Improving Continuity of Care Reduces Emergency Department Visits by Long-Term Care Residents. Marshall, E., G., Clarke, B., Burge, F., Varatharasan, N., Archibald, G., & Andrew, M., K. Journal of the American Board of Family Medicine : JABFM, 29(2):201-208, by the American Board of Family Medicine, 2016.
abstract   bibtex   
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.
@article{
 title = {Improving Continuity of Care Reduces Emergency Department Visits by Long-Term Care Residents},
 type = {article},
 year = {2016},
 identifiers = {[object Object]},
 keywords = {Continuity of Patient Care,Emergency Departments,Long-Term Care,Primary Health Care},
 pages = {201-208},
 volume = {29},
 publisher = {by the American Board of Family Medicine},
 city = {From the Department of Family Medicine, Dalhousie University, Halifax, NS, Canada (EGM, FB, NV, GA); the Capital District Health Authority, Integrated Continuing Care, Halifax, NS, Canada (BC); and the Center for Health Care of the Elderly, Department of },
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 notes = {CI: (c) Copyright 2016; JID: 101256526; OTO: NOTNLM; ppublish},
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 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.},
 bibtype = {article},
 author = {Marshall, E G and Clarke, B and Burge, F and Varatharasan, N and Archibald, G and Andrew, M K},
 journal = {Journal of the American Board of Family Medicine : JABFM},
 number = {2}
}
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