Emerging Results - Care by Design

Preliminary Qualitative Findings

  • Improves clinical efficiency by reducing travel time to visit residents in multiple long-term care facilities - LTCF
  • Physician team provides peer support when addressing clinical challenges
  • Physician team shares on-call reducing individual burden
  • Regular visits within one LTCF floor or wing promotes better communication amongst care teams, residents and family members
  • Continuity and quality of care is improved for residents with a coordinated interdisciplinary team

Preliminary Quantitative Data

  • 36 per cent reduction in transfers from LTCF to Emergency Department over six months with the Care by Design Physicians
 Pre-Care by Design
(Time 1)
With Care by Design
Physicians (Time 2)
Average 911
~35% reduction
Average 911
Calls/Month resulting
in transport to ED
~94.5% of calls
~92.0% of calls
  ~Overall 36.2% urgent
transport reduction


Preliminary findings are promising and give support for the continued integration of a physician-per-floor model with 24 hour on-call coverage. Further outcomes (i.e., quality indicators) pre- and post-implementation, including a middle time period where the physician was in place prior to the extended care paramedics, continue to be analyzed. 


Marshall EG, Clarke, BS, Varatharasan, N and Andrew M  (2015) A Long Term Care - Comprehensive Geriatric Assessment (LTC-CGA) Tool: Improving Care for Frail Older Adults? Canadian Journal of Geriatrics October March 2015

Marshall EG, Clarke B, Peddle S, Jensen JL (2015) “Care by Design”: A New Model of Care in Long-Term Care Facilities Providing Residents Coordinated On-Site Primary and Acute Care. Canadian Family Physician. Vol 61:e129-34 Advance web-publication: March 2015. Type of publication: Peer Review Journal, Original Research and Program Description. Full Article.

Marshall EG, Boudreau M, Jenson, JL, Edgecombe, N, Clarke B, Burge, F, Archibald, G, Taylor, A, Andrew, M (2013) Protocol for A Mixed-Methods Study of “Care by Design”: A New Model of Care in Long-Term Care Facilities in Nova Scotia, Canada. JMIR Research Protocols 2013;2(2):e56) doi:10.2196/resprot.2915