JMIR Publications

ABSTRACT

Background:

In 2020, the Ministry of Health (MoH) in Ontario, Canada, introduced a virtual urgent care (VUC) pilot program to provide alternative access to urgent care services and reduce the need for in-person emergency department (ED) visits for patients with low acuity health concerns.

Objective:

The study objective was to compare the 30-day cost associated with VUC and in-person ED from a Ministry of Health perspective

Methods:

Using administrative data from Ontario (the most populous province of Canada), a population-based, matched cohort study of Ontarians who used VUC services from December 2020 to September 2021 was conducted. As it was expected that VUC and in-person ED users would be different, two cohorts of VUC users were defined: 1) those seen by a VUC provider with no referral to an in-person ED; those patients were matched to comparable patients who presented in-person to the ED and were discharged home by the ED physician; and 2) those who were promptly referred to an ED by a VUC provider and subsequently presented to an ED within 72 hours; those patients were matched to comparable in-person ED users with any discharge disposition. Bootstrap techniques were used to compare the 30-day costs of VUC (operational costs to set up the VUC program plus healthcare expenditures) versus in-person ED care (healthcare expenditures) from a MoH perspective.

Results:

We matched 14,179 patients seen by a VUC provider without a referral to an ED and 2,129 patients who presented to an ED within 72 hours of VUC referral. Our matched populations represented 98% of eligible VUC patients not referred to the ED by their VUC provider and 99% of eligible VUC patients referred to the ED by their VUC provider. Compared to matched in-person ED cohorts, 30-day costs per patient were lower for the VUC cohort of patients who did not require ED referral (difference of $362; 95% confidence interval [CI]: $284 to $446), and higher for the VUC cohort of patients referred to the ED by a VUC provider (difference of $506; 95% CI: $139 to $885). Overall, the absolute 30-day costs associated with the two VUC cohorts were $18.9 million (i.e., $12.9 million + $6.0 million) versus $22.9 million ($18.0 million + $4.9 million) for the two in-person ED cohorts.

Conclusions:

This economic evaluation supports the appropriate use of VUC as most complaints were addressed without referral to ED. Future research should evaluate targeted applications of VUC to inform future resource allocation and policy decisions. Clinical Trial: N.A.