Clinical and economic impact of a community-based, hybrid model of in-person and virtual care in a Canadian rural setting: a cross-sectional population-based comparative study

Fitzsimon, Jonathan; Belanger, Christopher; Glazier, Richard H.; Green, Michael E.; Peixoto, Cayden; Mahdavi, Roshanak; Plumptre, Lesley; Bjerre, Lise M.

doi:10.1136/bmjopen-2022-069699

Cited by 5 publications

(4 citation statements)

References 15 publications

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“…These studies are focused on overcrowded emergency departments, where the situation is different from that of local community hospitals. There are some reports researching the effect of the implementation of tele-ICU systems in small local hospitals [14,15]; however, these hospitals have ICUs and the ICUs and local community hospital systems differ between countries. Hence, our results apply to countries where the situation is similar to that of Japanese hospitals.…”

Section: Discussionmentioning

confidence: 99%

The Experience and the Characteristics of Patients With Tele-ICU Implementation in a Rural Community Hospital

Iwashita,

Ishigame-Kitayama,

Yamamoto

et al. 2023

Cureus

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Background Tele-ICUs are increasingly being used in the US. In Japan, young physicians mainly operate rural community hospitals to manage severely ill patients. However, the introduction of the tele-ICU system in Japan is still uncommon. We introduced a tele-ICU system to a community hospital. The objective of this study is to determine if the newly introduced tele-ICU system is being effectively utilized. Methods This is a single-center, retrospective observational study. We introduced the tele-ICU system to the NachiKatsuura Town Onsen Hospital, Japan, in 2019. Thereafter, we retrospectively explored the characteristics of the consulted cases, the time of consultation, the Sequential Organ Failure Assessment (SOFA) score, and the number of consultations by month from 1st July 2019 to 31st March 2020. The main outcome was the monthly number of consultations, and other measures included the clinical characteristics of the consulted cases. Results A total of 81 cases were referred to the tele-ICU system within nine months. Sixty-two cases, excluding those with missing data, were included in the analysis. The number of consultations was almost constant during the study period and was most frequent during the day. The recommendations from tele-ICU physicians were mostly “advice on the treatment plan.” The mean SOFA score was 2.56. Conclusions We introduced a Japanese-type tele-ICU system for Japanese rural community hospitals. Many cases from rural community hospitals that were referred to the tele-ICU systems were moderately severe and did not require urgent transportation. These cases are not indicated for emergency transportation and should be treated in rural community hospitals.

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Section: Discussionmentioning

confidence: 99%

The Experience and the Characteristics of Patients With Tele-ICU Implementation in a Rural Community Hospital

Iwashita,

Ishigame-Kitayama,

Yamamoto

et al. 2023

Cureus

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“…This was done in the context of the quadruple aim framework for evaluating innovations and change in healthcare, looking for improved clinical outcomes, lower healthcare costs, enhanced patient experience and enhanced provider experience [ 24 ]. The clinical and economic impact of VTAC has been evaluated elsewhere [ 20 , 21 ] and further work is underway to evaluate patient experience of VTAC. This study focuses on the physician experience of delivering care through VTAC and reports descriptive results from a study questionnaire, as well as results from a qualitative thematic analysis of focus group interview data.…”

Section: Methodsmentioning

confidence: 99%

“…Previous research has demonstrated that VTAC may be an economical and effective way of delivering acute, episodic care in rural, remote, and underserved communities [ 20 , 21 , 23 ]. However, physician satisfaction and their experiences with delivering care through VTAC have yet to be investigated.…”

Section: Introductionmentioning

confidence: 99%

Family physicians’ experiences with an innovative, community-based, hybrid model of in- person and virtual care: a mixed-methods study

