A Novel Collaborative Care Program to Augment Nursing Home Care During and After the COVID-19 Pandemic

Abstract

The 2019 novel coronavirus (COVID-19) pandemic created an immediate need to enhance current efforts to reduce transfers of nursing home (NH) residents to acute care. Long-Term Care Plus (LTC+), a collaborative care program developed and implemented during the COVID-19 pandemic, aimed to enhance care in the NH setting while also decreasing unnecessary acute care transfers. Using a hub-and-spoke model, LTC+ was implemented in 6 hospitals serving as central hubs to 54 geographically associated NHs with 9574 beds in Toronto, Canada. LTC+ provided NHs with the following: (1) virtual general internal medicine (GIM) consultations; (2) nursing navigator support; (3) rapid access to laboratory and diagnostic imaging services; and (4) educational resources. From April 2020 to June 2021, LTC+ provided 381 GIM consultations that addressed abnormal bloodwork (15%), cardiac problems (13%), and unexplained fever (11%) as the most common reasons for consultation. Sixty-five nurse navigator calls addressed requests for non-GIM specialist consultations (34%), wound care assessments (14%), and system navigation (12%). One hundred seventy-seven (46%, 95% CI 41%-52%) consults addressed care concerns sufficiently to avoid the need for acute care transfer. All 36 primary care physicians who consulted the LTC+ program reported strong satisfaction with the advice provided. Early results demonstrate the feasibility and acceptability of an integrated care model that enhances care delivery for NH residents where they reside and has the potential to positively impact the long-term care sector by ensuring equitable and timely access to care for people living in NHs. It represents an important step toward health system integration that values the expertise within the long-term care sector.

Keywords: Nursing homes; implementation; models of care; quality improvement.

Fig. 1

LTC+ program overview. The key LTC+ program elements are as follows: (1) Virtual specialist consultations: Acute care hospital hubs made virtual specialist consultation available to NHs, with GIM and palliative care specialists on-call 24/7 to field urgent request. (2) Nurse navigator: Available weekdays via phone or email during daytime hours to coordinate timely access to community-based services such as nursing outreach, behavioral support programs, and wound care. (3) Rapid access to laboratory and diagnostic imaging services: Coordinated with private sector laboratory and diagnostic imaging providers to expand access to these services. • Increased access to laboratory services whereby a phlebotomist was available 7 days per week to draw samples and deliver them to the lab for same-day reporting of results. • Mobile diagnostic imaging service technologist traveled to NHs to perform on-site radiography and ultrasonography. (4) Educational webinars: We codesigned and codelivered a series of educational webinars with NH Medical Directors and Administrators, archived on the LTC+ website (https://ltcplus.ca/primary-care-provider/#Education-and-Webinars). Clinical experts presented care delivery topics relevant to the pandemic (eg, Management of Residents with COVID-19 in NHs, Facing Decline and Death in the Time of COVID, Infection Prevention and Control in NHs). A downloadable PDF of this form is available at www.sciencedirect.com.

Supplementary Fig. 1

Screenshots of LTC+ data dashboard that summarizes acute care transfer data from the 54 nursing homes enrolled in the program. LTC+ data dashboard: Top panel displays weekly acute care transfer data from the 54 nursing homes enrolled in the program (red line), alongside the number of LTC+ encounters per week plotted below (green line). Bottom panel displays a Pareto chart that summarizes the main reasons for acute care transfer—can be set to include data for the entirety of the program as well as for the past 7 days (not shown). LTC+, Long-Term Care Plus.

Supplementary Fig. 2

Number of LTC+ consults per nursing home between April 2020 and June 2021. Bar graph showing the number of general internal medicine (GIM) consults and nurse navigator calls by nursing home (data available for 335 GIM consults and 59 nurse navigator calls). LTC+, Long-Term Care Plus.