Article Figures & Tables
Tables
- Table 1:
Baseline demographic characteristics for all eligible virtual urgent care (VUC) records, classified by adult and pediatric VUC pilot sites*
Characteristic No. (%) of patient encounters† Adult
n = 12 593Pediatric
n = 7002Overall
n = 19 595Age, yr, mean ± SD 40.7 ± 19.3 3.9 ± 4.4 27.6 ± 23.6 Sex, female 8291 (65.8) 3419 (48.8) 11 710 (59.8) Urban residents 12 183 (96.7) 6415 (91.6) 18 598 (94.9) Neighbourhood income quintiles 4–5‡ 4932 (39.2) 3586 (51.2) 8518 (43.5) ON-Marg ethnic diversity quintiles 4–5‡ 6778 (53.8) 3227 (46.1) 10 005 (51.1) ON-Marg residential instability quintiles 4–5‡ 5750 (45.7) 2460 (35.1) 8210 (41.9) ON-Marg material deprivation quintiles 4–5‡ 4779 (37.9) 1566 (22.4) 6345 (32.4) ON-Marg dependency quintiles 4–5‡ 3686 (29.3) 1700 (24.3) 5386 (27.5) Asthma 3132 (24.9) 809 (11.5) 3941 (20.1) Congestive heart failure 341 (2.7) – 341 (1.7) Hypertension 2702 (21.5) – 2702 (13.8) Chronic obstructive pulmonary disease 322 (2.6) – 322 (1.6) Diabetes 1456 (11.6) 28 (0.4) 1484 (7.6) Dementia 189 (1.5) – 189 (1.0) Johns Hopkins ADGs 0–4 3509 (27.9) 2576 (36.8) 6085 (31.0) 5–9 5421 (43.0) 3386 (48.4) 8807 (44.9) 10–14 2810 (22.3) 938 (13.4) 3748 (19.1) ≥ 15 853 (6.8) 102 (1.5) 955 (4.9) Physician (PCP and specialists) visits in preceding 365 d, mean ± SD 11.40 ± 15.2 6.49 ± 6.8 9.64 ± 13.0 ED visits in preceding 365 d, mean ± SD 1.32 ± 4.1 0.86 ± 1.5 1.16 ± 3.4 Hospital admissions in preceding 365 d, mean ± SD 0.21 ± 0.8 0.31 ± 0.7 0.24 ± 0.8 No. of patients with PCP information reported 11 618 7002 18 620 Patient has PCP 9492 (81.7) 6291 (89.8) 15 783 (84.8) No. of patients with acuity level§ 4283 – 4283 Resuscitation (CTAS 1) 1–5** – 1–5** Emergent (CTAS 2) 279–283** – 279–283** Urgent (CTAS 3) 1061 (24.8) – 1061 (24.8) Less urgent (CTAS 4) 1030 (24.0) – 1030 (24.0) Nonurgent (CTAS 5) 1908 (44.5) – 1908 (44.5) No. of patients with VUC discharge disposition¶ 10 800 6234 17 034 Discharged home 7461 (69.1) 4382 (70.3) 11 843 (69.5) Referred to ED 1872 (17.3) 1059 (17.0) 2931 (17.2) Referred to PCP 692 (6.4) 423 (6.8) 1115 (6.5) Referred to specialist 573 (5.3) 90 (1.4) 663 (3.9) Referred to COVID-19 or outpatient clinic 202 (1.9) 280 (4.5) 482 (2.8) ↵Note: ADGs = aggregated diagnosis groupings, CTAS = Canadian Triage and Acuity Scale, ED = emergency department, ON-Marg = Ontario Marginalization Index, PCP = primary care provider, SD = standard deviation.
↵* Adult sites were Lakeridge Health, Health Sciences North/Horizon Santé Nord, Sunnybrook Health Sciences Centre, St. Joseph’s Healthcare Hamilton, Humber River Hospital, University Health Network, William Osler Health System, Thunder Bay Regional Health Sciences Centre and Unity Health Toronto. Pediatric sites were the Children’s Hospital of Eastern Ontario, London Health Sciences Centre and SickKids.
↵† Unless otherwise specified.
↵‡ Quintiles 4–5 represent the highest income, diversity, instability, deprivation and dependency.
↵§ None of the pediatric VUC sites reported CTAS scores.
↵¶ 2561 missing disposition.
↵** Data in cells are suppressed to protect patient privacy.
