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Visits to the Emergency Department for Conditions That Could Be Managed in Primary Care (In Person and Virtual)

The percentage of unscheduled visits to the emergency department that were for conditions that could be managed in primary care and through virtual primary care, such as with a family doctor

Lower results are preferable.

For information on using this indicator, see our companion report, Primary and virtual care access: Emergency department visits for primary care conditions.

Data updated:
Data availability: to (fiscal years)
Geographic coverage
Prince Edward Island, Nova Scotia, Ontario, Saskatchewan, Alberta, Yukon
Reporting level
National, Province/Territory, Region
Calculation

The percentage of emergency department visits with a primary care sensitive condition as a main diagnosis that were discharged home and not emergent, divided by all unscheduled emergency department visits with a valid diagnosis code, over 1 year. For the virtual care variant of this indicator, the numerator includes only the subset of visits with a primary care sensitive condition that could be managed through virtual care as the main diagnosis.

Denominator

Unscheduled visits to the emergency department for patients age 2 or older with a main problem (NACRS Level 3) or a valid discharge diagnosis (NACRS Level 1 or 2)

Numerator

Visits to the emergency department with a primary care sensitive condition as a diagnosis that were discharged home and were triaged as non-emergent

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Short/Other Names

Visits to the emergency department for primary care sensitive conditions (in person or virtual)

Description

The percentage of unscheduled visits to the emergency department that were for conditions that could be managed in primary care and through virtual primary care, such as with a family doctor, nurse practitioner or other health care provider in the community

Rationale

Patients who need primary care but cannot access timely and high-quality care in the community may seek care in the emergency department. These indicators are designed to monitor the state of primary care access through its manifestations in the emergency department by measuring the percentage of visits that were for conditions that could be managed in primary care and through virtual primary care. The indicator for virtual primary care can additionally give insights to the role that virtual care can play in increasing access to primary care.

Interpretation

Lower results are preferable.

For information on using this indicator, see our companion report, Primary and virtual care access: Emergency department visits for primary care conditions.

HSP Framework Dimension

Health system outputs: Access to comprehensive, high-quality health services

Areas of Need

Getting Better

Targets/Benchmarks

Not applicable

Available Data Years

to (fiscal years)

Geographic Coverage

  • Prince Edward Island
  • Nova Scotia
  • Ontario
  • Saskatchewan
  • Alberta
  • Yukon

Reporting Level/Disaggregation

  • National
  • Province/Territory
  • Region

Indicator Results

Results available in Your Health System: In Depth

Update Frequency

Every year

Latest Results Update Date

Updates

Not applicable

Description

The percentage of emergency department visits with a primary care sensitive condition as a main diagnosis that were discharged home and not emergent, divided by all unscheduled emergency department visits with a valid diagnosis code, over 1 year. For the virtual care variant of this indicator, the numerator includes only the subset of visits with a primary care sensitive condition that could be managed through virtual care as the main diagnosis.

Type of Measurement

Percentage or proportion

Denominator

Description:

Unscheduled visits to the emergency department for patients age 2 or older with a main problem (NACRS Level 3) or a valid discharge diagnosis (NACRS Level 1 or 2)

Inclusions:

Visits meeting all the following criteria

  1. Ambulatory Care Group code of Emergency Department
  2. ED Visit Indicator of ED visit (i.e., unscheduled visit)
  3. Sex or gender recorded as male or female
     

Exclusions:

Visits meeting any of the following criteria:

  1. Invalid age at admission
  2. Age at admission younger than 2 years
  3. Visit Disposition of medical assistance in dying
  4. ED visit at an urgent care centre
  5. For NACRS Level 1 or 2 cases, any of the following:
    1. Discharge Diagnosis code is missing
    2. Discharge Diagnosis CED-DxS code is Z769
       

Numerator

Description:

Visits to the emergency department with a primary care sensitive condition as a diagnosis that were discharged home and were triaged as non-emergent

Inclusions:

Same as for the denominator, and additionally meeting all criteria below:

  1. Main problem ICD-10-CA code (for NACRS Level 3) or discharge diagnosis CED-DxS code (for NACRS Level 1 or 2) is a primary care sensitive condition:
    1. For the virtual care indicator subset, the numerator includes cases as defined above but using the subset of primary care sensitive conditions considered amenable to virtual care
    2. See the detailed methodology notes for the full list of conditions.
  2. Visit disposition is one of the following:
    1. Home with support/referral
    2. Private home
    3. Residential care
    4. Group/supportive living
    5. Correctional facility
    6. Leave post registration
    7. Leave post initial treatment
    8. Left after triage
    9. Left after initial assessment
       

Exclusions:

Same as for the denominator, and additionally any cases with a Canadian Triage and Acuity Scale level of resuscitation (I) or emergent (II)

Method of Adjustment

Logistic regression

Adjustment Applied

Age-sex-adjusted

Covariates used in risk adjustment:

See the detailed methodology notes for regression coefficients.

Geographic Assignment

Place of residence

Data Sources

  • NACRS

Caveats and Limitations

Indicator results reflect a system-level measure of access to primary care and cannot speak to individual patient scenarios or the appropriateness of the ED visit for the following reasons:

  1. Inclusion and exclusion criteria for this indicator are retrospectively based on diagnosis data. Patients do not know their diagnosis when they choose to go to the ED; their signs, symptoms or other clinical history may make them concerned about an emergency for which an ED visit may be appropriate.
  2. CIHI data lacks information such as severity and presentation of the condition. Depending on a patient’s presentation and severity, an ED visit may be appropriate even for a condition that could be managed in primary care (in person or virtual). 
  3. In some jurisdictions, particularly in rural and remote areas, the ED may be the only place for patients to receive care. 
  4. Patients should have a choice in how they receive care given their situation; an in-person visit may be appropriate, even for a condition that could be managed through virtual primary care.

As such, indicator results should not be used to influence patient choice, assign blame, penalize individuals for visiting the ED or receiving in-person care or deter them from visiting the ED or receiving in-person care. These indicators are intended to be used in aggregate at the population level to assess the impact of access to primary care on the health system.
 

Trending Issues

Not applicable

Comments

Data from Quebec and British Columbia is based on NACRS Level 1 or 2 submissions and is not available publicly due to the limitations that underestimate their results and affect comparability with other jurisdictions. See detailed methodology notes for more information. 

References

Not applicable

How to cite:

Canadian Institute for Health Information. Visits to the Emergency Department for Conditions That Could Be Managed in Primary Care (In Person and Virtual). Accessed April 25, 2025.