The Digital Divide in End-of-Life Care: Evaluating Health Policies to Bridge the Gap in Virtual Care (FR206B)

ABSTRACT

1. Identify clinical and sociodemographic disparities associated with virtual end-of-life care and understand the role of physician practice behaviors in such disparities. 2. Recognize potential clinical and health policy initiatives that may help to alleviate disparities in virtual end-of-life care. Virtual care was rapidly expanded in Ontario, Canada, during the COVID-19 pandemic following the introduction of new fee codes on March 14, 2020, that incentivized physician delivery of virtual care, including end-of-life care (EOLC). The objective of this study was to measure the associated impact of these fee incentives on disparities in access to virtual EOLC and the variation in use according to a physician's annual practice volume. This population-based cohort study used linked health administrative data of adults in the last three months of life between January 25, 2018, and December 31, 2022, in Ontario, Canada, with practice data for the 38,282 physicians most responsible for their EOLC. Modified Poisson regression was used to measure the association between the intervention and use of virtual EOLC. Multilevel hierarchical logistic regression was used to measure the association between tertiles of annual physician practice volume (Low-bottom, 25%;Average, 25%-75%;High-top, 25%). There were 14,189 people (12%) who received virtual EOLC before March 14, 2020, and 100,934 people (88%) after that date, representing a 9-fold increase (RR, 9.22;95% CI, 8.92-9.52;p<0.0001). Of the measured sociodemographic variables, 10/51 (19.6%) were associated with a lower probability of receiving virtual EOLC before the policy intervention;7 of these 10 had a RR of ≥1 after the intervention (p<0.05). High annual physician volume accounted for 28%-36% of the variation in receipt of virtual EOLC before March 14, 2020, and 10%-12% after March 14, 2020. The introduction of new physician fee codes to broaden the delivery of virtual EOLC was associated with a substantial increase in virtual EOLC utilization and a leveling of preexisting disparities in use among different demographic groups. Physician-level factors accounted for substantial variation in receipt of virtual care, though these effects were attenuated over time as virtual care was more broadly utilized. [ FROM AUTHOR] Copyright of Journal of Pain & Symptom Management is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)