- Table 2:
Health care utilization for all eligible virtual urgent care (VUC) records, classified by adult and pediatric VUC pilot sites*
Variable No. (%) of patient encounters Adult
n = 12 593Pediatric
n = 7002Overall
n = 19 595ED visit, in-person Within 72 h of index VUC visit 1609 (12.8) 835 (11.9) 2444 (12.5) Within 7 d of index VUC visit 2019 (16.0)‡ 1009 (14.4) 3028 (15.4) Within 30 d of index VUC visit 2841 (22.6)‡ 1382 (19.7) 4223 (21.5) VUC revisit Within 72 h of index VUC visit 384 (3.0)‡ 163 (2.3) 547 (2.8) Within 7 d of index VUC visit 611 (4.8)‡ 284 (4.1) 895 (4.6) Within 30 d of index VUC visit 1050 (8.3) 550 (7.8) 1600 (8.2) Hospital admission Within 72 h of index VUC visit 310 (2.5)‡ 112 (1.6) 422 (2.1) Within 7 d of index VUC visit 381 (3.0)‡ 146 (2.1) 527 (2.7) Within 30 d of index VUC visit 560 (4.4)‡ 194 (2.8) 754 (3.8) Primary care visit Visit on same day as index VUC visit† 6245 (49.6)‡ 552 (7.9) 6797 (34.7) Within 7 d of index VUC visit (excluding index date) 3661 (29.1)‡ 935 (13.3) 4596 (23.4) Within 30 d of index VUC visit (excluding index date) 6512 (51.7)‡ 1851 (26.4) 8363 (42.7) Specialist visit Visit on same day as index VUC visit† 284 (2.3) 5129 (73.2)‡ 5413 (27.6) Within 7 d of index VUC visit (excluding index date) 1996 (15.8) 1142 (16.3) 3138 (16.0) Within 30 d of index VUC visit (excluding index date) 4583 (36.4)‡ 2407 (34.4) 6990 (35.7) ↵Note: ED = emergency department.
↵* Adult sites were Lakeridge Health, Health Sciences North/Horizon Santé Nord, Sunnybrook Health Sciences Centre, St. Joseph’s Healthcare Hamilton, Humber River Hospital, University Health Network, William Osler Health System, Thunder Bay Regional Health Sciences Centre and Unity Health Toronto; pediatric sites were the Children’s Hospital of Eastern Ontario, London Health Sciences Centre and SickKids.
↵† For patients who saw a primary care provider or specialist on the same day as the VUC visit, it is not known which occurred first.
↵‡ Indicates significant difference between the adult and pediatric cohorts.
- Table 3:
Emergency department (ED) characteristics and health care utilization for virtual urgent care prompt referrals who presented to ED within 72 hours versus matched in-person controls
Variable No. (%)* patients referred to ED by VUC
n = 2129No. (%)* of control patients who presented in person to ED
n = 2129Δ, %* (95% CI) Arrival by ambulance 62 (2.9) 204 (9.6) −6.7 (−8.1 to −5.2) Acuity score Resuscitation (CTAS 1) 11 (0.5) 11–15§ NA Emergent (CTAS 2) 365 (17.1) 423 (19.9) −2.8 (−5.1 to −0.4) Urgent (CTAS 3) 1242 (58.3) 1161 (54.5) 3.8 (0.9 to 6.8) Less urgent (CTAS 4) 402 (18.9) 417 (19.6) −0.7 (−3.1 to 1.7) Nonurgent (CTAS 5) 109 (5.1) 114 (5.3) −0.2 (−1.6 to 1.1) Unknown 0 (0.0) 1–5§ NA Top 5 CEDIS complaints Other (not top 5) 1427 (67.0) 1423 (66.8) 0.2 (−3.0 to 2.6) Abdominal pain 234 (11.0) 240 (11.3) −0.3 (−2.2 to 1.6) Fever 210 (9.9) 204 (9.6) 0.3 (−2.1 to 1.5) Upper extremity injury 107 (5.0) 