Specialty-specific Evaluation of Virtual care Outcomes: A retrospective QUality and safety analysis (S-EVOQUe)

The objective was to compare specialty-specific 7- and 30-day outcomes between virtual care visits and in-person visits which occurred during the SARS-CoV-2 pandemic. Using administrative data from provincial databases in Ontario, ambulatory care visits occurring virtually and in-person during specific timeframes within the pandemic were analyzed. Virtual care visits were matched with corresponding in-person visits based on multiple baseline patient characteristics. We assessed short-term patient outcomes at 7 and 30 days, including subsequent visits, hospital and ICU admissions, surgeries, and mortality and compared them using multivariate logistic regression. Odds ratios were calculated as measures of association between populations. For statistical significance, we used 99% confidence intervals to account for the increased likelihood of chance findings due to the multiple comparisons conducted. Overall, 9,340,519 visits were compared between populations using a 1:1 match on a 20% random sample of the available eligible visits. Over 70% of patients included were seen by a General Practitioner. With few exceptions and across almost all specialties, revisits, ED visits, admissions, ICU and OR use, and mortality were found to be more frequent for patients seen in person. When using the administrative data available to policy makers, there is no evidence to suggest that, in the short-term, virtual care is less safe than in person care. The causes for worse in-person outcomes are not yet clear although are likely related to the streaming of more acutely unwell patients towards in-person care.