Evidence map›Paper›PMID 38478533›Full record

ArticlePLOS digital health2024

Association of virtual end-of-life care with healthcare outcomes before and during the COVID-19 pandemic: A population-based study.

John M Lapp, Thérèse A Stukel, Hannah Chung, Chaim M Bell, R Sacha Bhatia, Allan S Detsky, James Downar, Sarina R Isenberg, Douglas S Lee, Nathan Stall and 2 more

Open access · goldAbstract read
In one paragraph

Article in PLOS digital health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
1.1field-weighted citation impact, top 24% of its field
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

2 citing papers in PubMed, 2 citations in OpenAlex.

  1. Article
  2. Article
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

12 authors at 4 institutions in 2 countries.

John M LappDepartment of Medicine, Sinai Health System, Toronto, Canada.
Thérèse A StukelICES, Toronto and Ottawa, Canada.
Hannah ChungICES, Toronto and Ottawa, Canada.
Chaim M BellDepartment of Medicine, Sinai Health System, Toronto, Canada.
R Sacha BhatiaInsitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
Allan S DetskyDepartment of Medicine, Sinai Health System, Toronto, Canada.
James DownarDivision of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Canada.
Sarina R IsenbergDivision of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Canada.
Douglas S LeeICES, Toronto and Ottawa, Canada.
Nathan StallDepartment of Medicine, Sinai Health System, Toronto, Canada.
Peter TanuseputroICES, Toronto and Ottawa, Canada.ORCID https://orcid.org/0000-0002-4409-0795
Kieran L QuinnDepartment of Medicine, Sinai Health System, Toronto, Canada.ORCID https://orcid.org/0000-0002-1681-5170
University of Toronto · CAUniversity of Ottawa · CAUniversity Health Network · CASinai Health System · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The use of virtual care for people at the end-of-life significantly increased during the COVID-19 pandemic, but its association with acute healthcare use and location of death is unknown. The objective of this study was to measure the association between the use of virtual end-of-life care with acute healthcare use and an out-of-hospital death before vs. after the introduction of specialized fee codes that enabled broader delivery of virtual care during the COVID-19 pandemic. This was a population-based cohort study of 323,995 adults in their last 90 days of life between January 25, 2018 and December 31, 2021 using health administrative data in Ontario, Canada. Primary outcomes were acute healthcare use (emergency department, hospitalization) and location of death (in or out-of-hospital). Prior to March 14, 2020, 13,974 (8%) people received at least 1 virtual end-of-life care visit, which was associated with a 16% higher rate of emergency department use (adjusted Rate Ratio [aRR] 1.16, 95%CI 1.12 to 1.20), a 17% higher rate of hospitalization (aRR 1.17, 95%CI 1.15 to 1.20), and a 34% higher risk of an out-of-hospital death (aRR 1.34, 95%CI 1.31 to 1.37) compared to people who did not receive virtual end-of-life care. After March 14, 2020, 104,165 (71%) people received at least 1 virtual end-of-life care visit, which was associated with a 58% higher rate of an emergency department visit (aRR 1.58, 95%CI 1.54 to 1.62), a 45% higher rate of hospitalization (aRR 1.45, 95%CI 1.42 to 1.47), and a 65% higher risk of an out-of-hospital death (aRR 1.65, 95%CI 1.61 to 1.69) compared to people who did not receive virtual end-of-life care. The use of virtual end-of-life care was associated with higher acute healthcare use in the last 90 days of life and a higher likelihood of dying out-of-hospital, and these rates increased during the pandemic.

Identifiers

PMID38478533
PMCPMC10936771
OpenAlexW4392747247

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

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 OpenQuestion graph.