Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada; Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada.
J Am Med Dir Assoc. 2022 Feb;23(2):304-307.e3. doi: 10.1016/j.jamda.2021.11.018. Epub 2021 Nov 24.
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.
2019 年新型冠状病毒（COVID-19）大流行立即需要加强目前减少疗养院（NH）居民转至急性护理的努力。长期护理加（LTC+）是在 COVID-19 大流行期间开发和实施的协作护理计划，旨在加强 NH 环境中的护理，同时减少不必要的急性护理转介。LTC+ 使用中心辐射模型，在加拿大多伦多的 6 家医院作为中心枢纽，为 54 家地理位置相关的 NH 提供服务，这些 NH 共有 9574 张床位。LTC+ 为 NH 提供了以下服务：（1）虚拟普通内科（GIM）咨询；（2）护理导航员支持；（3）快速获得实验室和诊断成像服务；和（4）教育资源。从 2020 年 4 月至 2021 年 6 月，LTC+ 提供了 381 次 GIM 咨询，解决了异常血液检查（15%）、心脏问题（13%）和不明原因发热（11%）等最常见的咨询原因。65 次护理导航员电话解决了非 GIM 专科咨询请求（34%）、伤口护理评估（14%）和系统导航（12%）。177 次（46%，95%CI 41%-52%）咨询足以解决护理问题，避免了急性护理转介的需要。咨询 LTC+计划的 36 名初级保健医生均报告对提供的建议非常满意。早期结果表明，一种增强 NH 居民居住环境中护理服务的综合护理模式是可行且可接受的，有可能通过确保 NH 居民公平、及时地获得护理，对长期护理部门产生积极影响。这代表了朝着重视长期护理部门专业知识的卫生系统整合迈出了重要一步。
