Virtual physician triage: impact on access and emergency department visits
Notice bibliographique
Résumé
Background: The Virtual MD program was established in 2022 to enhance the appropriateness of nurse teletriage and divert low-acuity patients from the emergency department (ED). The program proved valuable during the peak of the Covid-19 pandemic as an alternate source of access, followed by continued use and expanding uptake in the year following. This study investigates the impact of the Virtual MD program on near-term emergency department visits. Who this is for: A subset of callers to the nurse health advice phone service, Health Link 811 who require more urgent but non-emergent consultation with a health care provider. Engagement/Involvement: Alberta Health Services' Health Link 811 program designed, implemented, and operates the Virtual MD program. It incorporates continuous input and guidance from physicians, nurses, healthcare administrators, allied health professionals, and patient representatives. Initiative: This study examined demographic profiles and immediate emergency department (ED) utilization within 7 days post-Virtual assessment among 21,171 patients directed to the Virtual MD program via the Health Link 811 nurse advice line from April 1st, 2022, to March 31st, 2023. Demographic characteristics including sex, age, rurality, clinical complexity, geographical measures of socio-economic status, prior history of ED utilization among Virtual MD patients were compared with the overall Alberta population as well as all callers to Health Link 811. Recommendations during the Virtual MD consult included: 1) call 911; 2) see primary care provider; 3) go to ED; 4) self-care/remain at home. Outcomes of interest included: 1) percentage of patients who were recommended to self-care who did not visit the ED; 2) percentage of patient who were recommended to attend ED who adhered to recommendations; and 3) and assessment of hospitalizations within 7 days for either outcome. Results/Impact: Results revealed that referral to the program followed similar distribution as the Alberta general population, demonstrating broad uptake across varied patient groups. Moderate differences were observed with respect to age and sex with Virtual MD referrals being slightly more common among younger and female patients, mirroring known trends in healthcare participation in general. 17% of Virtual MD patients lived in rural and remote areas. Preliminary findings suggest that Virtual MD reduces the overall proportion of callers advised to seek urgent in-person visits. Adherence outcomes post-referral and subsequent health care utilization will be completed early 2024. International Relevance: This study offers insights on a novel virtual program linking Health Link 811 callers to physicians via phone or video, aiming to decrease ED visits. These findings are valuable for global healthcare systems seeking timely, quality care and scaling similar programs. Next Steps: Future steps involve analyzing adherence, health care utilization data, and outcomes (e.g., hospitalization) following Virtual MD assessment.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».