108 (5.1) −0.1 (−1.4 to 1.3) Lower extremity injury 81 (3.8) 76 (3.6) 0.2 (−0.9 to 1.4) Lower extremity pain 70 (3.3) 78 (3.7) −0.4 (−1.5 to 0.7) Procedures† No procedures 173 (8.1) 99 (4.6) 3.5 (2.0 to 5.0) Diagnostic only 97 (4.6) 32 (1.5) 3.1 (2.0 to 4.1) Laboratory only 0 (0.0) 1–5§ NA Laboratory, therapeutic and diagnostic 25 (1.2) 22 (1.0) 0.2 (−0.8 to 0.5) Therapeutic only 817 (38.4) 1045 (49.1) −10.7 (−13.7 to −7.7) Therapeutic and diagnostic 1017 (47.8) 931 (43.7) 4.1 (1.0 to 7.0) Top 5 discharge diagnosis Other (not top 5) 1766 (82.9) 1807 (84.9) −2.0 (−4.9 to 0.3) Other and unspecified abdominal pain 94 (4.4) 88 (4.1) 0.3 (−1.5 to 0.9) Fever, unspecified 84 (3.9) 71 (3.3) 0.6 (−0.5 to 1.7) Urinary tract infection, site not specified 61 (2.9) 64 (3.0) −0.1 (−0.9 to 1.2) Chest pain, unspecified 72 (3.4) 47 (2.2) 1.2 (0.2 to 2.2) COVID-19 52 (2.4) 52 (2.4) 0.0 (−0.9 to 0.9) Discharge disposition Missing 11 (0.5) 20 (0.9) −0.4 (−0.9 to 0.1) Admitted 201 (9.4) 186 (8.7) 0.7 (−1.0 to 2.4) Discharged 1902 (89.3) 1909 (89.7) −0.4 (−2.2 to 1.5) Transferred 15 (0.7) 14 (0.7) 0.0 (−0.5 to 0.5) ED visit, in-person Within 72 h of index visit 149 (7.0) 166 (7.8) −0.8 (−2.4 to 0.8) Within 7 d of index visit 207 (9.7) 225 (10.6) −0.9 (−2.7 to 1.0) Within 30 d of index visit 362 (17.0) 372 (17.5) −0.5 (−2.7 to 1.8) VUC visit Within 72 h of index visit 51 (2.4) 0 (0.0) 2.4 (1.8 to 3.1) Within 7 d of index visit 81 (3.8) 0 (0.0) 3.8 (3.1 to 4.7) Within 30 d of index visit 142 (6.7) 0 (0.0) 6.7 (5.7 to 7.8) Hospital admission Within 72 h of index visit 224 (10.5) 200 (9.4) 1.1 (−0.7 to 2.9) Within 7 d of index visit 241 (11.3) 215 (10.1) 1.2 (−0.6 to 3.1) Within 30 d of index visit 274 (12.9) 234 (11.0) 1.9 (−0.1 to 3.8) Length of stay, d, mean ± SD 7.5 ± 17.5 5.1 ± 6.0 2.4 (1.6 to 3.2) Primary care visits Visit on same day as index visit‡ 654 (30.7) 248 (11.6) 19.1 (16.7 to 21.5) Within 7 d of index visit (excluding index date) 523 (24.6) 498 (23.4) 1.2 (−1.4 to 3.7) Within 30 d of index visit (excluding index date) 979 (46.0) 938 (44.1) 1.9 (−1.1 to 4.9) Specialist visits Visit on same day as index visit‡ 631 (29.6) 95 (4.5) 25.1 (23.0 to 27.3) Within 7 d of index visit (excluding index date) 512 (24.0) 373 (17.5) 6.5 (4.1 to 9.0) Within 30 d of index visit (excluding index date) 1035 (48.6) 794 (37.3) 11.3 (8.4 to 14.3) Note: CTAS = Canadian Triage and Acuity Scale, CEDIS = Canadian Emergency Department Information System, CI = confidence interval, NA = not applicable, SD = standard deviation, VUC = virtual urgent care.
↵* Unless otherwise specified.
↵† Diagnostic refers to investigations such as diagnostic imaging or performing an electrocardiogram. Therapeutic refers to a procedure having been done or medication administered.
↵‡ For patients who saw a primary care provider or specialist on the same day as the VUC visit, it is not known which occurred first.
↵§ Data in cells are suppressed to protect patient privacy.
