Table 1
The characteristics of patients.
| N | % | |
|---|---|---|
| Age | 83.58 (± 10.46) | |
| Sex (Women) | 57 | 75% |
| Long-term care beneficiaries grade | ||
| 1 Very heavy need | 13 | 17.1% |
| 2 Moderate need | 13 | 17.1% |
| 3 Partial need | 21 | 27.6% |
| 4 Light need | 12 | 15.8% |
| 5 Alteration in cognition | 2 | 2.6% |
| Disability grade | ||
| Severely disabled | 12 | 15.8% |
| Mildly disabled | 9 | 11.8% |
| Coverage | ||
| National health insurance | 62 | 81.6% |
| Medical care | 13 | 17.1% |
| Referral pathway | ||
| Public hospital | 32 | 42.1% |
| Promotion materials | 22 | 28.9% |
| Long-term care institution | 11 | 14.5% |
| Community referrals | 11 | 14.5% |

Figure 1
The PICS-K scheme.

Figure 2
Public hospital – Primary care physician network.
Table 2
Satisfaction of patients and providers with the HHSC.
| PATIENTS/CAREGIVERS (41) | DOCTORS (7) | COORDINATOR (8) | NURSE (2) | |
|---|---|---|---|---|
| Overall satisfaction with PICS-K (5) | 4.49 | 4.14 | 5 | 5 |
| Recommendation (5) | 4.88 | 4.28 | 4.375 | 5 |
| Willingness to re-engage (5) | 5 | 4.28 | 4.375 | 5 |
Table 3
Service linkage rate and mortality rate during the first four months.
| SERVICE LINKAGE RATE (76) | |||
|---|---|---|---|
| PERSON | CASE NUMBER | RATE | |
| Primary care home visits | 57 | 137 | 75% |
| Home nursing | 36 | 36 | 47.4% |
| Long-term care Home visit nursing | 14 | 14 | 18.4% |
| Home visit care | 11 | 11 | 14.5% |
| Home visit bathing | 3 | 3 | 3.9% |
| Personal care for the disabled | 3 | 3 | 3.9% |
| Day-care center | 1 | 1 | 1.3% |
| NHIS healthcare services | 2 | 2 | 2.6% |
| Home-type hospice | 1 | 1 | 1.3% |
| Mortality rate | |||
| PERSON | RATE | ||
| Overall mortality | 9 | 11.8% | |
| Death at home | 7 | 77.8% | |
