Travel Time Influences Readmission Risk: Geospatial Mapping of Surgical Readmissions

Abstract

The University of Virginia (UVA) has recently become an Accountable Care Organization (ACO), intensifying efforts to provide better care for individuals. UVA's ACO population resides across the entire Commonwealth, with a large percentage of patients living in rural areas. To provide better health for this population, the central tenet of the ACO mission, we identified geographic risk factors influencing hospital readmission. We analyzed the relationship between the distance of patients’ residence to the nearest hospital and 30-day readmission in general surgery patients. A retrospective chart review using January 1, 2011 through October 31, 2013 American College of Surgeons National Surgical Quality Improvement Program data for general surgery procedures was conducted. ArcGIS mapped street addresses provided graphical representation of distance between surgical population and the nearest hospital. We analyzed the impact on readmission, of time traveled, insurance status, and median household income. Each increase of 10 minutes in travel time from the patient's residence to the nearest hospital, not just UVA, was associated with a 9 per cent increase in the probability of readmission after adjusting for patient characteristics, preoperative comorbidities, laboratory values, and postoperative complications before or after discharge (odds ratio = 1.09; 95% confidence interval = 1.01–1.17; P = 0.019). Unlike urban hospitals, those serving rural populations may be at particular risk of postsurgical readmissions. Patients living furthest from a hospital facility are most at risk for readmission after a general surgery procedure. This vulnerable population may benefit most from comprehensive discharge planning.

Geospatial, Clinical, and Social Determinants of Hospital Readmissions

“…This finding may be related to easier hospital access of the underserved population served by the medical center. These results differ from those of Turrentine et al, in which longer travel time to the nearest hospital was associated with a higher probability of readmission, 23 possibly because of methodological differences. For example, Turrentine et al examined travel time to the nearest Virginia hospital for surgical patients with a 30-day readmission, while the present study measured driving distance for surgical and nonsurgical patients readmitted after 90 days at 2 target hospitals in Nebraska.…”

Accessing surgical care for pancreaticoduodenectomy: Patient variation in travel distance and choice to bypass hospitals to reach higher volume centers

“…For example, among patients undergoing pancreatectomy, the elderly, racial minorities, and patients with self‐pay or Medicaid payer status were most sensitive to travel burden . Access to comprehensive oncologic care at major cancer programs is important because delays in treatment may lead to worse oncologic outcomes …”

Nonclinical Barriers to Care for Neurogenic Patients Undergoing Complex Urologic Reconstruction

“…12 Another study found that with every 10-minute increase in travel time from a patient’s residence to the nearest hospital, there was an associated 9% increase in the probability of hospital readmission following sur-gery. 13 Since many patients undergoing complex surgery live long distances from the hospital, ensuring that community-based providers are knowledgeable and adept at caring for these multifaceted patients is critical as it may not be possible for patients to see their surgeon when complications arise.…”