Evaluation of low acuity patients discharged from a virtual emergency department at a major urban academic health sciences centre in Toronto, Canada.
Objective In response to the COVID-19 pandemic, Sunnybrook Health Sciences Centre launched the first virtual emergency department (VED) in Toronto, Ontario. The objective of this pilot project was to leverage linked administrative data to describe the healthcare utilization of VED patients compared...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Swansea University
2022-08-01
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| Series: | International Journal of Population Data Science |
| Subjects: | |
| Online Access: | https://ijpds.org/article/view/1926 |
| _version_ | 1797422461809065984 |
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| author | Emily Borgundvaag Lesley Plumptre Michael Paterson Diana An Shelley McLeod Jean-Eric Tarride Clare Atzema Michael Schull Aikta Verma Justin Hall |
| author_facet | Emily Borgundvaag Lesley Plumptre Michael Paterson Diana An Shelley McLeod Jean-Eric Tarride Clare Atzema Michael Schull Aikta Verma Justin Hall |
| author_sort | Emily Borgundvaag |
| collection | DOAJ |
| description |
Objective
In response to the COVID-19 pandemic, Sunnybrook Health Sciences Centre launched the first virtual emergency department (VED) in Toronto, Ontario. The objective of this pilot project was to leverage linked administrative data to describe the healthcare utilization of VED patients compared to matched patients who attended an ED in person.
Approach
Evaluation of the VED program was supported by the ICES Applied Health Research Question Program, which is funded by the Ontario Ministry of Health to answer questions directly related to Ontario healthcare policy, planning, or practice. VED visit records from December 2020 to May 2021 were linked with Ontario administrative data. VED patients with low acuity complaints were matched 1:1 with in-person ED comparators according to visit date, presenting complaint, and a propensity score that incorporated age, sex, comorbidities, and other important potential confounders. The primary outcomes were healthcare utilization within 7 days and all-cause mortality within 30 days.
Results
Of the 609 eligible patients discharged from the VED, 600 (98.5%) were successfully matched to a comparator. Mean (SD) age was 43.0 (21.1) and 64.1% were female. In-person ED revisits and hospitalizations were similar for VED and comparator patients at 72 hours (ED: 12.1% vs. 11.3%; Δ 0.8%, 95%: -2.8, 4.5%; hospitalization: 1.2% vs. 1.5%; Δ 0.3%, 95%: -0.7, 1.4%,) and 7 days (ED: 16.1% vs. 14.4%; Δ 1.7, 95%: -2.4, 5.7%; hospitalization: 1.7% vs. 1.8%; Δ 0.2%, 95%: -0.1, 1.4%) following the index visit. The number of patients visiting a primary care provider within 7 days was also similar between groups (36.7% vs. 32.4%; Δ 4.3, 95%: -1.1, 9.8%). No patients died within 30 days.
Conclusion/Implications
VED patients and their matched comparators had similar healthcare utilization in the 7 days following their index ED visit. Methodology from this study will inform a province-wide evaluation of VED programs across Ontario.
