Background: The COVID-19 omicron variant pandemic has created a community outbreak and the need for tele-consultation with hospital-at-home care has surged, especially in the rural area, like Taitung. There were some innovated telemedicine pilot programs developed in Taitung over the past 4 years in Taiwan.
Purpose: This study examines the key success factors driving teleconsultation with point-of-care ultrasound (POCUS) at home model for multi-morbid patients.
Description: Through observation and selection of a representative rural clinic (Home Clinic Dulan) engaged in home health care in Taitung to discuss the scope, application process, possible challenges, and opportunities of key elements of the medical service model and analyze the correlation of its success factors.
Conclusions: From March 2021 to October 2023, 70 patients were recruited in the doctor-to-doctor-to-patient (D2D2P) model and the main findings are as follows: 1. The services were highlighted in execution field as 57% in roving medical services, 34% at home, 9% in outpatient in outpatient clinic. The specialist’s consultation types were 9% by renal-hospitalist, 40% by cardiologists, 36% by rehab physician, 6% by neurologist, 7% for swallow training, 1% for traditional Chinese Medicine. Multi-target POCUS was applied in 7 (10%) patients, especially 2 patients with advanced chronic kidney disease and fluid-overload. Flexible nasopharyngoscopy were used for 5 (7%) patients with dysphagia. Renal supportive care was introduced for a multimorbid full-dependent end-stage renal disease patient.2. Identify the correct customer value preposition: Improve medical accessibility, 24-hour quick response, and provide high-value services. With affordable medical expenses, the home health care team, patients, and caregivers all have good reputation and are relaxed.3. Use the teleconsultation platform with multi-source synchronous display and the on-spot physician performs multi-target ultrasound scanning in the prepare stage.4. The financial break-even points were evaluated in 24 situations of tele-consultation with POCUS at home and 6 priority plans were recommended.5. Adopt regional medical cooperation, establishing a value network to repair the healthcare broken links, and provide differentiated remote home health care services.
