Quality of Care, Hospital Bypass, and Follow-Up Visits Following an ED Visit for Rural Heart Failure Patients

To determine if hospital bypass (use of the non-closest hospital) and/or hospital quality are associated with the probability of a patient receiving a timely follow-up visit following discharge from an Emergency Department (ED) visit for heart failure.

Our sample consisted of all ED visits for heart failure in a population of Medicare beneficiaries. Our outcome was an outpatient visit within 7 days of discharge. Our primary independent variables consisted of an indicator of hospital bypass and four hospital quality measures: Overall Star Rating, Hospital Consumer Assessment of Health Providers and Services (HCAHPS) Summary Star Rating, Hospital-Wide Readmission Rate, and Heart Failure Readmission Rate. We used propensity score weighted-logistic regression models to predict the probability of follow-up within 7 days. Propensity score weighting accounted for clinical and demographic differences between those who bypassed and those who did not. Separate models were generated for each quality measure.

We used data from a 2015-2019 20% Sample of Medicare Fee-for-Service claims, hospital quality measures from the Centers for Medicare and Medicaid Services' Hospital Compare, and data from the Healthcare Cost Reporting Information System.

76,949 visits met the eligibility criteria. We found that patients who used the nearest hospital were more likely to have a follow-up visit than those who bypassed (average marginal effect [AME]: 0.010, p < 0.05). Better performance on each quality measure was also associated with a higher probability of follow-up, with HCAHPS having the strongest (AME: 0.015, p < 0.001) association.

Using the nearest hospital (i.e., not bypassing it) and using higher quality hospitals was associated with a higher probability of timely follow-up, which may be important in preventing hospital readmissions. There may be benefits to rural patients' use of their nearest hospital, such as proximity to support and lower travel burden.