Taiwan Hospital Uses Task Force Recommendations in Medical Care Screening Program
A computer-aided screening program driven by U.S. Preventive Services Task Force recommendations and aided by a computerized decision support system has been successfully implemented at the National Taiwan University Hospital Yun-Lin Branch in Yun-Lin County, Taiwan (NTUH-YL). Designed to facilitate preventive interventions at the frontline clinical encounter, the program incorporated the Task Force's A and B recommendations. A total of 11 preventive services were included.
Jou-Wei Lin, MD, Cardiovascular Center at NTUH-YL says, "We deeply appreciate the great efforts by AHRQ to facilitate preventive services, which inspired our motivation to develop a decision support system to help our people get better medical care."
Patients visiting NTUH-YL during June and July 2005 were recruited into the multiple screening program. The number of new registrations to the hospital's outpatient department is about 3,000 per month. A total of 5,600 questionnaires was mailed to patients who made new visits to NTUH-YL, with a response rate of only 9.6 percent.
Due to the low response rate to the initial mail survey, phone interviews were conducted with some of the people who did not reply. Through the phone interviews, it was learned that many of the interviewees did not regard preventive interventions as such an urgent necessity that they should visit a clinic, or they just did not bother to answer.
The questionnaire contained items to check the eligibility of screening for high coronary risk, diabetes, lipid disorder, hypertension, obesity, tobacco use, depression, colorectal cancer, breast cancer, cervical cancer, and osteoporosis. During the two-month period, a total of 283 men and 199 women were identified to need one to six preventive interventions.
Patients were given health information about the diseases they were at risk for and the merits of preventive measures. They were scheduled for a clinic visit, and access to screening tools was arranged. Physicians were prompted with clinical reminders on the encounter. Multiple diseases were screened simultaneously if eligibility was met in order to fulfill the Task Force recommendations.
The overall attendance rate-people who took at least one preventive intervention-was 62.2 percent for men and 52.3 percent for women. The screening program presented all the special features needed to achieve successful improvement in clinical practice.
In addition to improving patient care, the computer-aided screening program also provided useful information about local epidemiology and implications for future health policymaking. For example, the prevalence of diabetes was 13.4 percent for men and 5.8 percent for women, when previous statistics had shown that the prevalence of type 2 diabetes in Taiwanese aged 40 and older was 11 to 13 percent. In contrast, the prevalence of hypertension concurred with previous data from the Bureau of Health Promotion of Taiwan.
Obesity was found in 44 percent of both sexes among participants. Tobacco use was highly prevalent in men, but was a rare habit among the women of Yun-Lin.
By weighing the contribution of the 11 Task Force preventive tools, it was shown that the overall cost-effectiveness of the computer-aided screening program was very favorable compared to no screening. The overall effectiveness of the 11 components in the screening program was evaluated in terms of expected lives saved.
The screening results have also provided implications for development of health policy in the country. For example, effective screening for breast cancer, cervical cancer, and osteoporosis in women at risk and the number of women who receive Pap smears, mammograms, and bone mineral densitometry could be improved. The attitude of women toward examination of private body parts remains a social stigma in the rural areas of Taiwan. The cultural impact on the health-seeking behavior of women should be explored so as to design a better protocol to improve women's health in Taiwan.
Yun-Lin Branch is the only medical center in Yun-Lin County, Taiwan, an agricultural county with a population of 700,000. Information is available at its Web site: http://www.ylh.ntuh.mc.ntu.edu.tw/English/index.html.
Lin, JW, Chu, PL, Liou, JM, Hwang, JJ. Applying a multiple screening program aided by a guideline-driven computerized decision support system: A pilot experience in Yun-Lin, Taiwan. Journal Formosa Medical Association January 2007; 106 (1): 58-68.