Medical errors and suboptimal hospital conditions are a leading cause of death in the United States, resulting in hundreds of thousands of fatalities each year. Of course, some hospitals are worse than others, and the quality of care in a hospital depends largely on where the facility is located.
Clear and effective communication from medical practitioners, clean and quiet rooms, timely treatment, and efficient use of medical technology and resources are all aspects of high-quality hospital care. While best practices such as these do not guarantee the best patient outcomes, hospitals that excel in these areas tend to report lower readmission and death rates — two of the most commonly used metrics when measuring hospital quality.
24/7 Wall St. reviewed readmission rates, mortality rates, and hospital grades published by hospital rating organization Leapfrog Group to identify the metropolitan areas with the worst hospitals. The Hot Springs, Arkansas metro area is the worst area in which to visit a hospital. Visalia-Porterville, California rounds out the list of metros with the worst hospitals in 10th place.
Nationwide, 15.7% of discharged hospital patients return to the hospital within 30 days. Such patients return with infections after surgery, blood clots left untreated, and other unplanned complications. Readmission rates do not vary tremendously across metropolitan areas. In most of these 10 cities, however, readmission rates are inline with or higher than the national percentage.
Based on a range of expert-determined and government-set standards, including for example the tracking of prescriptions, adequate ICU physician staff, and the patient experience, patient safety watchdog Leapfrog Group rates hospitals A through F. In the most recent assessment, the group found that compared to A-rated hospitals the risk of avoidable death is 35% higher in C hospitals and 50% higher in D and F hospitals. The average grade of hospitals in all of the 10 worst cities is C or worse.
Doctors and nurses are finite resources in hospitals, and inefficiencies in hospital systems can have a considerable impact on patient outcomes. Hospitalizations for illnesses and conditions that should have been treated in outpatient facilities are largely preventable. While the burden presented by preventable hospitalizations can affect the quality of service, the hospitals themselves are not typically to blame. Preventable hospitalizations are common among the uninsured and individuals who receive poor or no primary care — problems that disproportionately affect low income communities in the United States.
Hospital rating methods control for individual risk factors such as age, past medical history, and other conditions that increase the chances of dying or of readmission. Controlling for such parameters aims to evaluate hospitals on the basis of the care they give — regardless of how sick patients are. Once these parameters are controlled for, it appears that external socioeconomic factors — such as high poverty in an area — are the ones that largely explain hospital quality and therefore patient outcomes.
In the report, Quality Reporting That Addresses Disparities in Health Care, published by the American Medical Association in 2014, Harvard physician and researcher Ashish Jha argued that hospital quality scores tend to penalize safety-net facilities, which primarily provide care for disadvantaged and poor populations. Low income populations tend to require greater medical attention, which could skew patient outcome data, even for hospitals providing high quality care.
It is likely no coincidence that all of the worst metropolitan areas in which to get sick are also among the nation’s poorer areas. The median household incomes in all of these areas do not exceed the national median of $53,657 a year. Of the 10 cities, only the Altoona, Pennsylvania area has a poverty rate lower than the national poverty rate of 15.6%.
Correction: A previous version of this article incorrectly characterized some aspects of LeapFrog’s methodology. We wrote for example that the quality of treatment at hospitals was a feature of the hospital score. In fact, while the 30 measures comprising LeapFrog’s hospital scores can be used to evaluate patient safety, the group does not rate hospitals on the quality of treatment of injuries. These errors have been corrected.