by Isis Monteiro and Paul Trigonoplos
Covid-19 accelerated the shift of care out of the hospital and the adoption of new care models as providers adapted to unprecedented capacity challenges and changes in patient preferences.
How Michael Garron designed a team-based care model
Below we outline five of the most popular examples of emerging care models our members are implementing.
1. Virtual care: Virtual care is here to stay, but not at the levels we saw at the peak of the pandemic. Two challenges lie ahead: creating virtual visit workflows that don't overwhelm clinicians and setting sustainable virtual visit targets that signal top-down commitment to a 'new normal.'
Part of the solution to these challenges is connecting clinicians to the value of telehealth. While there's no magic number to which organisations should aspire, there are two helpful guidelines to follow when setting defensible targets: targets should be set at the specialty or sub-specialty level and virtual visits should occur at a level that safeguards social distancing in in-person care settings.
2. Ambulatory surgical centres: Ambulatory surgical centres, or ASCs, are off-site ORs used for procedures that don't require an overnight hospital stay, such as cataract or joint replacement surgery. ASCs provide a faster, cheaper alternative to hospitals for lower-risk procedures.
ASCs are becoming more common in some parts of Canada. In Alberta specifically, ASCs are emerging as joint partnerships between physicians and management companies. This trend is being driven in part by the government's goal to move 30% of surgeries out of the hospital by 2023. This model is also gaining traction as systems look for new ways to ramp up surgical capacity in order to cut through the surgical backlog exacerbated by Covid-19.
3. ED 'buffers': During Covid-19, some governments implemented measures to keep non-emergent patients out of the ED. These measures triage patients to more appropriate sites of care, alleviating capacity pressures and reducing risk of COVID-19 transmission in waiting areas.
The United Kingdom and Ireland implemented appointment-only EDs modeled after Denmark. Under this model, patients with non-life-threatening conditions must call before presenting to the ED. Patients are often routed to urgent care centres, general practices, or a mental health professional.
When cases began to spike in Ontario, Canada, the government built an assessment centre infrastructure for testing Covid-19 patients. We are hearing members are repositioning these centres as the new permanent 'front door' to the system. These centres will serve as the first port of call for patients with respiratory symptoms in order to limit their interaction with the hospital.
4. Naturally occurring retirement communities: Many nursing and long-term care (LTC) facilities in the United States, Canada, and Western Europe were ravaged by Covid-19. In the United States, 38% of all Covid-19 deaths are linked to nursing homes. The statistics in Canada are even grimmer: 81% of all Covid-19 deaths occurred in LTCs.
Naturally occurring retirement communities, or NORCs, offer a promising alternative option for delivering care to seniors. NORCs are unplanned communities that have a high concentration of elderly, independent residents. NORCs develop as long-term residents of a community age in place or as the elderly migrate to areas with large numbers of senior residents.
In Canada, OASIS is a prominent example of a NORC programme. OASIS provides health and social services for its residents through public-private partnerships, decreasing social isolation and hospital utilisation. Providers can deliver and proactively manage care for elderly citizens by partnering with community organisations that already operate within NORCs or by creating programmes that deploy home care teams during the hours when demand is highest.
5. High-value surgical alternatives: An often-overlooked way to increase OR capacity is to reduce the number elective surgical procedures by providing alternative treatments instead.
High-value surgical alternatives include a range of non-surgical, preventive care options to help patients with non-urgent conditions. This set of options include physiotherapy, palliative care, pain clinics, virtual rehab, and patient activation. These models can either eliminate the need for a surgical procedure or be used as a short- to medium-term solution until the patient receives surgery.
As the effects of the pandemic continue to be felt across the care continuum, these care model shifts are likely to continue gaining traction and will redefine how we deliver care in a post-pandemic world.