Early data show Residential Care Initiative (RCI) projects are making a difference in the quality of care provided to seniors living in care facilities. All divisions of family practice are now working on projects covered by RCI funding, meaning that 97% of the eligible 30,000 residential care beds in the province are now covered by projects funded by the initiative. Regional and community level evaluation data from seven divisions (Fraser Northwest, Kootenay Boundary, Mission, Richmond, Shuswap North Okanagan, Victoria, and Vancouver) have yielded data showing that RCI projects underway in those communities are already meeting some or all of the five best-practice expectations, and some are moving toward fulfilling the RCI’s three system-level outcomes.
Fraser Northwest division’s RCI work has ensured that all residential care patients in New Westminster, Coquitlam, Port Moody, and Port Coquitlam are now attached to a most responsible physician (MRP) (1,722 beds in total). The number of family doctors providing care to residential care patients has doubled, reducing the median number of patients per doctor from 80 to 35. The division has also implemented a standardized 24/7 call system. In the first 20 months of the program, emergency transfer rates from residential care facilities were reduced by 5%, acute care admissions were reduced by 9%, and acute care length of stay was reduced by 19%. Data show that these results have led to cost savings of more than $1.5 million to the health care system in less than two years.
RCI projects have greatly improved care for patients in residential care facilities in Kootenay Boundary. The hospital transfer rate for residential care across the region decreased by 34% from 2015/16 to 2016/17, and seniors are receiving consistent care and regular medication reviews. Across Kootenay Boundary, antipsychotic use without a diagnosis of psychosis and the number of patients on nine or more medications are below the IH and provincial averages for all but two facilities, and have declined in the Kootenay Boundary region by more than 12% and 18% respectively over the past two years. As well, family doctors in most communities have now organized regular visits to residential care facilities, reducing the need for unnecessary hospital transfers and reducing critical pressure on the local ER.
In Victoria, a new after-hours call system is in place covering all residents (not only those covered by RCI physicians) at each of the included 29 sites. Coverage is provided between 5 p.m. and 7 a.m. on weekends and at all hours on Saturdays, Sundays, and holidays, to ensure that facilities can reach a physician in less than five minutes by calling one convenient number. Call group coverage is optional—MRPs may opt to provide after-hours coverage for their own residents by leaving a note in the resident chart and alerting facility staff. If care is provided by an on-call physician, a follow-up communication is sent to the MRP after each after-hours call to ensure consistency of care.
As well, regular medication reviews are taking place in Victoria care facilities to reduce unnecessary prescriptions and avoid negative interactions between medications. These reviews are scheduled to ensure that both a physician and a pharmacist can attend.
Regular medication reviews are also taking place in Mission care facilities, helping to reduce the number of patients on nine or more medications by 18% and resulting in a 33% decrease in patient transfers from care facilities to the ER.
Shuswap North Okanagan
In the past year, Shuswap North Okanagan division’s RCI work has included proactive physician visits to facilities, meaningful medication reviews, and physician attendance at case conferences. The division has also implemented a system to ensure all residential care patients have an MRP, through which orphaned patients from the community or in alternate level of care beds are assigned an MRP to facilitate their transition to residential care beds.
This work has resulted in hospital admissions from care facilities in Salmon Arm to decrease by 25% in the past year, and a 19% drop in emergency transfer rates from care facilities in that community. Emergency transfer rates from facilities in Armstrong, Enderby, Lumby, and Vernon over the same period have decreased by 25%, and hospital admissions from care facilities in those communities have decreased by 20%.
In Richmond, 80% of eligible residential care beds are now attached to an RCI MRP. The division has organized an after-hours call group consisting of 13 physicians, who responded to an average 8 calls per week between May and December 2017. RCI family doctors are required to participate in the call group, which ensures continuity and coordination of care for residents.
RCI physicians in Richmond are now actively supporting their colleagues by taking on more patients in local facilities, enabling family doctors to reduce their panels and transition care of patients in residential care facilities to an RCI family doctor. Since the initial launch of RCI in May 2017, four doctors new to residential care have been recruited to join the physician group and, through RCI supports, the incoming family physicians were mentored and supported in the provision of residential care.
As a result of Vancouver division’s RCI work, the number of physicians attached to residential care facilities in Vancouver has increased by almost 50 percent. A total of 2,327 beds are now covered by RCI facility attached physicians.
With the launch of the new after-hours care program, participating facilities are able to access a family doctor within an average of two minutes through a central dispatch.
The division is also supporting newly graduated doctors in taking on residential care patients from retiring doctors, and providing them with access to a mentorship program to support their transition into provision of care in the residential care setting.
Finally, the division has worked to ensure that residents at two Vancouver care facilities who would have been left without a family doctor are now connected with a new family physician, and a mechanism is now in place to ensure that all patients in Vancouver long-term care facilities are connected with a family doctor.
Meeting the system-level outcomes
As evidenced in the data above, these division-led RCI projects have successfully reduced hospital transfer rates through strategies like proactive visits, meaningful medication reviews, and after-hours on-call coverage.
Patient attachment efforts and regular physician visits to residential care facilities have ensured that work is shared between a greater number of physicians, reduced the median number of patients per doctor, and enabled doctors to take vacation and sick leave when they need to. This work has dramatically improved the overall patient-provider experience.
These early results from divisions and health authorities around the province show that the Residential Care Initiative is already saving the system money through cost avoidance; e.g., reducing ER transfers and acute care stays, and eliminating unnecessary prescriptions. Once all local and regional data is collected, a clearer picture will emerge of the provincial impact of the Residential Care Initiative, including an estimate of overall provincial cost savings.