Marshall Emily Gard, Clarke Barry, Peddle Sarah, Jensen Jan
Can Fam Physician. 2015 Mar;61(3):e129-34.
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.
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.
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.
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.
长期护理机构（LTCF）最近实施的一种名为“按设计护理”的护理模式，解决了此前护理系统缺乏协调、家庭医生服务减少以及救护车转运至急诊科的高发生率等问题。
“按设计护理”旨在增加家庭医生提供护理的可及性、护理的连续性和质量，减少不必要且不想要的急诊室转诊，并减轻包括长期护理机构中的医生和护士在内的护理团队的负担。
“按设计护理”的核心是为长期护理机构的每个楼层配备一名专职家庭医生，进行定期现场访视；每周7天、每天24小时提供随叫随到的医生服务；以及常备医嘱和规程。“按设计护理”还包括一种全面的老年评估工具、一种跨学科团队方法、接入一个专门的扩展护理护理辅助计划以应对紧急护理需求，以及持续的绩效评估。
“按设计护理”旨在通过多种方式改善长期护理机构居民的现场护理以及家庭医生提供护理的体验，包括提高临床效率、沟通和连续性，以及在跨学科团队模式内提供适当支持。
