Evidence map›Paper›PMID 40460327›Full record

ArticlePloS one2025

Association of physician-delivered virtual care near the end of life with healthcare use outcomes: A national population-based study of Canadians.

Mohammed Rashidul Anwar, Rabia Akhter, Thérèse A Stukel, Hannah Chung, Chaim M Bell, James Downar, Nathan Stall, Peter Tanuseputro, Aynharan Sinnarajah, Sandra Peterson and 3 more

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In one paragraph

Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Mohammed Rashidul AnwarInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Rabia AkhterTemmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada.
Thérèse A StukelInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Hannah ChungICES, Toronto and Ottawa, ON, Canada.
Chaim M BellInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
James DownarDivision of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Nathan StallICES, Toronto and Ottawa, ON, Canada.
Peter TanuseputroInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Aynharan SinnarajahDepartment of Medicine, Queen's University, Kingston, ON, Canada.ORCID https://orcid.org/0000-0002-7967-159X
Sandra PetersonCentre for Health Services and Policy Research, The University of British Columbia, Vancouver, BC, Canada.
Asmita BhattaraiDepartment of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
John C KnightDivision of Population Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, NLFD, Canada.
Kieran L QuinnInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.ORCID https://orcid.org/0000-0002-1681-5170

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe last 90 days of life are marked by high healthcare utilization in acute care settings, often conflicting with the preference to remain at home. The COVID-19 pandemic accelerated the adoption of virtual care, but its impact on healthcare utilization near the end-of-life remains unclear. This study assessed the association between physician-delivered virtual care use near the end-of-life and acute healthcare utilization, before and during the COVID-19 pandemic across four Canadian provinces.

methodsA retrospective population-based cohort study using linked health administrative data from January 1, 2018, to December 31, 2021, across British Columbia (BC), Alberta (AB), Ontario (ON), and Newfoundland & Labrador (NFLD). The study included 548,955 adult decedents who died within the study period. Virtual care use in the last 90 days of life, categorized by pre-pandemic and pandemic periods, was the primary exposure. Primary outcomes were rates of ED visits, hospitalizations, and in-hospital deaths during the last 90 days of life. Modified Poisson regression models were used to measure associations, adjusting for demographic and clinical characteristics.

resultsAmong the 548,955 decedents, virtual care utilization during the pandemic varied by province, ranging from 53% in NFLD to 78% in BC. During the pandemic, virtual care was associated with higher ED visits (adjusted rate ratios [aRateRs] ranging from 1.12 to 1.72) and hospitalizations (aRateRs: ranging from 1.01 to 1.59) in most provinces. Virtual care was linked to a higher risk of in-hospital death in AB (adjusted risk ratios [aRiskR]: 1.11; 95% CI: 1.08-1.14; P < 0.001) and ON (aRiskR: 1.04; 95% CI: 1.03-1.05; P < 0.001). Pre-pandemic, associations were weaker, with virtual care linked to lower in-hospital death rates in ON, AB and BC.

conclusionVirtual care during the pandemic was linked to increased acute healthcare utilization, contrasting with pre-pandemic patterns when it appeared more selective and associated with fewer in-hospital deaths. Findings highlight the evolving role of virtual care and the need for region-specific policies to optimize end-of-life care delivery.

Indexed as

COVID-19Patient Acceptance of Health CareTelemedicineTerminal CareAdultAgedAged, 80 and overCanadaFemaleHospitalizationHospital MortalityHumansMaleMiddle AgedNorth American PeoplePandemics

Identifiers

PMID40460327
PMCPMC12133171

What Socratic holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.