Virtualizable visits in a Canadian pediatric emergency department: A retrospective cohort study
Notice bibliographique
Résumé
Background: The rapid expansion of telemedicine triggered by the COVID-19 pandemic has transformed ambulatory care delivery. Some Canadian pediatric emergency departments (PED) have initiated telemedicine programs for selected clinical encounters, but the appropriateness of telemedicine has not been systematically assessed across all types of clinical encounters in the PED. The objective of this study was to estimate the proportion of pediatric ED visits that were potentially suitable for telemedicine, and to identify factors associated with telemedicine suitability.Methods: A retrospective cohort of consecutive visits to an urban tertiary pediatric hospital was assembled for the interval February 1, 2018 to December 31, 2019. Visits of patients who left the ED prior to physician evaluation, of those traveling from a distance greater than 200 km for ED, and visits during the first and last 96 hours of the study period were excluded. Three definitions of telemedicine suitability were developed: 1) a definition based on “resource use” classifying visits as virtualizable if they resulted in a home discharge, no diagnostic testing, and no ED return visit within 72 hours; 2) a “diagnostic definition” based on primary ED diagnosis; 3) a stringent “combined definition” by which visits were classified as virtualizable if they met both the resource use and diagnostic definitions. Visits with a high acuity triage level (1 or 2) classified as virtualizable were considered false positives. Neighbourhood, patient and visit characteristics were compared between visits classified as virtualizable and non-virtualizable according to each definition. Multivariable logistic regression was used to identify factors associated with telemedicine suitability. Results: There were 130,535 eligible visits from 80,727 individual patients during the study period (69,067 visits/year). Using the most stringent combined definition of telemedicine suitability, 37.9% (95%CI 37.6%-38.2%) of eligible in-person visits were virtualizable. In comparison, an estimated 56.1% (95%CI 55.9%-56.4%) and 60.6% (95%CI 60.4%-60.9%) were virtualizable according to the resource use and diagnostic definitions, respectively. The combined definition classified 2,475 visits (1.9%) with triage level 1 or 2 as virtualizable. Presentation during the night shift, non-Canadian citizenship, high area-level ethnocultural vulnerability, and consultation for “head trauma” were strongly associated with higher telemedicine suitability across all definitions. Conclusion: According to diagnostic and resource use definitions of telemedicine suitability, a large proportion of in-person visits to an urban Canadian PED were potentially virtualizable. Few virtualizable visits had a high acuity triage level, particularly when classified by the combined definition, suggesting an acceptable face validity. The system-level, area-level sociodemographic and clinical determinants of telemedicine suitability may inform clinical eligibility criteria and streamline the initial mode of care delivery for pediatric acute care visits
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 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 | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,005 |
| Études des sciences et des technologies | 0,003 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 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 ».