Presentation (CTI)

OBJECTIVES: Access to primary care is a challenge in Canada’s public healthcare system, including in Quebec, where 16% of the population is not attached to a designated family doctor or nurse practitioner. Since 2020, Quebec has implemented a real-time orchestration Platform connecting the primary care ecosystem to align supply with demand and support programs improving access. This study evaluates the Platform’s economic impact on emergency department (ED) utilization before and after implementation and recent acuity trends.
METHODS: Economic impacts of ED utilization were estimated using changes in ED use and in ED visits redirected to primary care clinics before (2018-2019) and after (2024-2025) Platform implementation. Trends by acuity levels and by attachment status were also examined. Utilization data were obtained through a Freedom of Information request to Sante Quebec. Unit costs (CAD) were sourced from the literature.
RESULTS: ED visits per capita declined by 6.8%, from 0.4402 in 2018-2019 to 0.4104 in 2024-2025. Assuming constant utilization without the platform, observed ED levels correspond to 269,238 fewer ED visits. Redirected visits increased from 4.5% of ED visits to 8.0%, corresponding to 128,459 more redirected visits in 2024-2025. The combined impact of avoided and redirected visits yields an annual economic benefit of $121.7 million in 2024-2025 and $339.1 million since implementation. The reduction in ED visits was driven by low-acuity (CTAS 4 or 5) visits, which declined from 0.72 per capita in 2018-2019 to 0.63 in 2024-2025. While unattached patients (16% of the population) accounted for 24% of ED use in 2024-2025, the gap with attached patients for low-acuity visits has narrowed over years.
CONCLUSIONS: The Platform appears to improve system efficiency by reducing non-urgent ED use and increasing redirections to primary care. The cumulative economic benefit of $339.1 million highlights the value of digital infrastructure in supporting system-wide efficiency gains.