Return Visits after Breast Imaging Examination: A Multicenter Analysis of Patient Age, Modality, and Hospital Rating Factors

Abstract

Background: Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores are used nationally to assess patient experience and hospital performance. Whether a higher overall hospital rating is associated with increased return visits to affiliated radiology centers remains unclear. Objective: To evaluate the likelihood of patients returning for additional breast imaging exams to the same hospital-affiliated imaging center, based on patient age & breast imaging exams received at the earliest visit, and the hospital’s HCAHPS patient satisfaction scores (overall hospital rating).
Method: We conducted a retrospective cohort study using data from hospital-affiliated radiology centers between January 4, 2022, and December 31, 2023. Patient demographics, imaging encounter data, and return visit status were obtained from the medical records of imaging centers, each stationed at and affiliated with a hospital. The affiliated hospitals’ overall rating (linear mean scores) was also obtained. The primary outcome was the odds of return visits to the same imaging center for additional breast imaging exams-either follow up or unrelated. A multilevel logistic regression model, adjusting for patient- and hospital-level covariates, was used to assess the odds of patient return to the same imaging centers, by patient age & breast imaging exams received at the earliest visit, and the hospital’s HCAHPS overall rating. A second analysis was to determine the predicted probability of return based on the same factors.
Results: A mixed-effects logistic regression model was used to assess factors associated with return visits, while accounting for clustering at the hospital level. The analysis included 12,879 patient encounters across 18 imaging centers. After adjusting for relevant covariates, a higher overall hospital rating also showed a modest increase in return visit likelihood; however, it was statistically insignificant (OR = 1.04, 95% CI: 0.98–1.11,
p = 0.203). Older age at earliest visit (OR = 1.012, 95% CI: 1.006–1.018, p < 0.001) was associated with a slight increase in odds of return visits. Compared to the reference group (patient who received only screening mammography at the earliest visit), patients had a significantly lower odds of returning for additional breast imaging if they had only diagnostic mammography exams (OR = 0.30, 95% CI: 0.22–0.42, p < 0.001) or a combination of two breast imaging modality done on the same day at earliest (OR = 0.25, 95% CI: 0.18–0.36, p < 0.001). Those imaged with only MRI of the breast on the earliest visit had a lower, but statistically insignificant odds of return for additional imaging (OR = 0.79, 95% CI: 0.45–1.40, p = 0.418), compared to the reference group.
Conclusion: Hospitals with higher patient satisfaction scores demonstrated modestly increased but statistically insignificant odds of patient return to affiliated imaging centers. Older patients are also more likely to return to imaging centers for additional breast imaging exams than younger patients. Additionally, compared to patients who had only screening mammography at the earliest visit on their earliest visit, patients who had diagnostic mammography exams only, breast ultrasound only, breast MRI only, or a combination of two breast imaging modalities done on the same day on their earliest visit had lower odds of return visits for additional imaging. These findings support the potential downstream value of patient age, breast imaging modality, and hospital-level patient experience metrics in outpatient imaging services.