PT  - JOURNAL ARTICLE
AU  - Emily Gard Marshall
AU  - Barry Clarke
AU  - Frederick Burge
AU  - Nirupa Varatharasan
AU  - Greg Archibald
AU  - Melissa K. Andrew
TI  - Improving Continuity of Care Reduces Emergency Department Visits by Long-Term Care Residents
AID  - 10.3122/jabfm.2016.12.150309
DP  - 2016 Mar 01
TA  - The Journal of the American Board of Family
                Medicine
PG  - 201--208
VI  - 29
IP  - 2
4099  - http://www.jabfm.org/content/29/2/201.short
4100  - http://www.jabfm.org/content/29/2/201.full
SO  - J Am Board Fam Med2016 Mar 01; 29
AB  - 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.