Predictors of Unplanned Emergency Department Visits and Hospitalization Among Adults Accessing Virtual Outpatient Oncology Services in Queensland, Australia

BACKGROUND: Virtual care has become an integral part of oncology services, following the COVID-19 pandemic. Its association with unplanned hospital service use, alongside sociodemographic and clinical factors, remains unclear. METHOD: A retrospective cohort study was conducted among 39,099 adults with confirmed cancer diagnoses who accessed outpatient oncology services in Queensland between January 1, 2018 and December 31, 2020 using linked administrative data on unplanned emergency department (ED) visits, hospitalizations, and cancer-related hospitalizations. Multivariable logistic regression examined associations between nonadmitted patient (NAP) virtual care and unplanned hospital service use. RESULTS: Among 39,099 patients accessing oncology services, 57.9% used at least one virtual care service. During one-year follow-up, 55.4% had an unplanned ED visit, 29.7% had an unplanned hospitalization, and 9.4% had an unplanned cancer-related hospitalization. Virtual care users had higher odds of unplanned ED visits (OR: 1.64; 95% CI: 1.50-1.79) and hospitalizations (OR: 1.20; 95% CI: 1.10-1.30), with no association for cancer-related admissions. Lower odds of unplanned service use were observed among females, individuals in the least disadvantaged areas, treated during lockdown, with poorly differentiated tumors, born outside Australia and with higher outpatient use. Presence of Charlson comorbidities, mental health conditions, and digestive or lung cancers (Vs breast cancer) were associated with higher odds of unplanned service use. Younger age and rural residence were linked to increased likelihood of unplanned ED visits but reduced likelihood of unplanned hospitalizations. Being on active treatment predicted unplanned hospitalizations only. CONCLUSIONS: The findings suggest an association between virtual care use and unplanned health service utilization among oncology patients. However, further research using more robust methodologies is needed to better understand this relationship and inform optimal integration of virtual care into routine oncology services.