10. Hot Springs, AR
> 30 day readmission rate: 15.9% (highest 25%)
> 30 day mortality rate: 14.4% (highest 10%)
> Preventable hospitalizations: 63.7 per 1,000 patients (highest 25%)
> No. of physicians: 75.1 per 100,000
> Median household income: $42,826 (lowest 10%)
Preventable infections, which can occur after surgery, are one major cause of unplanned readmissions to hospitals. According to the CMS ratings of St. Vincent hospital, one of the three major hospitals in the area, bloodstream and surgical site infections occur at much lower rates than they do nationwide. However, the hospital is considerably worse than national averages at avoiding urinary tract, MRSA, and C.difficile infections. The readmission rate across Hot Springs hospitals of 15.9% is among the higher rates among U.S. metro areas.
The mortality rate in area care facilities is also higher than it is across the country. Of patients admitted to area hospitals, 14.4% die within 30 days of admission, one of the highest percentages compared to all U.S. metros.
9. Lakeland-Winter Haven, FL
> 30 day readmission rate: 17.0% (highest 10%)
> 30 day mortality rate: 13.2%
> Preventable hospitalizations: 74.0 per 1,000 patients (highest 10%)
> No. of physicians: 49.5 per 100,000 (lowest 25%)
> Median household income: $46,355 (lowest 25%)
As the strong correlation between poverty and hospital quality would suggest, unplanned readmission, mortality, and unnecessary hospitalizations may be harder to avoid in low-income communities. For example, low-income patients who cannot afford the medication their doctors prescribe often end up returning to the hospital. This scenario is likely relatively common and is reflected in the high readmission rate in Lakeland-Winter Haven, where 12.8% of residents do not have health insurance, and 16.4% of people live in poverty, each among the highest respective rates of all U.S. metro areas. The typical household earns $46,355 annually, also among the lowest in the country.
The Lakeland area has remarkably few health professionals relative to the area’s population. For every 100,000 residents, there are fewer than 50 primary care physicians, less than 5 dentists, and 11 mental health practitioners, among the lower concentrations of U.S. metro areas.
8. Hanford-Corcoran, CA
> 30 day readmission rate: 16.2% (highest 10%)
> 30 day mortality rate: 14.8% (highest 10%)
> Preventable hospitalizations: 49.2 per 1,000 patients
> No. of physicians: 39.7 per 100,000 (lowest 10%)
> Median household income: $53,234
During the 30 days after admission to a hospital, hospital patients in the United States are more likely to die from pneumonia than any other health condition. The deadliness of the disease is especially severe in the Hanford metro area, where more than 1 in every 5 pneumonia patients die within 30 days of being admitted to an area hospital, the third highest proportion of all metro areas. Similarly, the 30-day mortality rate for patients admitted for COPD, an umbrella term for chronic lung conditions, is especially high at nearly 1 in every 10 patients admitted for the disease.
No city on this list has fewer doctors per capita than Hanford-Corcoran. There are fewer than 40 primary care physicians per 100,000 area residents, versus the national ratio of 76 doctors per 100,000 people.
7. Wheeling, WV-OH
> 30 day readmission rate: 16.2% (highest 10%)
> 30 day mortality rate: 13.8% (highest 25%)
> Preventable hospitalizations: 83.1 per 1,000 patients (highest 10%)
> No. of physicians: 77.0 per 100,000
> Median household income: $44,131 (lowest 25%)
Relatively frequent preventable hospitalizations in the Wheeling metro area the primary reason for the city’s poor hospital ratings. Over 83 of every 1,000 patients admitted to area hospitals reviewed might have been prevented with better outpatient and disease management services. By contrast, there are approximately 50 avoidable hospitalizations per 1,000 patients nationwide.
Not as shockingly high as the area’s preventable hospitalizations, Wheeling’s 30-day mortality rate of 13.4% of patients is just slightly above the average across the country of 12.7%. But deaths tied to certain procedures performed at area hospitals are troubling. For instance, 7% of individuals undergoing coronary artery bypass grafting (CABG) in Wheeling die within 30 days, more than double the comparable national 30-day mortality rate.
6. Clarksville, TN-KY
> 30 day readmission rate: 16.0% (highest 25%)
> 30 day mortality rate: 14.6% (highest 10%)
> Preventable hospitalizations: 62.3 per 1,000 patients (highest 25%)
> No. of physicians: 41.3 per 100,000 (lowest 10%)
> Median household income: $51,373
Some 14.6% of patients die within 30 days of being admitted to a hospital in Clarksville — among the highest rates in the country. Mortality rates are particularly high for heart attack and pneumonia patients. More than 15% of heart attack patients, and nearly 20% of pneumonia patients, die in the 30 days after admission.
The poor outcomes may be due to inefficient allocation of hospital resources. Preventable hospitalizations are often an indication of inefficiency, and Clarksville has one of the highest preventable hospitalization rates in the country. For every 1,000 hospital patients, 62 could have been treated in an outpatient facility.