Virtual Care Remuneration Policy and Postdischarge Follow-Up Trends

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Abstract
Importance: Timely follow-up after pediatric hospitalization is critical to support safe discharge, yet many children face barriers to in-person visits. Virtual care may facilitate follow-up; however, its association with follow-up trends remains unknown. Objective: To examine whether a system-wide virtual care remuneration policy, characterized by virtual care physician billing codes, was associated with changes in 7-day postdischarge follow-up rates overall and by hospitalization type and equity factors. Design, Setting, and Participants: This population-based, repeated cross-sectional study used administrative data on all children aged 18 years or younger with provincial health insurance in Ontario, Canada, who were discharged home after medical or surgical hospitalization between March 1, 2011, and June 30, 2024. Exposures: The primary exposure was the implementation of the virtual care remuneration policy (instituted December 1, 2022); effects were stratified by hospitalization type, rurality, and socioeconomic status. Main Outcomes and Measures: The primary outcome was the monthly rate of physician follow-up within 7 days of hospital discharge. The absolute difference in observed vs estimated follow-up visits per 1000 discharges was estimated using an interrupted time series analysis with autoregressive integrated moving average model. Results: The study included 643 156 hospital discharges across 469 066 children (mean [SD] age, 6.3 [5.7] years; 55.1% male). Before the virtual care policy, 42.0% of children received follow-up within 7 days of discharge vs 40.9% thereafter (follow-up provided virtually in 0.2% of postdischarge visits before the virtual care policy vs 11.0% after implementation). After policy implementation, follow-up remained lowest among rural (29.8%) and the most materially deprived populations (39.0%). Accounting for seasonality and autocorrelation, no significant change in slope (0.36; 95% CI, −0.15 to 0.87) or level (−2.70; 95% CI, −7.09 to 1.69) of follow-up rates were observed after policy implementation. Observed follow-up rates did not differ from those estimated (1 fewer visit per 1000 discharges). No clinically meaningful change in slope or level of follow-up rates were observed by hospitalization type, rurality, or socioeconomic status. Conclusions and Relevance: In this cross-sectional study of Ontario children discharged from the hospital, a virtual care remuneration policy was not associated with an increase in timely follow-up after pediatric hospitalization, nor was it associated with narrowing of geographic and socioeconomic disparities. Virtual care billing policies alone may be insufficient to enhance postdischarge follow-up and may reinforce existing inequities.

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