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Pediatric Emergency Transfers Following Virtual Urgent Care Visits
Ji Won Kim1, David Hancock2, Deborah Levine1
1Department of Emergency Medicine, Division of Pediatric Emergency Medicine.
Insights
Postpandemic virtual urgent care (VUC) shows low referral rates to emergency departments (EDs). However, disparities persist, with Medicaid patients more likely to self-refer to the ED but with lower admission rates.
Area of Science:
- Pediatric Health
- Digital Health
- Healthcare Disparities
Background:
- The COVID-19 pandemic accelerated telemedicine adoption, including virtual urgent care (VUC), aiming to improve healthcare access and reduce nonemergent emergency department (ED) visits.
- Understanding postpandemic VUC utilization in pediatric populations is crucial for optimizing its role as an accessible healthcare resource.
Purpose of the Study:
- To describe postpandemic virtual urgent care (VUC) utilization among children.
- To determine VUC-to-emergency department (ED) referral rates and associated outcomes in pediatric patients.
- To identify demographic factors influencing VUC utilization and referral patterns.
Main Methods:
- A retrospective cohort study analyzed 4676 pediatric VUC visits from March 2021 to February 2023.
- Data included patient demographics, VUC referral status (physician-referred vs. self-referred), and ED care and disposition.
- Logistic regression was used to examine factors associated with VUC-to-ED referrals.
Main Results:
- Patients preferring English, non-Hispanic individuals, and those with commercial insurance were more likely to complete VUC visits (72%).
- Physician referrals from VUC to the ED occurred in 5.9% of cases, with a 19% admission rate; 5% self-referred to the ED with a 6% admission rate.
- Medicaid insurance was associated with twice the odds of a self-referred VUC-to-ED visit, despite lower admission rates.
Conclusions:
- Postpandemic VUC demonstrates low referral rates to the ED in pediatric patients.
- Persistent disparities in VUC utilization exist, particularly for patients with Medicaid.
- Further research is needed to enhance VUC accessibility and equity in pediatric healthcare.
Objectives:
Telemedicine use has surged since the COVID-19 pandemic, offering patients access to remote health care and the potential to reduce nonemergent emergency department (ED) visits. This study aims to describe postpandemic virtual urgent care (VUC) utilization, including VUC-to-ED referral rates and outcomes in children.
Methods:
We performed a retrospective cohort study of patients under 21 years presenting to the ED within 72 hours following a VUC visit from March 1, 2021, through February 28, 2023, using the electronic medical record. We reviewed demographic data and examined ED care and disposition for patients VUC physician-referred compared with those who self-referred.
Results:
We analyzed 4676 completed VUC patient visits. Patients who preferred English, were non-Hispanic, and had commercial insurance were more likely to complete their VUC visit, with a rate of 72%. Among all patients who completed a VUC visit, 5.9% were referred to the ED by a VUC physician with a 19% admission rate, whereas 5% of patients self-referred with a 6% admission rate. On logistic regression analysis, only insurance status was significant; patients with Medicaid had twice the odds of a self-referred visit.
Conclusions:
This study demonstrated low referral rates from VUC to ED. Despite modifications to improve VUC access, disparities in VUC utilization persist. Patients with Medicaid are more likely to self-refer to the ED, although they have lower rates of admission when self-referred. Future qualitative studies are needed to optimize VUC as an equitable health care resource.
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