title: Patient bypass behavior and critical access hospitals: implications for patient retention.
abstract: OBJECTIVE
  To assess the extent of bypass for inpatient care among patients living in Critical Access Hospital (CAH) service areas, and to determine factors associated with bypass, the reasons for bypass, and what CAHs can do to retain patients locally.
  
  
  METHODS
  Six hundred and forty-seven subjects, aged 18 years and older, who had been admitted to a hospital for inpatient care in the past 12 months and lived within 15-20 miles of 25 randomly selected CAHs were surveyed by phone during the period from early February through late July 2005. Survey questions included demographic characteristics, general health status, travel time/distance to health care, questions on satisfaction with local health services, bypass behavior, and solicited suggestions on how local hospitals could retain patients locally.
  
  
  RESULTS
  About 60% of surveyed patients bypassed their local CAHs for inpatient care including 16% who were referred to another facility by the local CAH/health care providers and would use the local hospital if needed services were available. Bypass rates ranged from 16% to 70% across the sampled CAHs. Factors associated with bypass included age, income, satisfaction with the local hospital, and traveling distance/time. Lack of specialty care, limited services, and the quality/reputation of local services/doctors were most frequently mentioned as reasons why patients bypass local CAHs.
  
  
  CONCLUSIONS
  The bypass rate for sampled CAHs is considerably higher than the 20%-50% bypass rates documented in the literature for all hospitals in general using discharge/administrative data. The sizeable variation in bypass rates across CAHs suggests that the appropriate response/fix should come from the facility/community levels.
authors.affiliation: West Virginia University Institute for Health Policy Research, Charleston, WVA, USA. jiliu@som.umaryland.edu
authors.forename: Jiexin Jason
authors.initials: JJ
authors.lastname: Liu
authors.forename: Gail R
authors.initials: GR
authors.lastname: Bellamy
authors.forename: Melissa
authors.initials: M
authors.lastname: McCormick
mesh_terms: D000328:Adult; D000368:Aged; D002391:Catchment Area, Health / Q000706:statistics & numerical data*; D003710:Demography; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006780:Hospitals, Rural / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data; D012107:Research Design; D012424:Rural Population / Q000706:statistics & numerical data*; D014186:Transportation; D014481:United States