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. 2015 Mar;61(3):e129-34.

Care by design: New model of coordinated on-site primary and acute care in long-term care facilities

Emily Gard Marshall, Barry Clarke, Sarah Peddle, Jan Jensen

Care by design: New model of coordinated on-site primary and acute care in long-term care facilities

Emily Gard Marshall et al. Can Fam Physician. 2015 Mar.

Abstract
in English, French

Problem addressed: A recently implemented model of care in long-term care facilities (LTCFs) called Care by Design addresses concerns about a previously uncoordinated care system, a reduction in family physician services, and high rates of ambulance transports to emergency departments.

Objective of program: Care by Design is designed to increase access to care and continuity and quality of care by family physicians, reduce unwanted and unnecessary transfers to the emergency department, and lessen the burden on care teams including physicians and nurses in LTCFs.

Program description: The core of Care by Design is a dedicated family physician for each LTCF floor, with regular on-site visits; physician on-call coverage, 24 hours a day, 7 days a week; and standing orders and protocols. Care by Design also includes a comprehensive geriatric assessment tool, an interdisciplinary team approach, access to a dedicated extended care paramedic program to respond to urgent care needs, and ongoing performance measurement.

Conclusion: Care by Design aims to improve on-site care for LTCF residents and family physicians' experiences with providing care in several ways, including increased clinical efficiency, communication, and continuity, and appropriate support within the interdisciplinary team model.

Problème à l’étude: Le programme Care by Design, un modèle de soins récemment instauré à l’intention des résidents d’établissements de soins prolongés (ESP), veut répondre à une situation antérieure caractérisée par des soins mal coordonnés, une réduction des services dispensés par des médecins de famille et un trop grand nombre de transports ambulanciers vers les urgences.

Objectif du programme: Le programme Care by Design est conçu pour faciliter l’accès à des soins continus de qualité fournis par des médecins de famille, diminuer le nombre de transports inutiles ou non désirés vers les urgences et réduire la charge de travail des équipes de soins des ESP, médecins comme infirmières.

Description du programme: Care by Design repose principalement sur un médecin de famille dévoué qui prend en charge un étage de l’ESP, qu’il visite régulièrement; un médecin de garde 24 heures par jour, 7 jours par semaine; et des règlements et protocoles permanents. Le programme comprend aussi un outil d’évaluation gériatrique complet, un travail en équipe multidisciplinaire, l’accès à soins paramédicaux complets en cas d’urgence, et une mesure constante du rendement.

Conclusion: Le but de Care by Design est d’améliorer de diverses façons les soins donnés sur place aux résidents des ESP ainsi que l’expérience de travail des médecins de famille qui y prodiguent des soins, par exemple en améliorant l’efficacité clinique, les communications et la continuité, et en offrant un soutien approprié au sein d’une équipe interdisciplinaire.

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Figures

Figure 1.
Figure 1.
Implementation of the Care by Design model components
See this image and copyright information in PMC

References

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