Virtual Care Provision and Emergency Department Use Among Children and Youth
Bibliographic record
Abstract
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.
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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 | 0.000 | 0.002 |
| 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 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".