Implementation study of virtual goals of care consultation for advanced frailty: Lessons learned from the Pandemic

Background: Long-term care (LTC) residents disproportionately experienced critical illness and death in the setting of COVID-19. In response, a virtual specialist consultation service known as the "Med-LTC program" was developed to support residents and their families with advance care planning to establish acceptable levels of health care intervention. The program significantly improved goals of care to align with resident frailty and expected outcomes in the event of an acute health crisis. A post-implementation inquiry explored the factors that influenced the program success to inform ongoing collaboration between acute care and LTC sectors in the delivery of frailty-informed care. Methods The factors that impacted program effectiveness and implementation outcomes were systematically explored using the Consolidated Framework for Implementation Research (CFIR). Structured interviews (n = 20) were conducted with LTC leadership, LTC healthcare staff, and members of the program. Qualitative data were extracted from the transcripts and coded to the domains and constructs of the CFIR. Results The CFIR constructs of inner setting, intervention characteristics, and individual characteristics were most strongly represented, with emphasis on tension for change, relative priority, relative advantage, and other personal attributes (shared team vision grounded in pre-existing social bonds) featuring prominently. Challenges in terms of complexity, cost, and relative priority all contributed to the ultimate lack of sustainability of the virtual program in the post-acute phase of the COVID-19 pandemic. Conclusions Application of the CFIR identified key barriers to and enablers of program success and providing important insights into factors supporting the development of more sustainable future iterations of virtual specialist consultation to establish goals of care in LTC.