Virtual Care Remuneration Policy and Postdischarge Follow-Up Trends.

Area of Science:

• Pediatric Health Outcomes
• Health Services Research
• Digital Health Equity

Background:

• Timely post-hospitalization follow-up is crucial for pediatric patients but often hindered by access barriers.
• Virtual care presents a potential solution to improve follow-up rates, yet its impact on trends remains understudied.

Purpose of the Study:

• To assess the association between a provincial virtual care remuneration policy and changes in 7-day post-discharge follow-up rates for children.
• To investigate if the policy affected follow-up rates across different hospitalization types and socioeconomic groups.

Main Methods:

• Population-based, repeated cross-sectional study using administrative data from Ontario, Canada (March 2011-June 2024).
• Interrupted time series analysis with autoregressive integrated moving average (ARIMA) models to evaluate the policy's impact on monthly follow-up rates.
• Stratified analyses by hospitalization type, rurality, and socioeconomic status.

Main Results:

• The study included over 643,000 hospital discharges for children under 18.
• Following policy implementation (December 2022), 7-day follow-up rates did not significantly change (42.0% pre-policy vs. 40.9% post-policy).
• Virtual care use increased post-policy (0.2% to 11.0%), but no significant improvements in overall follow-up rates or reductions in disparities were observed for rural or socioeconomically disadvantaged groups.

Conclusions:

• A virtual care remuneration policy was not associated with increased timely follow-up after pediatric hospitalization.
• The policy did not narrow geographic or socioeconomic disparities in post-discharge care.
• Virtual care billing policies alone may be insufficient to improve pediatric post-discharge follow-up and could potentially exacerbate existing inequities.