An equity-based examination of access to follow-up care from psychiatric hospitalization before and after the introduction of Ontario's new physician billing structure for virtual care

Mental health disorders are common among Canadian youth with high rates of hospital readmission. Timely follow-up care following psychiatric hospitalization improves outcomes but its uptake is poor and inequitable. While Health Quality Ontario issued a standard for adolescents with depression to receive follow-up care within 7 days of discharge, Ontario hospitals are not consistently following this standard. Virtual care may reduce barriers to follow-up care but may also increase inequities. During the COVID-19 pandemic, a new billing structure was implemented which formalized the use of virtual care. Whether this change in billing structure impacts access to follow-up care for children/adolescents is unknown. This study aims to determine patterns of virtual follow-up care access before and after the introduction of Ontario's billing change as well as characteristics (socioeconomic status, gender, location and immigrant status) of those receiving virtual follow-up care. The research will characterize hospital-level patterns regarding the provision of follow-up care and examine reasons for these differences from the perspective of healthcare personnel. A mixed methods approach will be used. For the quantitative portion, health administrative data at ICES will be analyzed to determine changes in rates of virtual follow-up care for children/adolescents before and after the new billing structure. These data will be used to determine characteristics of those receiving follow-up care and to identify hospital-level patterns. Qualitatively, interviews will be conducted with hospital physicians who refer to follow-up care and leaders from high and low performing hospitals. The study will provide evidence on how virtual care impacts the provision of follow-up care and whether it is delivered equitably. It will identify whether and why variations exist across hospitals regarding follow-up care for children/adolescents following psychiatric hospitalization.