COPD patients enrolled in our hospital's quality improvement program who meet the criteria and receive comprehensive, transdisciplinary bundle care management.
Patient-centered, our team establishes the nation's largest-scale comprehensive care for COPD through active recruitment. Key clinical aspects involve tailored education, inhaler compliance guidance by pharmacists/nurses, and proximity care at the outpatient Lung Rehabilitation Room. We innovatively deploy digital healthcare, integrating a Clinical Decision Support System (CDSS) for high-risk alerts, a "DOSE" acute exacerbation early warning system, and a LINE mini platform for home-based life quality tracking. Furthermore, we actively practice green healthcare aligning with ESG goals by reducing carbon footprint via smart management. Our clinical outcomes are exceptional, leading to consecutive drops in hospitalization, ER visits, and mortality rates. Our excellence is proven by multiple national recognitions, including the Joint Commission of Taiwan (JCT) disease care certification, the SNQ National Quality Label, and the top ranking in the Health Promotion Administration’s quality awards
One-Stop Holistic Interdisciplinary Bundle Care: Patient-centered, we built the nation's largest multidisciplinary COPD care network, uniting pulmonologists, case managers, pharmacists, dietitians, tobacco counselors, and respiratory therapists. We initiate 3D (bio-psycho-social) assessments for patients. Post-discharge, they transition to our rehab room for personalized airway clearance and lung restructuring via advanced devices, enhancing care continuity and patient autonomy.
Dual-Track Intelligent Medical Early Warning Systems: We embed digital tech into clinical governance. In-hospital, the CDSS High-Risk Alert triggers a pop-up if a patient receives >2 courses of oral steroids/antibiotics within a year, enabling proactive intervention before exacerbation. For home care, the DOSE Warning System links medical history and dynamic data with a LINE Mini App for self-reporting mMRC/CAT scores. We also deployed AI Voiceprint systems for boundary-free home health monitoring.
Innovation in Medical ESG & Green Governance: We pioneer integrating ESG into chronic disease management. In Environmental (E) & Governance (G), we digitized respiratory workflows to save 24,000 A4 sheets annually. Clinically, we optimize green prescribing via low-carbon inhalers to cut chemical footprints. For Social Impact (S), we drive community screenings, high-risk warnings, and smoking cessation, setting a new paradigm for sustainable healthcare.
Capacity of Holistic Integrated Care Our transdisciplinary network delivers nation-leading COPD care. Annual enrollment grew from 680 to 756 person-times, with 665 active cases currently managed, ensuring regional medical accessibility. 100% of admitted patients undergo a holistic three-dimensional assessment. For pulmonary rehab, the outpatient facility maintained a high monthly average of over 700 person-times during 2023–2024, providing robust chronic-phase support.
Dual-Track Smart Warning and Digital Monitoring By pairing CDSS high-risk alerts with remote monitoring, we utilize mobile tech for home health tracking. The "LINE mini Platform" binding rate reached 63.2% (420 active patients). This cohort reports real-time mMRC and CAT scores, enabling dynamic monitoring via the DOSE system. We aim to deploy forward-looking "AI Voiceprint Smart Medical" home monitoring for 30% of enrolled patients.
Healthcare ESG Carbon Governance & Integration We translate green healthcare into clinical action. Via a smart respiratory management system, we digitized all records and workflows, saving 24,000 A4 sheets annually. In prescribing, transitioning to low-carbon inhalers cut SABA use by 19.3%, reducing our chemical carbon footprint. Globally, our social responsibility focuses on driving early community screenings.
Significantly reduced readmission rate: After implementing integrated care, the 14-day readmission rate dropped dramatically from 17.6% to 5.8%; the 30-day readmission rate dropped from 29.4% to 11.7%; and the 90-day readmission rate dropped from 35.2% to 17.6%.
Improved quality of life and attack control: Patients' quality of life scores significantly improved from 4.6 to 2.3, and the rate of acute exacerbations among those who underwent more than 12 pulmonary rehabilitation sessions decreased year by year, reaching 2.1% in 2024.
Outstanding cross-team care outcomes: The smoking cessation success rate was over 94%, and the proportion of patients receiving pulmonary rehabilitation reached 96%; the completion rate of inpatient swallowing assessment and training increased from 80.85% to 96.5%, and the readmission rate of aspiration pneumonia after intervention for patients with swallowing disorders identified during screening was 0%.
Nutritional Assessment and Intervention Results: For hospitalized patients with a BMI < 21 kg/m², the proportion of those who received nutritional intervention and achieved weight gain or maintenance reached 90% in 2023 and 92% in 2024.
National Recognition and Awards: Certified by the Medical Policy Council for Disease Care and awarded the SNQ National Quality Mark, accumulating the highest quality awards nationwide, and selected as a 2025 Featured Hospital for Pulmonary Obstruction by CommonHealth Magazine.
Annual quality and safety audits.
Swallow rehab rate up to 96.5%.
0% readmission for pneumonia.
Patient satisfaction at 4.8.
Zero major adverse events.
Won JCT and SNQ certifications.
Overall satisfaction at 96%.
Health room workflow rated 4.9.
Inhaler consultation rated 4.9.
Daily guidance satisfaction 4.8.
Rehab room workflow rated 4.8.
Outpatient referral rated 4.7.
Quality Enhancement: Dropped 14-day readmission to 5.8% and achieved 96% satisfaction, setting a national benchmark.
Standard Creation: Implemented multi-specialty bundle care and proactive CDSS high-risk pop-up alerts
Patient Benefits: Leveraged LINE mini remote monitoring to track health dynamics and improve life quality.
Medical Sustainability: Reduced carbon footprint by 19.3% via green prescribing and full workflow digitization.