- Table 4:
Health care utilization for patients seen by a virtual urgent care provider with no emergency department (ED) referral plus matched in-person ED controls who were discharged from the ED
Variable No. (%)* of patients seen by VUC
n = 14 179No. (%)* of control patients discharged from in-person ED
n = 14 179Δ, %* (95% CI) ED visit, in-person Within 72 h of index visit 1948 (13.7) 988 (7.0) 6.7 (6.1 to 7.5) Within 7 d of index visit 2344 (16.5) 1460 (10.3) 6.2 (5.4 to 7.0) Within 30 d of index visit 3111 (21.9) 2532 (17.9) 4.0 (3.2 to 5.0) VUC visit Within 72 h of index visit 357 (2.5) 0 (0.0) 2.5 (2.2 to 2.8) Within 7 d of index visit 569 (4.0) 0 (0.0) 4.0 (3.7 to 4.4) Within 30 d of index visit 993 (7.0) 0 (0.0) 7.0 (6.6 to 7.4) Hospital admission Within 72 h of index visit 151 (1.1) 187 (1.3) −0.2 (−0.5 to 0.0) Within 7 d of index visit 221 (1.6) 268 (1.9) −0.3 (−0.6 to 0.0) Within 30 d of index visit 370 (2.6) 479 (3.4) −0.8 (−1.2 to −0.4) Length of stay, d, mean ± SD 6.2 ± 10.4 5.2 ± 9.3 1.0 (0.7 to 1.2) Primary care visits Visit on same day as index visit† 5089 (35.9) 1651 (11.6) 24.3 (23.3 to 25.2) Within 7 d of index visit (excluding index date) 3173 (22.4) 3242 (22.9) −0.5 (−1.5 to 0.5) Within 30 d of index visit (excluding index date) 5837 (41.2) 6134 (43.3) −2.1 (−3.2 to 0.9) Specialist visits Visit on same day as index visit† 3748 (26.4) 715 (5.0) 21.4 (20.6 to 22.2) Within 7 d of index visit (excluding index date) 1996 (14.1) 2368 (16.7) −2.6 (−3.5 to −1.8) Within 30 d of index visit (excluding index date) 4537 (32.0) 4757 (33.5) −1.5 (−2.6 to −0.5) - Table 5:
Characteristics of patients who visited the emergency department (ED) within 72 hours after being seen by virtual urgent care without an ED referral compared with patients discharged home after an in-person ED visit
Characteristic No. (%) of patients seen by VUC
n = 1948No. (%) of patients with in-person ED visit
n = 988Δ, % (95% CI) Arrival by ambulance 112 (5.6) 62 (6.3) −0.7 (−2.5 to 1.2) Acuity score Resuscitation (CTAS 1) 12 (0.6) 6–10* NA Emergent (CTAS 2) 346 (17.8) 131 (13.3) 4.5 (1.7 to 7.2) Urgent (CTAS 3) 1113 (57.1) 534 (54.0) 3.1 (−0.7 to 6.9) Less urgent (CTAS 4) 367 (18.8) 231 (23.4) −4.6 (−7.8 to −1.4) Nonurgent (CTAS 5) 110 (5.6) 85 (8.6) −3.0 (−5.1 to −1.0) Unknown 0 (0.0) 1–5* NA Top 5 CEDIS complaints Other (not top 5) 1383 (71.0) 625 (63.3) 7.7 (4.1 to 11.4) Fever 242 (12.4) 63 (6.4) 6.0 (3.8 to 8.1) Abdominal pain 201 (10.3) 56 (5.7) 4.6 (2.6 to 6.6) Imaging tests 38 (1.9) 116 (11.7) −9.8 (−12.0 to −7.8) Abnormal laboratory values 22 (1.1) 88 (8.9) −7.8 (−9.7 to −6.1) Rash 62 (3.2) 40 (4.0) −0.8 (−2.4 to 0.5) Procedures No procedures 77 (3.9) 60 (6.1) −2.2 (−4.0 to −0.5) Diagnostic only 29 (1.5) 21 (2.1) −0.6 (−1.8 to 0.3) Laboratory only 0 (0.0) 1–5* NA Laboratory, therapeutic and diagnostic 26 (1.3) 11 (1.1) 0.2 (−0.7 to 1.0) Therapeutic only 970 (49.8) 507 (51.3) −1.5 (−5.3 to 2.3) Therapeutic and diagnostic 846 (43.4) 389 (39.4) 4.0 (0.3 to 7.8) Top 5 discharge diagnosis Other (not top 5) 1598 (82.0) 858 (86.8) −4.8 (−7.5 to 2.0) Other and unspecified abdominal pain 75 (3.8) 47 (4.8) −1.0 (−2.6 to 0.6) Fever, unspecified 72 (3.7) 29 (2.9) 0.8 (−0.7 to 2.1) COVID-19 82 (4.2) 15 (1.5) 2.7 (1.4 to 3.8) Urinary tract infection, site not specified 61 (3.1) 23 (2.2) 0.9 (−0.5 to 2.0) Viral infection, unspecified 60 (3.1) 16 (1.6) 1.5 (0.3 to 2.5) Discharge disposition Missing 16 (0.8) 9 (0.9) −0.1 (−0.9 to 0.6) Admitted 135 (6.9) 119 (12.0) −5.1 (−7.9 to −2.9) Discharged 1786 (91.7) 854 (86.4) 5.3 (2.9 to 7.8) Transferred 11 (0.6) 6 (0.6) 0.0 (−0.8 to 0.7) Note: CI = confidence interval, CEDIS = Canadian Emergency Department Information System, CTAS = Canadian Triage and Acuity Scale, NA = not applicable, VUC = virtual urgent care.
