Journal of the Chinese Medical Association : JCMA
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The Pilot Project on Per-diem Payment for Inpatient Hospice Services of Taiwan's National Health Insurance Program was begun in July 2000. The project monitors hospices to control for a median length of stay (LOS) of not longer than 16 days to prevent inappropriate stasis in hospices. To determine the best utilization of palliative care, patients remaining in the hospice for more than 28 days were analyzed to discover their characteristics and reasons for not being discharged. ⋯ Better understanding of the factors related to LOS can help staff in the palliative ward of medical centers to identify patients who are apt to have long stay, and shorten their LOS by successfully dealing with their problems.
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In this paper, I argue that the International Classification of Functioning, Disability and Health (ICF), proposed by the World Health Organization, provides not only a model to understand health, but a model to understand rehabilitation and geriatric medicine. The ICF proposes that poor health is defined by a complex product of the interactions between several domains: body functions and structures (and impairments of them), activities (and limitations in their performance), participation (and restrictions to it), the physical and social environment (which may be facilitating or hindering) and personal factors. ⋯ An example is given illustrating this approach in the management of a person who has fallen. This model of rehabilitation illustrates that rehabilitation is a complex multidisciplinary process, comprising restorative and adaptive strategies including the use of assistive technologies, and which is reliant upon careful assessment and care planning.