15. Ocala, FL
> 30-day hospital readmission rate: 15.4%
> Mortality within 30 days of hospitalization: 15.3%
> Preventable hospitalizations: 44.3 per 1,000 Medicare enrollees
> No. of physicians: 58.7 per 100,000
> Median household income: $44,576
Along with Lakeland and Port St. Lucie, Ocala is one of three Florida metro areas to rank on this list. Ocala’s ranking is primarily attributable to the high post-hospitalization mortality rate in the area. Some 15.3% of those admitted to area hospitals die within 30 days — either in the hospital or after returning home — the fourth highest share of metro areas nationwide. Death rates for those hospitalized with pneumonia is particularly high, at 21.5%, well above the corresponding 15.6% national rate.
Post-hospitalization mortality rates are not necessarily attributable to hospital errors. Often, they are the result of unhealthy patient behaviors — and certain unhealthy behaviors are slightly more common in Ocala. Adults in Ocala are more likely to smoke and be obese and less likely to exercise than the typical American adult.
14. Bowling Green, KY
> 30-day hospital readmission rate: 16.4%
> Mortality within 30 days of hospitalization: 12.9%
> Preventable hospitalizations: 58.6 per 1,000 Medicare enrollees
> No. of physicians: 55.5 per 100,000
> Median household income: $51,365
There are just 56 primary care physicians per 100,000 residents in Bowling Green, far less than the national corresponding ratio of 75 per 100,000. A low doctor-to-resident ratio may result in a high number of patients visiting hospitals for conditions that are treatable in outpatient settings. Such preventable hospitalizations can increase the risk of infection and frailty due to hospital stays, and can be an indication of poor access to outpatient care. In Bowling Green, there are 59 preventable hospitalizations per 1,000 Medicare enrollees, among the most of any U.S. metro area.
Another possible indication of health care quality is the number of patients who return to the hospital after being discharged, which can sometimes be due to medical complications incurred while in treatment. Some 16.4% of patients in Bowling Green return to the hospital within 30 days of discharge, the 17th highest share of any U.S. metro area.
13. Albany, GA
> 30-day hospital readmission rate: 16.1%
> Mortality within 30 days of hospitalization: 13.9%
> Preventable hospitalizations: 51.3 per 1,000 Medicare enrollees
> No. of physicians: 67.0 per 100,000
> Median household income: $44,896
In Albany, Georgia, 13.9% of hospital patients die within 30 days of admission to the hospital. While this can be indicative of poor quality hospital care, it can also be attributable to the patient’s own behaviors and health — and many in Albany have unhealthy habits. For example, smoking is the leading cause of preventable death in the United States, and in Albany, more than 20% of adults smoke, well above the 17.0% national smoking rate.
Some other measures, however, also suggest the possibility of below-average quality of care in Albany hospitals. For example, 16.1% of those discharged from area hospitals are readmitted within 30 days, a higher share than the 15.3% national readmission rate. Unplanned hospital readmissions are often the result of preventable errors, like infections of surgical wounds.
12. Carbondale-Marion, IL
> 30-day hospital readmission rate: 17.1%
> Mortality within 30 days of hospitalization: 12.8%
> Preventable hospitalizations: 51.1 per 1,000 Medicare enrollees
> No. of physicians: 106.0 per 100,000
> Median household income: $42,716
In the Carbondale-Marion metro area, 17.1% of patients return to the hospital within 30 days of being discharged, the fifth largest share of any metro area. While the majority of hospital readmissions are non-preventable, many are due to poor post-acute care or medical complications incurred during initial treatment.
One of the largest determinants of the quality of a local health system is income. Wealthier areas are often more likely to attract qualified health professionals and have more resources to fund hospitals and outpatient treatment centers. In Carbondale, the typical household has an income of just $42,716 a year, over $19,000 less than the U.S. median and the 18th lowest of any metro area nationwide.
11. Dubuque, IA
> 30-day hospital readmission rate: 15.0%
> Mortality within 30 days of hospitalization: 12.7%
> Preventable hospitalizations: 83.3 per 1,000 Medicare enrollees
> No. of physicians: 75.3 per 100,000
> Median household income: $60,225
Dubuque, Iowa, is one of only three metro areas in the Midwest to rank on this list. Preventable hospitalizations can suggest inadequate outpatient treatment and also a tendency to overuse hospitals as a primary source of care. In Dubuque, about 83 Medicare enrollees for every 1,000 are hospitalized for conditions that could or should have been treated in an outpatient setting, the largest share of any metro area in the United States.
Despite the nation-leading preventable hospitalization rate and the unnecessary additional strain that such hospitalizations imposes on area facilities, by some measures, hospitals in Dubuque perform relatively well. For example, just 15.0% of those discharged by area hospitals are readmitted within 30 days, a smaller share than the 15.3% national readmission rate.