Virtual Care Provision and Emergency Department Use Among Children and Youth
Notice bibliographique
Résumé
Importance: Use of virtual care has rapidly expanded, but its impacts in pediatric emergency department use remain unclear. Objective: To assess whether modality of primary care visits (in-person visit or virtual visit) is associated with subsequent emergency department (ED) use in acutely ill children. Design, Setting, and Participants: Population-based cohort study using routinely collected administrative data of children and youth (age 0-17 years) in Ontario, Canada. Participants were children who had a primary care sick visit between September 2020 and March 2024. One visit per child was randomly selected during the study period and children were categorized by age group (aged <3 months, 3 months to <2 years, and 2-17 years). Exposures: Primary care sick visit modality identified from physician billing codes. Main Outcomes and Measures: The primary outcome was an ED visit within 3 days of the primary care visit. Secondary outcomes included (1) ED visits leading to hospitalization or death, (2) high-acuity ED visits, and (3) low-acuity ED visits. Age-stratified multivariable logistic generalized estimating equation models were used to estimate the association between modality of the primary care visit and each outcome, clustering patients within physicians and adjusting for sociodemographic, clinical, and health system factors. Results: Participants included 2 608 503 unique children with a sick visit (132 352 [5.1%] aged <3 months; 282 720 [10.8%] aged 3 months to <2 years; 2 608 503 [84.1%] aged 2-17 years). Virtual visits comprised 719 119 (27.6%) of sick visits. Children aged 3 months to less than 2 years had an increased adjusted risk of a subsequent ED visit when seen virtually compared with in person (4.4% vs 3.5%; adjusted risk ratio [ARR], 1.49; 95% CI, 1.41-1.57) as did children aged 2 to 17 years (2.2% vs 2.4%; ARR, 1.19; 95% CI, 1.15-1.24). Children aged 3 months to less than 2 years and aged 2 to 17 years seen virtually had a lower risk of ED visits leading to hospitalization or death, similar risk of high-acuity ED visit, and higher risk of low-acuity ED visits. Children aged less than 3 months seen virtually had a similar risk of subsequent ED visits to those seen in person. Conclusions and Relevance: In this population-based cohort study of Ontario children and youth, while emergency department visits following a primary sick visit were infrequent, virtual sick visits to primary care were associated with a small increase in emergency department use in children aged 3 months or older, especially low-acuity emergency department visits. Judicious use of virtual primary care to manage acute illness in children is warranted.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| 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 | 0,000 | 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) | 0,000 | 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 tête enseignante, 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 ».