THU132 Pediatric Diabetes Virtual Visit Quality And Outcome Not Associated With Social Determinants Of Health
Bibliographic record
Abstract
Abstract Disclosure: L. Bastien: None. C. Zuijdwijk: None. E. Goldbloom: None. R. Webster: None. E. Sucha: None. Word count: 350 Title: Pediatric diabetes virtual visit quality and outcome not associated with social determinants of health Authors: Laurence Bastien, Ellen Goldboom, Ewa Sucha, Richard Webster, IvanTerekov, Caroline Zuijdwijk Objectives: Social determinants of health (SDH) impact diabetes short- and long-term outcomes. In response to COVID-19, virtual care has become a solution to ensure ongoing healthcare access. However, socially disadvantaged groups have less access and skills related to technology, leading to potential increases in health disparities. We aimed to determine the association between SDH and physician-perceived virtual visit quality and outcome in pediatric diabetes patients. Methods: Retrospective chart review of patients who attended a scheduled virtual diabetes follow-up visit at a pediatric tertiary care centre from December 1, 2020 to March 31, 2021. During this time, a quality improvement study required physicians to rate the quality (same/better or worse than in-person) and outcome (successfully replaced in-person visit or not) of each virtual visit. These data, along with patient characteristics, were extracted from the electronic health record. Institut national de santé public du Québec Material and Social Deprivation Index and the Ontario Marginalization Index (Ethnic Concentration) were used to determine SDH based on postal code. Statistical analysis tested for an association between deprivation index quintiles and virtual visit quality and outcome. Results: Data were obtained for 447 patients with mean age 12.7±3.8 years; 47.7% female; 93.1% type 1 diabetes; and mean glucose management indicator 7.96±1.41%. During the study period, 17.9% visits were evaluated as worse than in person, 13.1% visits were unsuccessful in replacing an in-person visit, and 20.7% were rated worse or unsuccessful. The odds of having a worse or unsuccessful visit were not different in those with the highest vs. lowest degree of material deprivation (odds ratio [OR] 1.59, 95% confidence interval [CI] 0.53, 4.76), social deprivation (OR 1.36, 95%CI 0.48, 3.83), or ethnic concentration (OR 0.30, 95%CI 0.30, 1.77). Conclusion: In our pediatric diabetes population, virtual visit quality and outcome were not associated with material or social deprivation. These results show promising success in equitable access and delivery of high quality virtual diabetes care for patients regardless of socioeconomic status, which is important in the context of the current pandemic and sustainable widespread integration of virtual care. Further studies are required to assess this association in other populations. Presentation: Thursday, June 15, 2023
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".