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| first_indexed | 2024-03-09T07:32:38Z |
| format | Article |
| id | doaj.art-c7137f2d38af4aba94174b4181c66e9b |
| institution | Directory Open Access Journal |
| issn | 2399-4908 |
| language | English |
| last_indexed | 2024-03-09T07:32:38Z |
| publishDate | 2022-08-01 |
| publisher | Swansea University |
| record_format | Article |
| series | International Journal of Population Data Science |
| spelling | doaj.art-c7137f2d38af4aba94174b4181c66e9b2023-12-03T05:52:08ZengSwansea UniversityInternational Journal of Population Data Science2399-49082022-08-017310.23889/ijpds.v7i3.1926Evaluation of low acuity patients discharged from a virtual emergency department at a major urban academic health sciences centre in Toronto, Canada.Emily Borgundvaag0Lesley Plumptre1Michael Paterson2Diana An3Shelley McLeod4Jean-Eric Tarride5Clare Atzema6Michael Schull7Aikta Verma8Justin Hall9Institute for Clinical Evaluative Sciences (ICES)Institute for Clinical Evaluative Sciences (ICES)Institute for Clinical Evaluative Sciences (ICES)Institute for Clinical Evaluative Sciences (ICES)Schwartz/Reisman Emergency Medicine Institute (SREMI), Sinai HealthDepartment of Health Research Methods, Evidence and Impact (HEI), McMaster UniversityInstitute for Clinical Evaluative Sciences (ICES); Department of Emergency Services, Sunnybrook Health Sciences CentreInstitute for Clinical Evaluative Sciences (ICES); Department of Emergency Services, Sunnybrook Health Sciences CentreDepartment of Emergency Services, Sunnybrook Health Sciences CentreDepartment of Emergency Services, Sunnybrook Health Sciences Centre Objective In response to the COVID-19 pandemic, Sunnybrook Health Sciences Centre launched the first virtual emergency department (VED) in Toronto, Ontario. The objective of this pilot project was to leverage linked administrative data to describe the healthcare utilization of VED patients compared to matched patients who attended an ED in person. Approach Evaluation of the VED program was supported by the ICES Applied Health Research Question Program, which is funded by the Ontario Ministry of Health to answer questions directly related to Ontario healthcare policy, planning, or practice. VED visit records from December 2020 to May 2021 were linked with Ontario administrative data. VED patients with low acuity complaints were matched 1:1 with in-person ED comparators according to visit date, presenting complaint, and a propensity score that incorporated age, sex, comorbidities, and other important potential confounders. The primary outcomes were healthcare utilization within 7 days and all-cause mortality within 30 days. Results Of the 609 eligible patients discharged from the VED, 600 (98.5%) were successfully matched to a comparator. Mean (SD) age was 43.0 (21.1) and 64.1% were female. In-person ED revisits and hospitalizations were similar for VED and comparator patients at 72 hours (ED: 12.1% vs. 11.3%; Δ 0.8%, 95%: -2.8, 4.5%; hospitalization: 1.2% vs. 1.5%; Δ 0.3%, 95%: -0.7, 1.4%,) and 7 days (ED: 16.1% vs. 14.4%; Δ 1.7, 95%: -2.4, 5.7%; hospitalization: 1.7% vs. 1.8%; Δ 0.2%, 95%: -0.1, 1.4%) following the index visit. The number of patients visiting a primary care provider within 7 days was also similar between groups (36.7% vs. 32.4%; Δ 4.3, 95%: -1.1, 9.8%). No patients died within 30 days. Conclusion/Implications VED patients and their matched comparators had similar healthcare utilization in the 7 days following their index ED visit. Methodology from this study will inform a province-wide evaluation of VED programs across Ontario. https://ijpds.org/article/view/1926VirtualHealthcareEmergency departmentCOVID-19PolicyEvaluation |
| spellingShingle | Emily Borgundvaag Lesley Plumptre Michael Paterson Diana An Shelley McLeod Jean-Eric Tarride Clare Atzema Michael Schull Aikta Verma Justin Hall Evaluation of low acuity patients discharged from a virtual emergency department at a major urban academic health sciences centre in Toronto, Canada. International Journal of Population Data Science Virtual Healthcare Emergency department COVID-19 Policy Evaluation |
| title | Evaluation of low acuity patients discharged from a virtual emergency department at a major urban academic health sciences centre in Toronto, Canada. |
| title_full | Evaluation of low acuity patients discharged from a virtual emergency department at a major urban academic health sciences centre in Toronto, Canada. |
| title_fullStr | Evaluation of low acuity patients discharged from a virtual emergency department at a major urban academic health sciences centre in Toronto, Canada. |
| title_full_unstemmed | Evaluation of low acuity patients discharged from a virtual emergency department at a major urban academic health sciences centre in Toronto, Canada. |
| title_short | Evaluation of low acuity patients discharged from a virtual emergency department at a major urban academic health sciences centre in Toronto, Canada. |
| title_sort | evaluation of low acuity patients discharged from a virtual emergency department at a major urban academic health sciences centre in toronto canada |
| topic | Virtual Healthcare Emergency department COVID-19 Policy Evaluation |
| url | https://ijpds.org/article/view/1926 |
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