Moderation effect of mammography screening among women with multiple chronic conditions.

Comorbidity substantially affects breast cancer risk and prognosis. However, women with chronic conditions are less likely to participate in mammography screening. Few studies have examined potential benefits of mammography in women with chronic conditions. This study investigated the moderation effects of mammography screening on early stage breast cancer and all-cause mortality among women aged 50-69 years with chronic conditions in Taiwan. We used a matched cohort design with four nationwide population databases, and an exact matching approach to match groups with different chronic conditions. Women population aged 50-69 years in 2010 in Taiwan were studied. A generic Charlson comorbidity index (CCI) measure was used to identify chronic illness burden. The sample sizes of each paired matched group with CCI scores of 0, 1, 2, or 3+ were 170,979 using a 1-to-1 exact matching. Conditional logistic regressions with interaction terms were used to test moderation effect, and adjusted predicted probabilities and marginal effects to quantify average and incremental chronic conditions associated with outcome measures. Statistical analyses were conducted in 2020-2021. Women with more chronic conditions were less likely to participate in mammography screening or to receive early breast cancer diagnoses, but were at greater risk of mortality. However, mammography participation increased the likelihood of early breast cancer diagnosis (OR 1.48, 95% CI 1.36-1.60) and decreased risk of all-cause mortality (HR 0.53, 95% CI 0.51-0.55). The interaction terms of CCI and mammography participation indicated significantly increased benefits of early breast cancer diagnosis and decreased risk of all-cause mortality as chronic illness increased. Mammography participation significantly moderated the link between comorbidity and outcome measures among women with chronic conditions. Hence, it is important for public health policy to promote mammography participation for women with multiple chronic conditions.

Development of a home-based telehealthcare model for improving the effectiveness of the chronic care of stroke patients.

This study describes the development of an information technology (IT)-mediated home-based healthcare model designed to improve the effectiveness of caring for stroke patients who require chronic, home care. This model was evaluated at Kaohsiung Medical Hospital in Taiwan between 2005 and 2008; 84 newly diagnosed stroke patients diagnosed as the chronic covalence stage were enrolled for preliminary testing of this model. These patients required 24-hour in-home monitoring of their health status and emergency call service. Over the course of the study, 15 emergency transfers were carried out, and the acute stroke patients were sent to the emergency care within 26 minutes, on average. This system helped physicians, patients, and their families to more efficiently detect the occurrence of recurrent stroke. In addition, we found a statistically significant finding (p < 0.001) that daily blood pressure (BP) monitoring increased from 45.5% in the initial month of the study to 76% after 3-10 months of intervention. Meanwhile, the proportion of patients with an abnormal BP rate decreased from 20.5% in the initial month of the study to 10.9% after 3-10 months of intervention. This suggests that this model helped to improve patient behavior and their ability to care for themselves. This is the first study to develop an IT-mediated, home-based healthcare model in Taiwan. This model integrates both healthcare and clinical services and is capable of enhancing the effectiveness of the care provided to patients with chronic diseases, especially those in situations where self-care is essential for disease management.

Experiences of interprofessional implementation of a healthcare matrix.

The Taiwan Joint Commission on Hospital Accreditation endorsed the Institute of Medicine (IOM) dimensions of health care quality as safe, timely, effective, efficient, equitable, and patient-centered. The Taiwan Association of Medical Education has also adopted the Accreditation Council for Graduate Medical Education (ACGME) outcome project and core competencies for Taiwan physicians in training. These schemes focus on patient care, medical knowledge and skills, interpersonal and communication skills, professionalism, system-based practice and practice-based learning and improvement. Bingham (2004) described a Healthcare Matrix that links to the ACGME Core Competencies and the IOM Dimensions of Quality as a tool to improve health care. The matrix provides a blueprint to help residents learn the core competencies in patient care, and to help the faculty to link mastery of the competencies with improvements in quality of care. However, the "six-by-six" framework was too complicated to fill in. Furthermore, the translation of the IOM aims and ACGME core competencies into the Chinese language seemed incoherent and difficult to remember. We simplified the matrix by merging some columns of the original Healthcare Matrix, and reduced the 6 x 6 form into a 4 x 5 framework. The matrix was applied in case conferences, mortality and morbidity conferences, combined meetings and nursing quality assurance meetings in different departments. This format organizes the presentation and discussion, highlighting strengths or deficiencies in key aspects of patient care. With interprofessional collaboration, the matrix has been used in the departments of Plastic Surgery, and Nursing and Performance Management in our hospital. The achievements are encouraging. The Taiwan Edition Healthcare Matrix is worthy of consideration, having been used in a Mandarin-speaking region of Asia.