Special Report

Cities Where You Don't Want to Get Sick

4. Clarksville, TN-KY
> Readmission rate: 15.9%
> Avg. 30 day mortality rate: 15.3%
> Hospital safety score grade: C
> Preventable hospitalizations: 76.6 per 1,000 patients

The 15.3% share of people who die within 30 days of being admitted to a hospital in Clarksville is nearly the highest in the country. The high mortality rate is partly the result of the high death rate among patients admitted for pneumonia. More than one in five patients admitted for pneumonia at area hospitals die within 30 days, a higher rate than in all but six other U.S. metros.

The poor outcomes may be due to inefficient allocation of hospital resources. Preventable hospitalizations are an indication of inefficiency, and Clarksville has one of the highest preventable hospitalization rates in the country. For every 1,000 hospital patients, 76.6 could have been treated in an outpatient facility.

3. El Centro, CA
> Readmission rate: 16.4%
> Avg. 30 day mortality rate: 13.8%
> Hospital safety score grade: D
> Preventable hospitalizations: 48.1 per 1,000 patients

Hospital ratings are often accused of unfairly penalizing areas that serve poor residents, who before even visiting a hospital are generally at greater risk of adverse health outcomes. The worst rated metropolitan hospital systems tend to serve relatively poor populations. With a poverty rate of 23.7%, 19th highest of all U.S. metro areas, El Centro is one such example.

Leapfrog rated El Centro’s hospitals very poorly, and other traditional measures of quality of area hospitals, such as the readmission rate, are also relatively poor. On the other hand, 12.2% of patients admitted to hospitals in the area for stroke die within 30 days, one of the lowest mortality rates for stroke patients nationwide.

2. Binghamton, NY
> Readmission rate: 15.5%
> Avg. 30 day mortality rate: 15.2%
> Hospital safety score grade: C
> Preventable hospitalizations: 60.4 per 1,000 patients

The Binghamton metro area is nearly the worst city in which to visit a hospital. Our Lady of Lourdes Memorial Hospital and the United Health Services Hospital network serve the Binghamton metro area. The two hospitals report some of the nation’s highest preventable hospitalization rates, as well as among the highest mortality rates for common fatal ailments. For example, of patients admitted for coronary artery bypass surgery — one of the most commonly performed major operations — 6.4% die within 30 days, the highest such mortality rate of any metro area. After evaluating patient safety at Our Lady of Lourdes, the Leapfrog Group gave the hospital a D.

1. Hot Springs, AR
> Readmission rate: 16.2%
> Avg. 30 day mortality rate: 15.6%
> Hospital safety score grade: C
> Preventable hospitalizations: 68.0 per 1,000 patients

Two hospitals in the Hot Springs metro area, National Park Medical Center and St. Joseph’s Mercy Health Center, received C grades in overall patient safety from Leapfrog. Among a range of other problems, both hospitals ranked below average in preventing infections. Preventable infections, which can occur after surgery, are one major cause of unplanned readmissions to hospitals. The readmission rate of 16.2% in Hot Springs area hospitals is among the higher rates among U.S. metro areas.

The mortality rate in area care facilities is also far higher than is typical across the country, particularly among patients with heart problems. Of those patients admitted for heart failure, 16% die within 30 days of admission, the second highest heart failure mortality rate of any metro area in the country.