Abstract
Introduction: Care by Design ™ (CBD) (Canada), a model of coordinated team-based primary care, was implemented in long-term care facilities (LTCFs) in Halifax, Nova Scotia, Canada, to improve access to and continuity of primary care and to reduce high rates of transfers to emergency departments (EDs). Methods: This was an observational time series before and after the implementation of CBD (Canada). Participants are LTCF residents with 911 Emergency Health Services calls from 10 LTCFs, representing 1424 beds. Data were abstracted from LTCF charts and Emergency Health Services databases. The primary outcome was ambulance transports from LTCFs to EDs. Secondary outcomes included access (primary care physician notes in charts) and continuity (physician numbers and contacts). Results: After implementation of CBD (Canada), transports from LTCFs to EDs were reduced by 36%, from 68 to 44 per month (P =.01). Relational and informational continuity of care improved with resident charts with ≥10 physician notes, increasing 38% before CBD to 55% after CBD (P =.003), and the median number of chart notes increased from 7 to 10 (P =.0026). Physicians contacted before 911 calls and onsite assessment increased from 38% to 54% (P =.01) and 3.7% to 9.2% (P =.03), respectively, before CBD to after CBD. Conclusion: A 34% reduction in overall transports from LTCFs to EDs is likely attributable to improved onsite primary care, with consistent physician and team engagement and improvements in continuity of care.
| Original language | English |
|---|---|
| Pages (from-to) | 201-208 |
| Number of pages | 8 |
| Journal | Journal of the American Board of Family Medicine |
| Volume | 29 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - Mar 1 2016 |
Bibliographical note
Funding Information:This study was funded by the Capital Health Research Fund, the Dalhousie University Department of Family Medicine, the Canadian Dementia Knowledge Translation Network, and the Network for End of Life Studies. BC is the district medical director of Integrated Continuing Care at the Capital Health District and has been instrumental in establishing and coordinating the Care by DesignTM Model. His role was limited to providing background information on the model and participating in the study design and editing of the manuscript, and he had limited involvement in data collection and analysis and the interpretation of findings. The authors acknowledge the contributions of the other study team members: Dr. Nancy Edgecombe, Anthony Taylor, Gary MacLeod, Dr. Andrew Travers, and Jan Jensen. In addition, the authors are thankful for the assistance of the participating longterm care facilities and their staff and residents. The authors also acknowledge Dr. Frank Hoel for his pioneering work in longterm care models that inspired Care by DesignTM and for acting as a reader of this manuscript.
ASJC Scopus Subject Areas
- Public Health, Environmental and Occupational Health
- Family Practice
