Care by design: New model of coordinated on-site primary and acute care in long-term care facilities.

PROBLEM ADDRESSED 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. OBJECTIVE OF PROGRAM 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. PROGRAM DESCRIPTION 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. CONCLUSION 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.