Harnessing a novel multi-institutional cross-sectoral partnership for providing enhanced COVID and non-COVID care in long term care homes

In April 2020, responding to the first wave of the COVID-19 pandemic, we developed and rapidly implemented a multi-institutional model of collaborative virtual care providing rapid access to specialists and diagnostic services for long term care homes (LTCHs) in the Greater Toronto Area (GTA). Coincidentally, we called our program LTC+ (www.ltcplus.ca), and it has received attention from health system leaders and policy makers as well as the media.To avoid confusion, we refer to our program as GTA-LTC+. Initially GTA-LTC+ focused on preventing avoidable hospital transfers, reflecting the perceived priority at the time of ensuring acute care capacity during the pandemic's first wave. However, meeting care needs in the LTC setting has intrinsic value, offering person-centered care aligned with residents' goals of care. Minimizing avoidable exposures to acute care settings decreases risks of delirium, care discontinuity and functional decline. Even prior to COVID-19, the need already existed for more coordinated access to specialist care, ideally consolidated in a single partner hospital for any given LTCH and minimizing the frequency with which residents need to receive such care outside of their homes. We thus came to view GTA-LTC+ as a program which would improve care even without the problems posed by COVID-19, but with additional value in ensuring that residents can continue to receive high quality, specialized care during future outbreaks. GTA-LTC+ uses a hub and spoke design, where 6 hospital hubs provides rapid access to a suite of virtual and in-person clinical and diagnostic services to geographically-associated LTCHs in 2 of the 5 Ontario Health Regions (i.e., Toronto and Central). Implementation of the intervention was guided by the RE-AIM framework as we grew it from just 3 pilot sites to 52 LTCHs. As the health system braces for the pandemic's second wave, this intervention may represent a solution to improve both COVID-19 and non-COVID-19 care and minimize unnecessary acute care transfers. Yet, the overall impact of the intervention requires further evaluation before the model can be scaled, as does the value of specific enhancements to the intervention currently available at only some sites. We will use a mixed-methods study design to address the following objectives: 1. Evaluate the degree to which GTA-LTC+ provides adequate access to COVID-19 and non- COVID-19 care in LTCHs using reductions in acute care transfers as a marker for such access 2. Explore the impact of GTA-LTC+ on the care experience of residents, caregivers, staff and providers at the 6 LTCHs from the GTA-LTC+ cohort enrolled in the national LTC+ program 3. Identify factors influencing the adoption and maintenance of the intervention to inform ongoing program implementation and spread.