scholarly journals Using administrative data to explore potentially aberrant provision of virtual care during COVID-19: a retrospective cohort study of Ontario provincial data (Preprint)

10.2196/29396 ◽  
2021 ◽  
Author(s):  
Vess Stamenova ◽  
Cherry Chu ◽  
Andrea Pang ◽  
Mina Tadrous ◽  
Sacha Bhatia ◽  
...  
Keyword(s):  
Cohort Study ◽  
Administrative Data ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Virtual Care

Using administrative data to explore potentially aberrant provision of virtual care during COVID-19: a retrospective cohort study of Ontario provincial data (Preprint)

2021 ◽  
Author(s):  
Vess Stamenova ◽  
Cherry Chu ◽  
Andrea Pang ◽  
Mina Tadrous ◽  
Sacha Bhatia ◽  
...  
Keyword(s):  
Cohort Study ◽  
Administrative Data ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Significant Positive Correlation ◽  
Ambulatory Visit ◽  
High User ◽  
Positive Correlation ◽  
Virtual Care ◽  
Very High

BACKGROUND The COVID-19 pandemic has led to a rapid increase in virtual care utilization across the globe. Many healthcare systems have responded, by creating virtual care billing codes that allow physicians to see their patients over telephone or video. This rapid liberalization of billing requirements, both in Canada and other countries, has led to concerns about potential abuse, but empirical data are limited. OBJECTIVE The objectives of this study were to examine whether there were substantial changes in physicians’ ambulatory visit volumes coinciding with the liberalization of virtual care billing rules and to describe the characteristics of physicians who significantly increased their ambulatory visit volumes during this period. We also sought to describe the relationship between visit volume changes in 2020 and the volumes of virtual care use in individual physicians and across specialties. METHODS We conducted a population-based, retrospective cohort study using health administrative data from the Ontario Health Insurance Plan (OHIP), which was linked to the ICES Physician Database (IPDB). We identified a unique cohort of providers based on physicians’ billings and calculated the ratio of total ambulatory visits (in-person and virtual) over January-June, 2020 (virtual predominating) relative to that over January-June, 2019 (in-person predominating) for each physician. Based on these ratios, we then stratified physicians into four groups: low, same, high and very high use physicians. We then calculated various demographic and practice characteristics of physicians in each group. RESULTS Among 28,383 eligible physicians in 2020, the mean ratio of ambulatory visits in January-June 2020: 2019 was 0.99, SD=2.53 (median 0.81; IQR 0.59-1.0). Only 2,672 physicians (9.4% of all physicians) fell into the high user group and only 291 (1.0% of physicians) fell into the very high users group. High user physicians were younger, more recent graduates, more likely female, and less likely to be international graduates. They also had on average lower volume practices. There was a significant positive correlation between percent virtual care and the 2020:2019 ratio only in the group of physicians who maintained their practice (R=0.35, p<.001). There was also a significant positive correlation between the 2020:2019 ratio and the percent virtual care per specialty (R=0.59, p<.01). CONCLUSIONS During the early stages of the pandemic, the introduction of virtual care did not lead to significant increases in visit volume. Our results provide reassuring evidence that relaxation of billing requirements early in the COVID-19 pandemic in Ontario were not associated with widespread and aberrant billing behaviors. Furthermore, the strong relationship between the ability to maintain practice volumes and the use of virtual care suggest that the introduction of virtual care allowed continued access to care for patients.

scholarly journals Uptake and patient and provider communication modality preferences of virtual visits in primary care: a retrospective cohort study in Canada

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e037064 ◽  
Author(s):  
Vess Stamenova ◽  
Payal Agarwal ◽  
Leah Kelley ◽  
Jamie Fujioka ◽  
Megan Nguyen ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Secure Messaging ◽  
Communication Modality ◽  
Care Services ◽  
Virtual Care ◽  
Virtual Visits

