Bypassing the local rural hospital for outpatient procedures.
OBJECTIVE
To assess the amount of local rural hospital outpatient department (HOPD) bypass for outpatient procedures.


METHODS
We analyzed data on colonoscopies and upper gastrointestinal endoscopies performed in the state of Florida over the period 1997-2004.


RESULTS
Approximately, 53% of colonoscopy and 45% of upper gastrointestinal endoscopy patients bypassed their local rural hospital for treatment at either a free-standing ambulatory surgical center (ASC) or a nonlocal hospital outpatient department. Independent predictors of bypass included risk-adjusted severity of the patient's medical condition, insurance status, and race. Patients treated in ASCs were predominately healthier, white and commercially insured. Nonlocal HOPDs tend to treat a sicker cohort of patients who were publicly insured or under managed care.


CONCLUSIONS
The results indicate that patients who bypass their local HOPD to an ASC differ from those bypassing to a nonlocal HOPD, and that patient factors influencing bypass for outpatient procedures differ from those influencing inpatient bypass. From a policy perspective, as procedures continue to migrate from the inpatient to the outpatient setting, bypassing the local rural hospital for treatment elsewhere could create conditions that negatively impact rural hospital operations.
Saunders
Charles
C
Department of Family Medicine and Rural Health, Florida State University College of Medicine, Tallahassee, FL 32306-4300, USA.
Bellamy
Gail R
GR
Menachemi
Nir
N
Chukmaitov
Askar S
AS
Brooks
Robert G
RG
D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003113:Colonoscopy / Q000706:statistics & numerical data; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data; D005260:Female; D005431:Florida; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012044:Regression Analysis; D012424:Rural Population / Q000706:statistics & numerical data*