Emerging Results - Care by Design
Preliminary Qualitative Findings
- Improves clinical efficiency by reducing travel time to visit residents in multiple long-term care facilities - LTCF
- Physician team provides peer support when addressing clinical challenges
- Physician team shares on-call reducing individual burden
- Regular visits within one LTCF floor or wing promotes better communication amongst care teams, residents and family members
- Continuity and quality of care is improved for residents with a coordinated interdisciplinary team
Preliminary Quantitative Data
- 36 per cent reduction in transfers from LTCF to Emergency Department over six months with the Care by Design Physicians
Pre-Care by Design (Time 1) | With Care by Design Physicians (Time 2) | |
Average 911 Calls/Month | 72.4 (range=60-88) | 47.4 (range=39-54) ~35% reduction |
Average 911 Calls/Month resulting in transport to ED | 68.4 (range=56-85) ~94.5% of calls | 43.6 (range=56-49) ~92.0% of calls |
~Overall 36.2% urgent transport reduction |
Conclusions
Preliminary findings are promising and give support for the continued integration of a physician-per-floor model with 24 hour on-call coverage. Further outcomes (i.e., quality indicators) pre- and post-implementation, including a middle time period where the physician was in place prior to the extended care paramedics, continue to be analyzed.
Resources
Marshall EG, Clarke, BS, Varatharasan, N and Andrew M (2015) A Long Term Care - Comprehensive Geriatric Assessment (LTC-CGA) Tool: Improving Care for Frail Older Adults? Canadian Journal of Geriatrics October March 2015
Marshall EG, Clarke B, Peddle S, Jensen JL (2015) “Care by Design”: A New Model of Care in Long-Term Care Facilities Providing Residents Coordinated On-Site Primary and Acute Care. Canadian Family Physician. Vol 61:e129-34 Advance web-publication: March 2015. Type of publication: Peer Review Journal, Original Research and Program Description. Full Article.
Marshall EG, Boudreau M, Jenson, JL, Edgecombe, N, Clarke B, Burge, F, Archibald, G, Taylor, A, Andrew, M (2013) Protocol for A Mixed-Methods Study of “Care by Design”: A New Model of Care in Long-Term Care Facilities in Nova Scotia, Canada. JMIR Research Protocols 2013;2(2):e56) doi:10.2196/resprot.2915