Fitzsimon

Patel

Peixoto

et al. 2023

BMC Health Serv Res

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Background Rural, remote, and underserved communities have often struggled to provide adequate access to family physicians. To bridge this gap in Renfrew County, a large, rural region in Ontario, Canada, a community- based, hybrid care model was implemented, combining virtual care from family physicians and in-person care from community paramedics. Studies have demonstrated the clinical and cost effectiveness of this model but its acceptability to physicians has not been examined. This study investigates the experiences of participating family physicians. Methods A mixed-methods study, combining physician questionnaire response data and qualitative thematic analysis of focus group interview data. Results Data was collected from n = 17 survey respondents and n = 9 participants in two semi-structured focus groups (n = 4 and n = 5 respectively). Physicians reported high satisfaction, driven by skills development and patient gratitude, and felt empowered to reduce ED visits, care for unattached patients, and address simple medical needs. However, physicians found it difficult to provide continuous care and were sometimes unfamiliar with local healthcare resources. Conclusion This study found that a hybrid model of in-person and virtual care from family physicians and community paramedics was associated with positive physician experiences in two main areas: clinical impacts, especially avoiding unnecessary ED visits, and physician satisfaction with the service. Potential improvements for this hybrid model were identified, and include better support for patients with complex needs, and more information about local health-system services. Our findings should be of interest to policymakers and administrators seeking to improve access to care through a hybrid model of in-person and virtual care.

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“…VTAC, a living and evolving healthcare program and innovative method of care delivery, warrants close attention to improve and understand its impact. Aligned with the well-recognized quintuple aim framework (20)(21)(22), VTAC has demonstrated notable clinical and economic bene ts, as supported by comprehensive evaluations (23,24). Furthermore, VTAC providers have reported high levels of satisfaction, according to a recent assessment of their experiences with the program (25).…”

Section: Introductionmentioning

confidence: 99%

Assessing Patient Experiences with a Virtual Triage and Assessment Centre (VTAC): A Mixed-Method Study Using an Online Survey and Semi-Structured Interviews in Renfrew County, Ontario.

St-Amant,

Peixoto,

Bair-Patel

et al. 2024

Preprint

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Background In March 2020, the Renfrew County Virtual Triage and Assessment Centre (VTAC) was launched as a large-scale, innovative, hybrid healthcare program. VTAC aims to alleviate pressure on emergency departments by providing additional and more equitable access to family physicians and allied health professionals. This study’s objective was to evaluate patients’ experiences with VTAC. Methods In this sequential explanatory mixed-method study, we distributed 397 online surveys and conducted 10 semi-structured interviews with Renfrew County residents aged 18 and above who had utilized VTAC at least once since 2023. Survey data were analyzed through descriptive statistics, chi-squared tests, and a multivariate binary logistic regression, while semi-structured interviews were coded and analyzed using reflexive thematic analysis. Results Our findings demonstrate widespread satisfaction with VTAC, and a perception of receiving high-quality care. This was irrespective of demographic characteristics, health status, or appointment modality. In our interviews, four main themes emerged: “Healthcare in Renfrew County”, “Accessing VTAC”, “VTAC Clinical Care”, and “Improving VTAC”. These themes underscore major difficulties residents encounter in accessing healthcare in Renfrew County and illustrate that services from VTAC align with a genuine population-level need, offering a valuable contribution to addressing some of these challenges. Conclusion Our study highlights that Renfrew County is grappling with a crisis of access to healthcare, and that VTAC fills a crucial gap, primarily by providing timely access to a family doctor. The findings provide evidence of patient acceptability and satisfaction with VTAC, potentially guiding the design of future healthcare programs.

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Clinical and economic impact of a community-based, hybrid model of in-person and virtual care in a Canadian rural setting: a cross-sectional population-based comparative study

Cited by 5 publications

References 15 publications

The Experience and the Characteristics of Patients With Tele-ICU Implementation in a Rural Community Hospital

The Experience and the Characteristics of Patients With Tele-ICU Implementation in a Rural Community Hospital

Family physicians’ experiences with an innovative, community-based, hybrid model of in- person and virtual care: a mixed-methods study

Assessing Patient Experiences with a Virtual Triage and Assessment Centre (VTAC): A Mixed-Method Study Using an Online Survey and Semi-Structured Interviews in Renfrew County, Ontario.

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