The 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
Authors: Fitzsimon Jonathan , Belanger Christopher , Glazier Richard H. , Green Michael E. , Peixoto Cayden , Mahdavi Roshanak , Plumptre Lesley , Bjerre Lise M. 
Published: November 2022

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 April 1, 2018, until March 31, 2021.

Participants

All residents of Ontario, Canada under the age of 105 eligible for the Ontario Health Insurance Plan (OHIP) 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 March 27, 2020.

Main outcome measures

Primary outcome was change in emergency department (ED) visits anywhere in Ontario, secondary outcomes included changes in hospitalizations and health-system costs, using percent changes in mean monthly values of linked health-system administrative data for two years pre-implementation and one year post-implementation.

Results

Renfrew County saw larger declines in ED visits (−34.4%, 95% confidence interval -41.9% to -26.0%) and hospitalizations (−11.1%, 95% confidence interval -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 hospitalizations increased by 30.0%.

Conclusion

After implementing VTAC, Renfrew County saw reduced ED visits and hospitalizations and slower health-system cost growth compared to 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.

Trial registration

Not applicable.

STRENGTHS AND LIMITATIONS OF THE STUDY

This study uses population-level health administrative data to investigate the empirical effects of a community-based, hybrid model of in-person and virtual care in rural, remote, and underserved communities, where access to comprehensive primary care is insufficient.

Population-level data from administrative datasets were linked using unique encoded identifiers and analyzed at ICES, Ontario’s population health data steward.

The intervention jurisdiction is compared with two similar adjoining jurisdictions and with the whole Province.

Because of the relatively short time period studied — two years before the intervention and one year post — it remains to be seen whether the observed differences will persist over time.

This study’s design does not allow firm inferences about causality; however, the observed changes are in the right temporal sequence and benefit from local comparisons of similar jurisdictions.