Designs, facilitators, barriers, and lessons learned during the implementation of emergency department led virtual urgent care programs in Ontario, Canada

Hall, Justin; Ackery, Alun; Dainty, Katie N.; Gill, Paul; Lim, Rodrick; Masood, Sameer; McLeod, Shelley; Mehta, Shaun; Nijmeh, Larry; Rosenfield, Daniel; Rutledge, G. C.; Verma, Aikta; Mondoux, Shawn

doi:10.3389/fdgth.2022.946734

Cited by 13 publications

(11 citation statements)

References 13 publications

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“…We previously asked each VUC program lead to describe their local pilot initiative, share facilitators and barriers to adoption of VUC services, and summarize lessons learned for future VUC design and development. 9 Common facilitators included local champions to guide VUC program delivery, provincial funding support, incorporating patients throughout the planning process, and multimodal marketing and promotions. Common barriers included behaviour change strategies to support adoption of a new service; access to high-quality information technology to support new workflow models that consider privacy, risk and legal perspectives; and standardized data collection to support overall objective impact assessments.…”

Section: Discussionmentioning

confidence: 99%

“…The 14 sites approved for VUC pilot funding represented a mix of pediatric, northern, urban, academic and community sites across the province. 9 , 10 …”

Section: Methodsmentioning

confidence: 99%

“…8 This funding was intended to support emergency department diversion of patients with low-acuity complaints and reduce the need for in-person visits whenever possible. The design and implementation of the 14 emergency department–led virtual sites and the demographic characteristics and experience of patients using VUC have been described elsewhere; 9 , 10 the 14 different sites had various start dates, operating hours, screening and staffing models. Each site posted a list of presenting complaints that would be suitable for VUC, and those that should be assessed in person.…”

mentioning

confidence: 99%

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Health care utilization and outcomes of patients seen by virtual urgent care versus in-person emergency department care

McLeod,

Tarride,

Mondoux

et al. 2023

CMAJ

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Background: Virtual urgent care (VUC) is intended to support diversion of patients with low-acuity complaints and reduce the need for in-person emergency department visits. We aimed to describe subsequent health care utilization and outcomes of patients who used VUC compared with similar patients who had an in-person emergency department visit. Methods: We used patient-level encounter data that were prospectively collected for patients using VUC services provided by 14 pilot programs in Ontario, Canada. We linked the data to provincial administrative databases to identify subsequent 30-day health care utilization and outcomes. We defined 2 subgroups of VUC users; those with a documented prompt referral to an emergency department by a VUC provider, and those without. We matched patients in each cohort to an equal number of patients presenting to an emergency department in person, based on encounter date, medical concern and the logit of a propensity score. For the subgroup of patients not promptly referred to an emergency department, we matched patients to those who were seen in an emergency department and then discharged home. Results: Of the 19 595 patient VUC visits linked to administrative data, we matched 2129 patients promptly referred to the emergency department by a VUC provider to patients presenting to the emergency department in person. Index visit hospital admissions (9.4% v. 8.7%), 30-day emergency department visits (17.0% v. 17.5%), and hospital admissions (12.9% v. 11.0%) were similar between the groups. We matched 14 179 patients who were seen by a VUC provider with no documented referral to the emergency department. Patients seen by VUC were more likely to have a subsequent in-person emergency department visit within 72 hours (13.7% v. 7.0%), 7 days (16.5% v. 10.3%) and 30 days (21.9% v. 17.9%), but hospital admissions were similar within 72 hours (1.1% v. 1.3%), and higher within 30 days for patients who were discharged home from the emergency department (2.6% v. 3.4%). Interpretation: The impact of the provincial VUC pilot program on subsequent health care utilization was limited. There is a need to better understand the inherent limitations of virtual care and ensure future virtual providers have timely access to in-person outpatient resources, to prevent subsequent emergency department visits.

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Section: Discussionmentioning

confidence: 99%

“…The 14 sites approved for VUC pilot funding represented a mix of pediatric, northern, urban, academic and community sites across the province. 9 , 10 …”

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Health care utilization and outcomes of patients seen by virtual urgent care versus in-person emergency department care

McLeod,

Tarride,

Mondoux

et al. 2023

CMAJ

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“…6,7 To promote access to safe and timely urgent care, the provincial government of Ontario (14.9M inhabitants), Canada, funded 14 virtual urgent care pilot programs in the fall of 2020 under the guidance of a provincial health agency. 8,9 Each pilot program was responsible for designing and implementing an emergency physician-led service to evaluate same-day urgent, but non-life-threatening, patient presentations. Three large urban academic health sciences centers in Canada's most populous city, Toronto, collaborated and built an integrated regional service to support improved access for all.…”

Section: Context and Aimmentioning

confidence: 99%

Learning From a Regional Approach: Integration to Scale, Spread, and Sustain Virtual Urgent Care

Hall

Chartier

2023

INQUIRY

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While new offerings of virtual urgent care services from peer hospitals faltered after initial provincial pilot funding lapsed, our 3 regional academic health sciences centers decided to partner to enhance patient access, achieve efficiencies, and support long-term sustainability. Utilizing the Development Model for Integrated Care framework, we progressed through the 4 phases to ensure joint success and high-quality care: (1) initiative and design phase—individual parallel projects but with strong collaborations and broad stakeholder engagement; (2) experimental and execution phase—continuous quality improvement approach for governance, policies, and processes; (3) expansion and monitoring phase—weekly leadership touchpoints on key performance indicators; and (4) consolidation and transformation phase—sustainability through ongoing funding.

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“…To date, 4 peer-reviewed articles have been published on the design and results of this program. 1 , 15 – 17 This most recent evaluation, presented in the related research, provides a timely illustration of the value of comprehensive health administrative data. Recognizing the importance of good data is crucial, given the recent proliferation of novel commercial partnerships in Canada’s health systems.…”

mentioning

confidence: 99%

Critical evaluation of novel health system interventions is essential

Varner

2023

CMAJ

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Designs, facilitators, barriers, and lessons learned during the implementation of emergency department led virtual urgent care programs in Ontario, Canada

Cited by 13 publications

References 13 publications

Health care utilization and outcomes of patients seen by virtual urgent care versus in-person emergency department care

Health care utilization and outcomes of patients seen by virtual urgent care versus in-person emergency department care

Learning From a Regional Approach: Integration to Scale, Spread, and Sustain Virtual Urgent Care

Critical evaluation of novel health system interventions is essential

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