Clinical and economic impact of a community-based, hybrid model of in-person and virtual care in a Canadian rural setting: a cross-sectional population-based comparative study
Jonathan Fitzsimon, Christopher Belanger, Richard H. Glazier, Michael Green, Cayden Peixoto, Roshanak Mahdavi, Lesley Plumptre, Lise M. Bjerre
Abstract
OBJECTIVES: To determine the clinical and economic impact of a community-based, hybrid model of in-person and virtual care by comparing health-system performance of the rural jurisdiction where this model was implemented with neighbouring jurisdictions without such a model and the broader regional health system. DESIGN: A cross-sectional comparative study. SETTING: Ontario, Canada, with a focus on three largely rural public health units from 1 April 2018 until 31 March 2021. PARTICIPANTS: All residents of Ontario, Canada under the age of 105 eligible for the Ontario Health Insurance Plan during the study period. INTERVENTIONS: An innovative, community-based, hybrid model of in-person and virtual care, the Virtual Triage and Assessment Centre (VTAC), was implemented in Renfrew County, Ontario on 27 March 2020. MAIN OUTCOME MEASURES: Primary outcome was a change in emergency department (ED) visits anywhere in Ontario, secondary outcomes included changes in hospitalisations and health-system costs, using per cent changes in mean monthly values of linked health-system administrative data for 2 years preimplementation and 1 year postimplementation. RESULTS: Renfrew County saw larger declines in ED visits (-34.4%, 95% CI -41.9% to -26.0%) and hospitalisations (-11.1%, 95% CI -19.7% to -1.5%) and slower growth in health-system costs than other rural regions studied. VTAC patients' low-acuity ED visits decreased by -32.9%, high-acuity visits increased by 8.2%, and hospitalisations increased by 30.0%. CONCLUSION: After implementing VTAC, Renfrew County saw reduced ED visits and hospitalisations and slower health-system cost growth compared with neighbouring rural jurisdictions. VTAC patients experienced reduced unnecessary ED visits and increased appropriate care. Community-based, hybrid models of in-person and virtual care may reduce the burden on emergency and hospital services in rural, remote and underserved regions. Further study is required to evaluate potential for scale and spread.