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Hip fractures significantly affect patients' health and quality of life. Despite therapeutic treatments, many patients continue to experience poor prognoses that include recurrent fractures and mortality, especially the older ones. Therefore, understanding important factors associated with post-fracture prognoses is critical. This study focuses on patients' multimorbidity trajectories and examines how the trajectory's time span, number of coexisting chronic diseases, and sequential disease patterns relate to distinct prognostic outcomes. From the National Health Insurance Research Database in Taiwan, we obtain a sample of 128,822 patients who suffered an initial hip fracture between 1996 and 2011. We use this sample to analyze the relationships between multimorbidity trajectories and prognostic outcomes after an initial hip fracture. The results reveal that a patient's multimorbidity trajectory's time span and number of chronic diseases significantly associate with his or her post-fracture prognosis. In addition, essential sequential patterns of chronic diseases relate to post-fracture prognoses too. We then leverage the discovered relationships to develop a cross-attention neural network method for estimating patients' post-fracture prognoses and demonstrate its predictive utilities relative to several prevalent machine leaning methods. This study underscores the importance of leveraging the time span, number of chronic diseases, and sequential disease patterns in patients' multimorbidity trajectory profile to estimate their prognoses within three years of an initial hip fracture, which can support physicians' clinical decisions and patient management., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objectives: This study aimed to assess the impact of pay-for-performance (P4P) programmes on healthcare in Taiwan., Study Design: This was a systematic review and meta-analysis., Methods: A systematic literature search was performed using the PubMed, Medline, Embase, Cochrane review, Scopus, Web of Science and PsycINFO databases up to July 2023. Meta-analysis of the available outcomes was conducted using a random-effects model., Results: The search yielded 85 studies, of which 58 investigated the programme for diabetes mellitus (DM), eight looked at the programme for chronic kidney disease (CKD), and the remaining studies examined programmes for breast cancer, tuberculosis, schizophrenia and chronic obstructive pulmonary disease. The DM P4P programme was a cost-effective strategy associated with reduced hospitalisation and subsequent complications. The CKD P4P was associated with a lower risk of dialysis initiation. The P4P programme also improved outcomes in breast cancer, cure rates in tuberculosis, reduced admissions for schizophrenia and reduced acute exacerbation in chronic obstructive pulmonary disease. The meta-analysis revealed that the P4P programme for DM (odds ratio [OR] = 0.59; 95% confidence interval [CI] = 0.48-0.73) and CKD (OR = 0.73; 95% CI = 0.67-0.81) significantly reduced mortality risk. However, participation rate in the DM P4P programme was only 19% in 2014., Conclusions: P4P programmes in Taiwan improve quality of care. However, participation was voluntary and the participation rate was very low, raising the concern of selective enrolment of participants (i.e. 'cherry-picking' behaviour) by physicians. Future programme reforms should focus on well-designed features with the aim of reducing healthcare disparities., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

The number of treated end stage renal disease (ESRD) patients worldwide has rapidly grown. To prolong their lives ESRD patients require transplantation or dialysis treatment. Limited donor availability has caused most of the ESRD patients to rely on either hemodialysis (HD) or peritoneal dialysis (PD). Taiwan had the highest prevalence rate worldwide and sought to increase the PD utilization through a series of reimbursement incentives. This study evaluated the effect of those policy initiatives. A retrospective longitudinal study using a before-and-after analysis was conducted. ESRD patients initiating either PD or HD were identified from the entire population of Taiwan NHI's beneficiaries. PD patients, before and after the PD-encouraging initiatives, were matched through a propensity score technique, and the change in PD technical failure was analyzed. HD patients were also matched as the control group to assess the impact on PD mortality. The competing risk regression approach for survival analysis was adopted. The results indicate the increase in PD utilization during this period was also accompanied by increases in both technique failure and mortality. Since PD shifts more burden of care to patients, efforts to increase its utilization may require an increase in the education of providers and patients to benefit more effectively. It may also require an increase in staff to provide ongoing training and support as the policy unfolds., Competing Interests: Conflict of Interest The contributing authors have no potential conflict of interest., (Copyright © 2023. Published by Elsevier B.V.)

Investigation of the key indicators of health promotion policies for an aging society can shed light on the priority of the government's health promotion efforts. This study applied the fuzzy analytic hierarchy process (AHP) method in an empirical analysis of the key indicators of the health promotion policies for Taiwan's aging society. Based on a review of the literature and expert interviews, this paper first conducted a preliminary study and evaluation of major factors affecting health promotion policies and found 4 major evaluation aspects and 16 evaluation indicators. After employing an AHP expert questionnaire in an empirical investigation, the following findings were made: (1) "healthy living" was the most important evaluation aspect for Taiwan's health promotion policies for its aging society. (2) The six leading key indicators of health promotion policies were "promotion of personal health awareness and behavior," "promotion of home medical services," "guaranteeing the economic security of the elderly," "planning a family caregiver support service system," "well-planned health promotion plans for the elderly," and "training long-term care service personnel and providing professional medical care." Following discussion, recommendations concerning these six key indicators are made as a reference for future evaluation of health promotion policies for an aging society., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Ling-Mei Hsu and Ji-Feng Ding.)