ObjectivesTo evaluate the uptake of a platform for virtual visits in primary care, examine patient and physician preferences for virtual communication methods and report on characteristics of visits and patients experience of care.DesignA retrospective cohort study.SettingPrimary care practices within five regions in Ontario, Canada after 18 months of access to virtual care services.Participants326 primary care providers and 14 291 registered patients.InterventionsProviders used a platform that allowed them to connect with their patients through synchronous (audio/video) and/or asynchronous (secure messaging) communication.Main outcome measuresUser-level data from the platforms including patient demographics, practice characteristics, communication modality used, visit characteristics and patients’ satisfaction.ResultsAmong the participants, 44% of registered patients and 60% of registered providers used the platform at least once. Among patient users, 51% completed at least one virtual visit. The majority of virtual visits (94%) involved secure messaging. The most common patient requests were for medication prescriptions (24%) and follow-up from previous appointment (22%). The most common provider request was to follow-up on test results (59%). Providers indicated that 81% of virtual visits required no follow-up for that issue and 99% of patients reported that they would use virtual care services again.ConclusionsWhile there are a growing number of primary care video visit services, our study found that both patients and providers in rostered practices prefer secure messaging over video. Despite fears that virtual visits would be overused by patients, when patients connected with their own primary care provider, many virtual visits appeared to replace in-person visits, and patients did not overwhelm physicians with requests. This approach may improve access and continuity in primary care.

Formula supplementation in hospital and subsequent feeding at discharge among women who intended to exclusively breastfeed: An administrative data retrospective cohort study

Birth ◽  
2017 ◽  
Vol 44 (4) ◽  
pp. 352-362 ◽  
Author(s):  
Jason P. Bentley ◽  
Natasha Nassar ◽  
Maree Porter ◽  
Michelle de Vroome ◽  
Elizabeth Yip ◽  
...  
Keyword(s):  
Cohort Study ◽  
Administrative Data ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort

scholarly journals Associations between clusters of early life risk factors and developmental vulnerability at age 5: a retrospective cohort study using population-wide linkage of administrative data in Tasmania, Australia

BMJ Open ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. e033795
Author(s):  
Catherine Louise Taylor ◽  
Daniel Christensen ◽  
Joel Stafford ◽  
Alison Venn ◽  
David Preen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Administrative Data ◽  
Health Behaviour ◽  
Retrospective Cohort Study ◽  
Early Life ◽  
Retrospective Cohort ◽  
Latent Class ◽  
Teenage Mother ◽  
Factors Associated

ObjectiveEarly childhood is a critical time to address risk factors associated with developmental vulnerability. This study investigated the associations between clusters of early life risk factors and developmental vulnerability in children’s first year of full-time school at age 5.DesignA retrospective cohort study.SettingPopulation-wide linkage of administrative data records for children born in Tasmania, Australia in 2008–2010.ParticipantsThe cohort comprised 5440 children born in Tasmania in 2008–2010, with a Tasmanian 2015 Australian Early Development Census (AEDC) record and a Tasmanian Perinatal Collection record.Outcome measureThe AEDC is a national measure of child development across five domains: physical health and well-being, social competence, emotional maturity, language and cognitive skills (school-based), and communication skills and general knowledge. Children who scored below the 10th percentile on one or more AEDC domains were classified as developmentally vulnerable. Children with special needs are not included in the AEDC results.ResultsLatent class analysis identified five clusters of risk factors: low risks (65% of children), sociodemographic and health behaviour risks (24%), teenage mother and sociodemographic risks (6%), birth risks (3%), and birth, sociodemographic and health behaviour risks (2%). In this sample population, 20% of children were classified as developmentally vulnerable, but the proportion varied substantially by latent class. Logistic regression showed increased odds of developmental vulnerability associated with sociodemographic and health behaviour risks (OR 2.26, 95% CI 1.91 to 2.68, p<0.001), teenage mother and sociodemographic risks (OR 2.01, 95% CI 1.50 to 2.69, p<0.001), and birth, sociodemographic and health behaviour risks (OR 3.29, 95% CI 2.10 to 5.16. p<0.001), but not birth risks (OR 1.34, 95% CI 0.88 to 2.03, p=0.1649), relative to the reference group.ConclusionsThe patterning of risks across the five groups invites consideration of multisectoral policies and services to address complex clusters of risk factors associated with developmental vulnerability.

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