About 440,000 people die in the United States each year as a result of a preventable hospital error. Despite the precautions hospitals take to minimize the likelihood of a mistake, many are still harming patients through avoidable missteps.
Several measures can help in evaluating how well hospitals are run in a given area, including readmission rates of patients after they are discharged and patient mortality rates. Another indicator is unnecessary hospitalizations of patients who can be treated by ambulatory care. The hospital safety score from the Leapfrog Group also measures quality of care and is based on procedures hospitals put in place to prevent errors. Using a combination of these measures, 24/7 Wall St. reviewed hospitals in the country’s large metropolitan areas to determine the 10 cities where you don’t want to get sick.
According to Bruce Boissonnault, CEO of the Niagara Health Quality Coalition (NHQC), there is no “ultimate definition of quality.” However, there is no denying that health care results vary considerably from hospital to hospital. The Binghamton, New York metro area is the worst place to get sick in the country, while the Ames, Iowa hospital system reported some of the best outcomes.
One primary factor behind the different outcomes among hospitals is human error. The best hospitals have systems in place to “ensure that, at every decision point along the continuum of care for each patient, [doctors and nurses are doing] what leads to the best results,” Boissonnault said.
Different factors contribute to different outcomes. A high readmission rate for example, is often the symptom of an inefficient system. Boissonnault gave the Catholic Health system in Buffalo as an example where the opposite is the case. Hospitals in the area have a readmission rate of 15%, better than the national readmission rate. For Boissonnault, this is likely because area hospitals require doctors and specialists to have “a data system that allows data interchange,” so that an area hospital “can easily see the electronic medical record” of a referred patient. In Buffalo, the system increases communication and decreases the likelihood of error.
Inefficient hospital systems, on the other hand, can lead to mistakes, which can increase readmission rates. In each of the cities with the worst hospitals, the readmission rate was higher than the national average of 15.2%.
Another important factor is efficiency of care — the efficient use of medical care resources on those patients that require them. “All things being equal, [hospital systems] that do more actually have worse outcomes,” Boissonnault said. While it may be counter intuitive to some, overuse of medical care can be harmful, “because you’re exposing a patient to radiation that they don’t need, or some procedure that has a risk that they don’t need.” Even if unnecessary testing or treatment does not directly harm the patient, the resources used on that unneeded care “could have been spent on effective care for another patient.”
Hospitalization in cases where the patient could have been treated with an outpatient service is much more likely in areas where care is administered inefficiently. In six of the 10 cities with the worst hospitals, the number of unnecessary hospitalizations was greater than the national average.
Ultimately, however, people’s hospital choice may not be determined only by the quality of care at that facility, but also by other, more subjective, factors. “If your grandmother is in the last 11 days of her life, you might decide that the most important quality factor is which care provider is closest to your home so you can see her as many times as possible before she dies,” Boissonnault said.
These are the 10 cities where you don’t want to get sick.