As part of the triple aim, there is a very concerted effort to develop markers of high-quality care in all of American health care. The Centers for Medicare and Medicaid Services has developed reporting and payment targets for physicians and for hospitals, and a significant amount of reimbursement will be based on performance measures.
For more than 20 years, emergency physicians have been faced with hospital programs that report ED return visits, usually in a 72-hour window. Multiple studies have characterized the return visit rate as a poor marker of quality. Definitions have been unclear, and strategies to address associated factors have been very nonspecific.
One study of return visits focused on the patient-driven factors.1 Emergency medicine is a specialty driven by timeliness of care and perceived patient need. Research has found that patients used the emergency department based on their perception of good value. Patients returned due to perceived inability to access timely follow-up care, needed care that was not available, and concern about the progression of the original medical problem. The majority of patients had a primary care physician but felt that resources needed for completion of care would be accessed in a more timely manner by returning to the emergency department.