• Home-care disabled patients (Karnofsky ≥3, Barthel <60)

• NG tube, urinary catheter, tracheostomy patients

• Home pressure injury patients

• ACP candidates

Taipei VGH's affiliated Home Care Center, established in 1986 and accredited as an Open Practice Center in 1996, is led by Deputy Head Nurse Mei-Shu Huang. The center builds a service model of "3 Features + 2 Innovations + 4 Care Pillars." Three Features: Action ACP (entire home care team trained in advance care planning consultation; palliative consultation meetings, DNR/AD signed); Patient "Pa-Pa Go" (outdoor activities for Karnofsky ≥3 patients); Best Home Forum . Two Innovations: "Love Pharmacist" APP (Taiwan's only visual drug recognition app; won 20th National Medical Quality Award Smart Solutions Gold + Potential Award, 4th Government Service Award Social Care); teleACT mobile medical service (with Plastic Surgery, pressure injury wound healing rate keep above 68%). Four Care Pillars: tube-free care (committed to tube removal, high Type 1 admission), first tracheostomy change requires two-person visits, NHI-LTC integrated care, multi-team collaboration (656 referrals to specialists, 287 LTC referrals in 2016-2020). LACE prediction model reduced readmission rate by 44% (2017: 24.1% → 2019: 12.3%，2029 keep 24.7%), first application to home care. 2021-2025:17,967 nursing visits, 811 admitted home care cases, satisfaction >95%.

• Action ACP at home

• Patient Pa-Pa Go outings

• Best Home Forum (18 centers participating)

• "Love Pharmacist" APP (only drug recognition)

• teleACT remote wound service

• First LACE prediction model for home care

• 2016-2025 nursing visits: 38,077

• 2,050 home care admissions

• Home medical integration physician visits 9,566

• Service Shilin (40.7%) / Beitou (59.3%)

• Health bureau audits & accreditations: distinguished

• NG tube removal 107 0.91%→114 0.60%

• Urinary catheter removal 107 2.73%→114 2.38%

• Pressure injury rate 109 0.73%→114 0.33%

• PI healing rate 109 69.8%→114 66.7%

• Unplanned admission 107 6.46%→114 5.30%

• Readmission reduction 24.7% (LACE intervention)

• 0 incidents involving visiting staff

• Two-person first tracheostomy change

• Home environment safety assessment

• Home medication safety assessment

• COVID-19 pandemic response SOP

• Telemedicine clinic for pandemic

• Home care satisfaction >95%

• Families appreciate telemedicine

• Tube-free patient families praise patience

• Health bureau audit "Best Feature" award

• Home care nurses receive awards

• 20th NHQA Smart Medical Gold + Potential

• 4th Govt Service Social Care Award

• Int J Environ Res Public Health LACE model study

• J Pers Med home drug APP study

• 5 journal papers (incl. LACE/HOSPITAL)

• First LACE model for home care

• Leads national home care quality

• Plastic surgery teleACT model rolled out to islands/veteran homes

• Expanded telemedicine for pandemic

• 18 home care centers join Best Home Forum

• Commissioned by city health bureau/VAC

• Receives social bureau home assessments