1001/jamanetworkopen.2021.11568

Bick

Dowding

(2019). Hospitalization risk factors of older cohorts of home health care patients: A systematic review. Home Health Care Services Quarterly, 38(3), 111–152. https://doi.org/10.1080/01621424.2019.1616026

Chang

H. T.

Lai

H. H.

Hwang

I. H.

M. M.

Hwang

S. J.

(2010). Home healthcare services in Taiwan: A nationwide study among the older population. BMC Health Services Research, 10(1), 1–6. https://doi.org/10.1186/1472-6963-10-274

Chao

Y. H.

Huang

W. Y.

Tang

C. H.

Pan

Y. A.

Chiou

J. Y.

L. E.

Wei

J. C. C.

(2022). Effects of continuity of care on hospitalizations and healthcare costs in older adults with dementia. BMC Geriatrics, 22(1), 724. https://doi.org/10.1186/s12877-022-03407-7

Charlson

M. E.

Pompei

Ales

K. L.

MacKenzie

C. R.

(1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40(5), 373–383. https://doi.org/10.1016/0021-9681(87)90171-8

Chen

C. C.

Cheng

S. H.

(2023). Does continuity of care improve patient satisfaction? An instrumental variable approach. Health Policy, 130, 104754. https://doi.org/10.1016/j.healthpol.2023.104754

Chen

P. J.

C. H.

Liao

J. Y.

Smits

Hsiung

C. A.

S. J.

Zhang

K. P.

Petersen

Sampson

E. L.

(2020). The association between home healthcare and burdensome transitions at the end-of-life in people with dementia: A 12-year nationwide population-based cohort study. International Journal of Environmental Research and Public Health, 17(24), 9255. https://doi.org/10.3390/ijerph17249255

Cheng

S. H.

Chen

C. C.

Hou

Y. F.

(2010). A longitudinal examination of continuity of care and avoidable hospitalization: Evidence from a universal coverage health care system. Archives of Internal Medicine, 170(18), 1671–1677. https://doi.org/10.1001/archinternmed.2010.340

10.

Federman

A. D.

Soones

DeCherrie

L. V.

Leff

Siu

A. L.

(2018). Association of a bundled hospital-at-home and 30-day postacute transitional care program with clinical outcomes and patient experiences. JAMA Internal Medicine, 178(8), 1033–1040. https://doi.org/10.1001/jamainternmed.2018.2562

11.

Gaglio

Shoup

J. A.

Glasgow

R. E.

(2013). The RE-AIM framework: A systematic review of use over time. American Journal of Public Health, 103(8), e38–e46. https://doi.org/10.2105/AJPH.2013.301299

12.

Glasgow

R. E.

Battaglia

McCreight

Ayele

Maw

A. M.

Fort

M. P.

Holtrop

J. S.

Gomes

R. N.

Rabin

B. A.

(2022). Use of the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to guide iterative adaptations: Applications, lessons learned, and future directions. Frontiers in Health Services, 2, 959565. https://doi.org/10.3389/frhs.2022.959565

13.

Y. C.

Wang

C. T.

Weng

T. C.

C. H.

Tsai

K. T.

Hsu

C. C.

Lin

H. J.

Chen

H. C.

Huang

C. C.

(2024). Impact of the home-based medical integrated program on health outcomes and medical resource utilization in home healthcare patients in Taiwan. Clinical Interventions in Aging, 19, 1437–1444. https://doi.org/10.2147/CIA.S457281

14.

Huang

F. Y.

C. H.

Liao

J. Y.

Hsiung

C. A.

S. J.

Zhang

K. P.

Chen

P. J.

(2021). Medical care needs for patients receiving home healthcare in Taiwan: Do gender and income matter? PLoS One, 16(2), Article e0247622. https://doi.org/10.1371/journal.pone.0247622

15.