Background and Objectives: Taiwan is among the few hepatitis B virus (HBV) high-endemic countries that implement universal mini-pool nucleic acid testing (MP-NAT) and hepatitis B surface antigen (HBsAg) testing together with confirmatory individual donor nucleic acid testing (ID-NAT) for its blood supply since 2013. The aim of this study was to reappraise the value of HBsAg test in Taiwan's HBV testing strategy., Materials and Methods: A Markov model was constructed, and cost-effectiveness analysis was conducted in order to reappraise the existing HBV screening strategy in Taiwan., Results: The incremental cost-effectiveness ratio (ICER) for the current testing strategy in Taiwan was estimated to be $US 443 154 per quality-adjusted life year (QALY) gained. This is almost six times the willingness-to-pay (WTP) threshold that reflects local preferences., Conclusion: Universal HBsAg and MP-8-NAT together with confirmatory ID-NAT testing prevents a significant amount of HBV infections from entering the Taiwan blood supply. However, this comes at a disproportionate increase in cost., (© 2020 International Society of Blood Transfusion.)

Aim: The aim of this study was to develop and assess the reliability and validity of the Nurse Job Rotation Stress Scale (NJRS)., Methods: A convenience sampling method was utilized to recruit two groups of nurses (n = 150 and 253) from a 2751 bed medical center in southern Taiwan. The NJRS scale was developed and used to evaluate the NJRS., Results: Explorative factor analysis revealed that three factors accounted for 74.11% of the explained variance. Confirmatory factor analysis validity testing supported the three factor structure and the construct validity. Cronbach's alpha for the 10 item model was 0.87 and had high linearity., Conclusion: The NJRS can be considered a reliable and valid scale for the measurement of nurse job rotation stress for nursing management and research purposes., (© 2015 Japan Academy of Nursing Science.)

Background: The current shortage of professional nurses in Taiwan both undermines hospital quality of care and raises hospitals' human resource management costs. Few studies have concurrently investigated the interaction effect between professional commitment and, respectively, the positive and negative work attitudes of nurses. Results of this investigation may help improve strategies designed to raise nurse retention rates., Purpose: This study used the interaction effects of work excitement and work frustration to assess their influence on the professional commitment of nurses., Methods: This study was conducted at one hospital in southern Taiwan and used a cross-sectional design with self-administrated questionnaires. Seven hundred thirty-five nurses completed and submitted valid questionnaires (valid response rate: 68.5%). Exploratory and confirmatory factor analysis confirmed the reliability and validity of the three measurement models of work excitement, work frustration, and professional commitment. Correlation and hierarchical regression analysis verified the direct and interaction effects with the correlations among the three measured variables., Results: Work frustration was higher than work excitement among participants (M = 2.72, SD = 0.71 vs. M = 2.26, SD = 0.62). The mean participant score for professional commitment was 2.72 (SD = 0.45) on a 4-point Likert scale. There was a significant and positive correlation between work excitement and professional commitment and a significant and negative correlation between work frustration and professional commitment. High work frustration had a negative effect on professional commitment, whereas high work excitement had a higher positive effect on professional commitment. The two-way interaction between work excitement and frustration was statistically significant in explaining the effects of professional commitment (p < .01)., Conclusions/implications for Practice: Nurses often work in conditions that are highly frustrating. Although work excitement has been shown as having a greater influence on professional commitment when nurses experienced the dual work affects simultaneously, work frustration significantly reduces the professional commitment effect of nurses. This study suggests that managers should not only construct a positive and exciting work environment but also work to mitigate the causes of work frustration to promote professional commitment and retention among nurses.

This study, in which staff nurses in Taiwan participated, was aimed to construct a model for relationships among trustworthiness, trust behavior and organizational identification. One hundred and ninety five anonymously completed questionnaires were collected. Superiors' trustworthiness, staff nurses' trust behavior, and organizational identification were identified as latent variables to which the following indicators were to be applied: integrity, benevolence, ability, communication, consistency, compliance, sharing, teamwork, subordination, membership, loyalty and similarity. A logical trust and organizational identification model was constructed and tested with LISREL (Linear Structural Relations) analysis. Benevolence was eliminated due to excessive residual value. The adjusted model passed pertinent tests. It was also revealed that trust behavior acts as a mediator between trustworthiness and organizational identification. The results of this study may be taken as a reference for the training of supervisory level personnel, as well as for strengthening the organizational identification of staff nurses, and as a beginning phase in the construction and testing of a relationship model for the relationship between trust and organizational identification.

This study was conducted at a single hospital selected in Taipei during the SARS (Severe Acute Respiratory Syndrome) outbreak from March to July, 2003 in Taiwan. During this period of time, 104 SARS patients were admitted to the hospital. There were no negative reports related to the selected hospital despite its being located right in the center of an area struck by the epidemic. The purpose of this study was to identify the key factors enabling the hospital to survive SARS unscathed. Data were collected from in-depth interviews with the nursing directors and nursing managers of the SARS units, along with a review of relevant hospital documents. The five key elements identified as survival factors during this SARS crisis are as follows: 1. good control of timing for crisis management, 2. careful decision-making, 3. thorough implementation, 4. effective communication, and 5. trust between management and employees. The results of this study reconfirmed the selected hospital as a model for good crisis management during the SARS epidemic.