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Improved continuity of care reduced trips to ED

Improved onsite primary care, with consistent physician and team engagement and increased continuity of care, likely led to a 34% reduction in transports from long-term care facilities to EDs, according to data published in the Journal of the American Board of Family Medicine.

“Frail older adults in long-term care facilities (LTCFs) have high rates of complex comorbidity and benefit from coordinated comprehensive primary care,” Emily Gard Marshall, PhD, of the department of family medicine, at Dalhousie University, Halifax, Nova Scotia, Canada, and colleagues wrote. “It is therefore useful to examine models of care to ensure primary care provision in LTCFs is optimized to improve resident well-being and health outcomes.”

The researchers conducted an observational time series to compare primary care provision and transport to EDs before and after the 2009 changeover in Halifax to the Care by Design model. The model includes a family medicine physician on each floor of a LTCF, weekly onsite visits for residents as necessary and coordinated 24/7 on-call coverage Participants included 203 LTCF residents with 911 calls before Care by Design implementation, and 150 residents with 911 calls after implementation. Patients were recruited from 10 LTCFs, with a total of 1,424 beds.

The researchers used data from LTCF charts and information available at the Emergency Health Services. Primary outcome was ambulance transports from LTCFs to EDs. Secondary outcomes included care access and continuity.

According to the researchers, transports from LTCFs to EDs decreased by 36%, from 68 to 44 per month, after implementation of Care by Design (P = .01). Continuity of care improved, with resident charts containing 10 or more physician notes, increasing from 38% before implementation to 55% after implementation, and the median number of chart notes rose from seven to 10 (P = .0026). Physicians contacted before 911 calls increased from 38% before implementation to 54% after (P = .01), and onsite assessment increased from 3.7% to 9.2% (P = .03).

“Implementation of the [Care by Design] model in LTCFs is associated with improved continuity of care and fewer ED transfers,” Marshall and colleagues wrote. “Further research evaluating its impact on specific aspects of care (eg, end-of-life care and care for residents with frailty and/or dementia and issue of polypharmacy) is underway.” – by Jason Laday

Disclosure: Marshall reports no relevant financial disclosures. See the full study for all other authors’ disclosures.