Jones

C. D.

Ginde

A. A.

Burke

R. E.

Wald

H. L.

Masoudi

F. A.

Boxer

R. S.

(2015). Increasing home healthcare referrals upon discharge from US hospitals: 2001–2012. Journal of the American Geriatrics Society, 63(6), 1265–1266. https://doi.org/10.1111/jgs.13467

16.

Y. T.

Peng

A. C.

Shu

Y. M.

Chung

M. H.

Tsai

K. T.

Chen

P. J.

Weng

T. C.

Hsu

C. C.

Lin

H. J.

Huang

C. C.

(2018). Emergency geriatric assessment: A novel comprehensive screen tool for geriatric patients in the emergency department. The American Journal of Emergency Medicine, 36(1), 143–146. https://doi.org/10.1016/j.ajem.2017.07.008

17.

Kennedy

S. G.

Sanders

Estabrooks

P. A.

Smith

J. J.

Lonsdale

Foster

Lubans

D. R.

(2021). Implementation at-scale of school-based physical activity interventions: A systematic review utilizing the RE-AIM framework. Obesity Reviews: An Official Journal of the International Association for the Study of Obesity, 22(6), Article e13184. https://doi.org/10.1111/obr.13184

18.

Lai

Y. C.

Tsai

K. T.

C. H.

Liao

J. Y.

Tseng

W. Z.

Petersen

Wang

Y. C.

Chen

Y. H.

Chiou

H. Y.

Hsiung

C. A.

S. J.

Sampson

E. L.

Chen

P. J.

(2023). Mortality rate and its determinants among people with dementia receiving home healthcare: A nationwide cohort study. Internal and Emergency Medicine, 18(7), 2121–2130. https://doi.org/10.1007/s11739-023-03319-3

19.

Landers

Madigan

Leff

Rosati

R. J.

McCann

B. A.

Hornbake

MacMillan

Jones

Bowles

Dowding

Lee

Moorhead

Rodriguez

Breese

(2016). The future of home health care: A strategic framework for optimizing value. Home Health Care Management & Practice, 28(4), 262–278. https://doi.org/10.1177/1084822316666368

20.

Lee

Y. H.

C. W.

Huang

C. T.

Chang

H. H.

Yang

K. C.

Kuo

C. S.

Chang

Y. K.

Hsu

C. C.

Huang

K. C.

(2019). Impact of a home health care program for disabled patients in Taiwan: A nationwide population-based cohort study. Medicine, 98(37), Article e14502. https://doi.org/10.1097/MD.0000000000014502

21.

Lenhard

(2022). Computation of effect sizes. Retrieved from. https://www.psychometrica.de/effect_size.html.Psychometrica

22.

Levine

D. M.

Ouchi

Blanchfield

Saenz

Burke

Paz

Diamond

C. T.

Schnipper

J. L.

(2020). Hospital-level care at home for acutely ill adults: A randomized controlled trial. Annals of Internal Medicine, 172(2), 77–85. https://doi.org/10.7326/M19-0600

23.

C. M.

Yang

K. C.

Lee

Y. H.

Chen

Y. H.

Lin

I. W.

Huang

K. C.

(2020). Factors associated with one-year mortality of patients receiving home healthcare service in a regional hospital in northern Taiwan. Taiwan Journal of Family Medicine, 30(2), 68–77.

24.

Liao

J. Y.

Chen

P. J.

Y. L.

Cheng

C. H.

S. J.

Huang

C. H.

Wang

Y. W.

Zhang

K. P.

Liu

I. T.

Umegaki

Hamano

Mori

Petersen

Sampson

E. L.

Hsiung

C. A.

(2020). Home-based longitudinal investigation of the multidisciplinary team integrated care (HOLISTIC): Protocol of a prospective nationwide cohort study. BMC Geriatrics, 20(1), 511. https://doi.org/10.1186/s12877-020-01920-1

25.

Liu

C. Y.

Hung

Y. T.

Chuang

Y. L.

Chen

Y. J.

Weng

W. S.

Liu

J. S.

(2006). Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey. Journal of Health Management, 4(1), 1–22.

