Suchergebnisse

ObjectiveIn response to the COVID-19 pandemic, Sunnybrook Health Sciences Centre launched the first virtual emergency department (VED) in Toronto, Ontario. The objective of this pilot project was to leverage linked administrative data to describe the healthcare utilization of VED patients compared to matched patients who attended an ED in person.
ApproachEvaluation of the VED program was supported by the ICES Applied Health Research Question Program, which is funded by the Ontario Ministry of Health to answer questions directly related to Ontario healthcare policy, planning, or practice. VED visit records from December 2020 to May 2021 were linked with Ontario administrative data. VED patients with low acuity complaints were matched 1:1 with in-person ED comparators according to visit date, presenting complaint, and a propensity score that incorporated age, sex, comorbidities, and other important potential confounders. The primary outcomes were healthcare utilization within 7 days and all-cause mortality within 30 days.
ResultsOf the 609 eligible patients discharged from the VED, 600 (98.5%) were successfully matched to a comparator. Mean (SD) age was 43.0 (21.1) and 64.1% were female. In-person ED revisits and hospitalizations were similar for VED and comparator patients at 72 hours (ED: 12.1% vs. 11.3%; Δ 0.8%, 95%: -2.8, 4.5%; hospitalization: 1.2% vs. 1.5%; Δ 0.3%, 95%: -0.7, 1.4%,) and 7 days (ED: 16.1% vs. 14.4%; Δ 1.7, 95%: -2.4, 5.7%; hospitalization: 1.7% vs. 1.8%; Δ 0.2%, 95%: -0.1, 1.4%) following the index visit. The number of patients visiting a primary care provider within 7 days was also similar between groups (36.7% vs. 32.4%; Δ 4.3, 95%: -1.1, 9.8%). No patients died within 30 days.
Conclusion/ImplicationsVED patients and their matched comparators had similar healthcare utilization in the 7 days following their index ED visit. Methodology from this study will inform a province-wide evaluation of VED programs across Ontario.

ObjectiveTo provide an update on the key characteristics, refinements to project flow, and future opportunities for a program providing customized research evidence to health system policymakers and providers.
ApproachWith a goal to inform health system decision making, the program answers research questions posed by health system requestors that can be answered with linked, population-based administrative data. Now in its 10th year of operation, the program has been refined over time to improve efficiency, usefulness of research products, and requestor satisfaction. Satisfaction surveys and individual-level engagements with requestors are used to collect feedback on the needs of an increasingly diverse group of requests.
ResultsWith 508 requests, 82 Data Sharing Agreements, and 257 unique requestors since its inception, the program informs governmental decision making, evaluates intervention effectiveness, and aids grassroots organizations' planning for services. Notable updates to the program include, inserting multiple opportunities for connection between the program and requestors through the project life cycle to understand goals and needs; assigning staff scientists to shepherd projects and promote efficiency; training coordinators to review privacy impact assessments; and (soon) accepting a broader range of projects to include data beyond the health sector e.g. education.
ConclusionThis program continues to improve and is an exemplar of sustainable approaches to supporting health system requestors with evidence from administrative data in program evaluation, planning and policy change.
ImplicationsBeing responsive to requestor needs has allowed the program to attract an increasingly diverse range of requesters who can obtain impactful and timely research evidence.