Coastal COPD patients with limited literacy
Elderly with inhaler misuse
Patients with BMI<21
Smoking COPD patients
Patients with poor vaccine awareness
Patients lacking exercise prescriptions
Jiali Chi Mei Hospital, a 341-bed regional teaching hospital with 788 staff, joined the NHI COPD Pay-for-Performance program in November 2018 and became the first regional hospital in Taiwan to receive Joint Commission COPD Disease Certification in December 2021. The team centers on "COPD AE Bundle Care" — an interdisciplinary model integrating pulmonology, case managers, smoking cessation educators, dietitians, rehabilitation, pharmacists, and community education to provide seamless outpatient-to-inpatient continuity. Features include IT alert systems, illustrated education materials, individualized exercise prescriptions, nutrition referral workflows, visual vaccine education, official LINE group, and a COPD knowledge website, extending care into communities, schools, and workplaces. In 2024, an AI personalized prognostic prediction model was implemented (3/6-month exacerbation, mortality, ventilator dependency). As of May2026: 345 enrolled patients (258 OPD, 87 inpatient); inhaler accuracy rose from 35.4% to 100%; 6-month smoking cessation rate 72.4%; flu vaccination rate 85%.
Taiwan-first regional hospital with COPD certification
Interdisciplinary COPD AE Bundle Care model
IT-based enrollment/follow-up alert system
Illustrated visual education and exercise prescription
COPD knowledge website and LINE group
AI personalized prognostic prediction model
Total enrollment: 345
Enrollment time: 17 → 5 minutes
Education sheet usage: 0% → 100%
9 years in NHI improvement program
Pulmonary rehabilitation＞90%
Inhaler device assessment: 100%
Smoking cessation counseling: 100%
Nutritional assessment and education (BMI<21kg/m2) : 100%
6MWT execution rate: 100%
Individualized exercise prescription: 100%
Hospital stay reduced 1.3 days vs literature
28-day readmission improved 3.3%
Enrollment accuracy: 100%
Smoking referral rate: 100%
Seamless cross-team care
AI model supports clinical decisions
Education satisfaction: 35% → 100%
Significant CAT score improvement
Significant mMRC dyspnea improvement
Positive public feedback
100% cross-team professional rating
Multiple media reports
Compared with international literature (Chalder 2016) LOS and readmission better than international
AI prognostic prediction model established
Published paper on COPD with degenerative joint disease
2022 TCIA Regional Award, Silver Tower Award
Pioneers regional hospital COPD care excellence
Extends COPD care into communities/schools/workplaces
Positive media coverage broadens social impact
AI prediction model supports clinical decisions
Promotes preventive care for high-risk coastal populations