26.

Sabharwal

Wilson

Reilly

Gupte

C. M.

(2015). Heterogeneity of the definition of elderly age in current orthopaedic research. SpringerPlus, 4(1), 516. https://doi.org/10.1186/s40064-015-1307-x

27.

Saint-Pierre

Prieto

Herskovic

Sepúlveda

(2019). Relationship between continuity of care in the multidisciplinary treatment of patients with diabetes and their clinical results. Applied Sciences, 9(2), 268. https://doi.org/10.3390/app9020268

28.

Schaller

Gernert

Klas

Lange

(2022). Workplace health promotion interventions for nurses in Germany: A systematic review based on the RE-AIM framework. BMC Nursing, 21(1), 65. https://doi.org/10.1186/s12912-022-00842-0

29.

Schuchman

Fain

Cornwell

(2018). The resurgence of home-based primary care models in the United States. Geriatrics, 3(3), 41. https://doi.org/10.3390/geriatrics3030041

30.

Scotland

R. E.

Estabrooks

P. E.

(2018). Pragmatic applications of RE-AIM for health care initiatives by community and clinics settings. Preventing Chronic Disease, 15, Article E02. https://doi.org/10.5888/pcd15.170271

31.

Shih

C. Y.

Chen

Y. M.

Huang

S. J.

(2023). Survival and characteristics of older adults receiving home-based medical care: A nationwide analysis in Taiwan. Journal of the American Geriatrics Society, 71(7), 1526–1535. https://doi.org/10.1111/jgs.18232

32.

Siclovan

D. M.

Bang

J. T.

Yakusheva

Hamilton

Bobay

K. L.

Costa

L. L.

Hughes

R. G.

Miles

Bahr

S. J.

Weiss

M. E.

(2021). Effectiveness of home health care in reducing return to hospital: Evidence from a multi-hospital study in the US. International Journal of Nursing Studies, 119, 103946. https://doi.org/10.1016/j.ijnurstu.2021.103946

33.

Smolić

Š.

Čipin

Međimurec

(2022). Access to healthcare for people aged 50+ in Europe during the COVID-19 outbreak. European Journal of Ageing, 19(4), 793–809. https://doi.org/10.1007/s10433-021-00631-9

34.

Taiwan Ministry of Health and Welfare . (2018). Report of disabled People’s living Condition and Demand Survey 2016. Retrieved from. https://dep.mohw.gov.tw/dos/lp-5096-113-xCat-y105.html

35.

Thomé

Dykes

A. K.

Hallberg

I. R.

(2003). Home care with regard to definition, care recipients, content and outcome: Systematic literature review. Journal of Clinical Nursing, 12(6), 860–872. https://doi.org/10.1046/j.1365-2702.2003.00803.x

36.

Wang

Y. C.

Tsai

K. T.

C. H.

Tseng

W. Z.

Petersen

Lai

Y. C.

Chiou

H. Y.

Hsiung

C. A.

S. J.

Sampson

E. L.

Liao

J. Y.

Chen

P. J.

(2025). Characteristics and hospitalization of people living with dementia after home healthcare: A nationwide cohort study. Medicine, 104(1), Article e40981. https://doi.org/10.1097/MD.0000000000040981

37.

Williams

G. A.

Cylus

Roubal

Ong

Barber

(2019). Sustainable health financing with an ageing population: Will population ageing lead to uncontrolled health expenditure growth? Copenhagen (Denmark): European Observatory on Health Systems and Policies. WHO Regional Office for Europe. Website. https://pubmed.ncbi.nlm.nih.gov/31820890/

38.

Zimbroff

R. M.

Ornstein

K. A.

Sheehan

O. C.

(2021). Home-based primary care: A systematic review of the literature, 2010–2020. Journal of the American Geriatrics Society, 69(10), 2963–2972. https://doi.org/10.1111/jgs.17365

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.42 MB