Virtualizable visits in a Canadian pediatric emergency department: A retrospective cohort study
Bibliographic record
Abstract
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
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 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".