• Shelley L McLeod, Jean-Eric Tarride, Shawn Mondoux, J Michael Paterson, Lesley Plumptre, Emily Borgundvaag, Katie N Dainty, Joy McCarron, Howard Ovens, and Justin N Hall.
• Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. shelley.mcleod@sinaihealth.ca.
• CMAJ. 2023 Nov 6; 195 (43): E1463E1474E1463-E1474.

BackgroundVirtual 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.MethodsWe 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.ResultsOf 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%).InterpretationThe 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.© 2023 CMA Impact Inc. or its licensors.

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