* Data in cells are suppressed to protect patient privacy.
- Table 6:
Characteristics of patients who visited the emergency department (ED) within 30 days after being seen by virtual urgent care without an ED referral compared with patients discharged home after an in-person ED visit
Characteristic No. (%) of patients seen by VUC
n = 3111No. (%) of patients with in-person ED visit
n = 2532Δ, % (95% CI) Arrival by ambulance 235 (7.5) 224 (8.8) −1.3 (−2.7 to 0.1) Acuity score Resuscitation (CTAS 1) 16–20* 16–20* NA Emergent (CTAS 2) 548 (17.6) 441 (17.4) 0.2 (−1.8 to 2.2) Urgent (CTAS 3) 1767 (56.8) 1319 (52.1) 4.7 (2.1 to 7.3) Less urgent (CTAS 4) 599 (19.2) 517 (20.4) −1.2 (−3.3 to 0.9) Nonurgent (CTAS 5) 176 (5.7) 234 (9.2) −3.6 (−5.0 to −2.2) Unknown 1–5* 1–5* NA Top 5 CEDIS complaints Other (not top 5) 2197 (70.6) 1862 (73.5) −2.9 (−5.3 to −0.6) Abdominal pain 306 (9.8) 187 (7.4) 2.4 (1.0 to 3.9) Fever 316 (10.2) 157 (6.2) 4.0 (2.5 to 5.4) Shortness of breath 144 (4.6) 85 (3.4) 1.5 (0.3 to 2.3) Rash 105 (3.4) 100 (3.9) −0.5 (−1.6 to 0.4) Imaging tests 43 (1.4) 141 (5.6) −4.2 (−5.2 to −3.2) Procedures No procedures 127 (4.1) 175 (6.9) −2.8 (−4.1 to −1.6) Diagnostic only 46 (1.5) 38 (1.5) 0.0 (−0.6 to 0.6) Laboratory only 0 (0.0) 1–5* NA Laboratory, therapeutic and diagnostic 47 (1.5) 32 (1.3) 0.2 (−0.4 to 0.9) Therapeutic only 1599 (51.4) 1334 (52.7) −1.3 (−3.9 to 1.3) Therapeutic and diagnostic 1292 (41.5) 953 (37.6) 3.9 (1.3 to 6.4) Top 5 discharge diagnosis Other (not top 5) 2606 (83.8) 2218 (87.6) −3.8 (−5.6 to −2.0) Other and unspecified abdominal pain 119 (3.8) 99 (3.9) −0.1 (−1.1 to 0.9) COVID-19 116 (3.7) 50 (2.0) 1.7 (0.9 to 2.6) Fever, unspecified 92 (3.0) 65 (2.6) 0.4 (−0.5 to 1.2) Urinary tract infection, site not specified 82 (2.6) 63 (2.5) 0.1 (−0.7 to 0.9) Viral infection, unspecified 96 (3.0) 37 (1.5) 1.5 (0.8 to 2.4) Discharge disposition Missing 264 (8.5) 329 (13.0) −4.5 (−6.2 to −2.9) Admitted 14 (0.4) 24 (1.0) −0.6 (−1.0 to −0.1) Discharged 2813 (90.4) 2149 (84.9) 5.5 (3.8 to 7.3) Transferred 20 (0.6) 30 (1.2) −0.6 (−1.1 to 0.0) Note: CI = confidence interval, CEDIS = Canadian Emergency Department Information System, CTAS = Canadian Triage and Acuity Scale, NA = not applicable, VUC = virtual urgent care.
* Data in cells are suppressed to protect patient privacy.
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