Abstract
Reimagining care for long-term care (LTC) residents can enhance the utilization and optimization of scarce health and human resources, and provide proactive interventions, improving resident outcomes, and resident/family and provider experience. Humber River Health (HRH) has developed, implemented and scaled an LTC Remote Monitoring - a suit of innovative services and pathways aimed to deliver best possible and barrier free care at/closer to home for LTC home residents to prevent avoidable Emergency department (ED) transfers and hospitalizations, comprised of LTC+, clinical deterioration tool Practical Routine Elder Variants Indicate Early Warning for Emergency Department (PREVIEW-ED), and LTC++ Diagnostic Imaging (DI) and Transportation initiative.The LTC+ program, launched in April 2020 and scaled to LTC homes affiliated with HRH, supporting over 2,200 residents, is a platform that provides LTC homes with direct access to a Nurse Navigator, virtual consultations with General Internal Medicine/Geriatrician on-call, specialist care, diagnostics, and community resources. Established pathways support timely linkage to services (e.g., medical imaging, fracture clinic, lower limb preservation), creating a seamless transition to and from the LTC home. This supports equitable access to care and services, ED avoidance, and positively contributes to LTC residents' quality of life, and resident/family and provider experience-quintuple aim.LTC+ has been leveraged to deliver remote monitoring to LTC homes, through the implementation of the PREVIEW-ED tool, developed from the evidenced-based NEWS2 system that focuses on four conditions: Pneumonia, Dehydration, Congestive Heart Failure, and Urinary Tract Infection. The tool systematically detects early signs of decline in LTC residents. Those with deteriorating status are connected with LTC+ to provide rapid access to hospital resources and specialist via an integrated escalation process that supports early intervention at/close to home. Initially launched in February 202 in seven LTC homes, PREVIEW-ED has been scaled to two more homes in January 2022, and a tenth home in March 2024. The LTC Remote Monitoring initiative has resulted in a 35% and 55% reduction in total ED visits and ED visits for tool sensitive conditions respectively, and a 36% and 32% reduction in admissions for total and tool sensitive conditions respectively, equating to 7.32 acute beds, increasing capacity for acute patients, with results sustained. In addition, the provider experience survey demonstrated that the program improved LTC staff's ability to identify early health decline (85.7%), fostered assessment skills (85%), and enhanced team communication (85.3%). Resident/family experience survey had an overall score of 3.8 on a -4 Likert scale, rating experience, managing health concerns, confidence in the program, ease of use, and recommendation. Further to positive outcomes, resident/family feedback, and HRH advocacy, Ministry of LTC provided HRH with funding towards non-emergency transportation for LTC residents and extended hours for DI in late 2022/23. Through this initiative, the residents of LTC homes affiliated with HRH have been able to leverage non-emergency transportation to receive timely DI services at HRH at no cost to resident/family and reduce avoidable ED visits. In 2023/24, 469 residents benefited from this service, avoiding 469 ED visits. 94% of resident/families surveyed reported good, very good and excellent experience. 90% of LTC staff reported good, very good and excellent experience with the service. The LTC Remote Monitoring streamlines access to community and hospital services that previously would have required transfer to the ED, reducing transfers for potentially avoidable conditions, as well as health care system burden and costs while enhancing resident/family and provider experience and ensuring equity of access. It leverages technology and data to support improved connectivity/ integration of the system and regular engagement with LTC homes leadership, clinical champions, and physicians to ensure collective ownership of the outcomes and commitment to ongoing quality improvement.