JustCare

Tag: Ranking

  • Which states have hospitals that deliver appropriate care, good patient outcomes and invest in their communities?

    Which states have hospitals that deliver appropriate care, good patient outcomes and invest in their communities?

    Even though health care is often about life and death, and out-of-pocket hospital costs can push many Americans with health insurance into medical bankruptcy, we know a lot more about the best restaurants and the best automobiles than we do about the best hospitals. The Lown Institute ranks states with the best hospitals using measures that most other agencies that rank hospitals do not consider.

    The Lown Institute rankings highlight strikingly different practice patterns and behaviors of hospitals in different parts of the country. They are helpful from a public health perspective and less helpful in helping you choose a hospital. Every hospital in a state is different, so even if you live in a state with good hospitals, it’s important to choose your hospital carefully.

    The Lown Institute defines the best hospitals as the ones that can best save patients’ lives and keep them healthy. They also invest in the communities’ health, have good financial assistance programs, and pay fair and equitable wages. And, they avoid delivering care that people do not need.

    For the Lown Institute, patient outcomes represent 50 percent of a hospital’s grade. Doing right by the community and staff and providing financial assistance to patients, which the Lown Institute calls “civic leadership”, represents 30 percent of a hospital’s grade. And, care value represents 20 percent of the grade.

    Patient outcomes cannot tell the full story about a hospital. Hospitals that treat the poorest patients and patients in the worst health will never have as good patient outcomes as hospitals that treat a relatively healthy and wealthy population, but they might deliver far better care.

    So, how do the states rank?

    Connecticut, Delaware, Hawaii, Massachusetts, Maryland, Ohio, and Rhode Island have hospitals that rank best overall according to the Lown Index. Of note, many of these states are in the northeastern US.

    Colorado, Kentucky, Louisiana, Maryland, New Mexico, West Virginia, and Washington, DC, have higher civic leadership rankings than other states. Of note, none of these states are in the northeastern US. 

    Maine, Minnesota, New Hampshire, and Vermont hospitals received the top rankings for value, meaning they do better at ensuring patients receive appropriate care. Florida, Maryland, New Jersey, and Nevada hospitals received the lowest rankings.

    While the Lown Institute findings overlap somewhat with other rankings, the Lown Institute finds some rural hospitals and safety net hospitals rank in the top 100, unlike other rankings.

    The top hospital in the country, according to the Lown Institute index is JPS Health Network. It is a large public safety net hospital in Fort Worth, TX. It had top rankings  in clinical outcomes, community benefit, inclusivity, and providing the right care. See here for the full list.

    Here’s more from Just Care:

  • How does your state rank on health care?

    How does your state rank on health care?

    The Commonwealth Fund recently issued its 2018 report ranking states on their health systems performance. Hawaii remains in first place. Mississippi ranked in last place. Overall, the picture is not pretty. How does your state rank on health care outcomes?

    The researchers found that life expectancy in the US fell for the second year in a row, in large part as a result of opioid and other substance abuse and suicide. They found a 50 percent increase in deaths from suicide, drugs and alcohol use since 2005. Rates rose in all states, doubling or more in Delaware, New Hampshire, New York, Ohio, and West Virginia.

    Deaths from conditions that are treatable also rose in two out of three states between 2014 and 2015. In a handful of states, the rise was more than five percent: 351 in Colorado, 643 in Oklahoma, and 988 in Texas, for example.

    And, the researchers found that most adults do not get mental health treatment. On average, 56 percent of adults with mental illness were not treated for it. In Nevada, two out of three adults were not treated.

    As for the states that did relatively well and those that did poorly: The five highest ranking states were Hawaii, Massachusetts, Minnesota, Vermont and Utah. The five lowest ranking states were Arkansas, Florida, Louisiana, Oklahoma and Mississippi.

    The authors recommend a move to integrative care, bringing together behavioral health and physical health, with a focus on the social determinants of health. Some states are working to connect residents in need to community social services programs, including good housing and nutrition, health screenings and substance abuse counseling services. In fact, the Centers for Medicare and Medicaid Services is contracting with agencies in many states to create Accountable Health Communities, which are supposed to bridge the gap between clinical care and community services.

    Some good news: Medicare covers alcohol screenings and counseling  as well as nutrition counseling.

    Here’s more from Just Care:

  • Which states have the best health outcomes and why?

    Which states have the best health outcomes and why?

    In the U.S., we invest heavily in health care and not nearly enough on the support services and programs that affect health, sometimes called the social determinants of health. Yet, there’s good evidence to suggest it would be wise if states invested more money on public health services to support their populations. People living in states that invest more in public health and social supports, such as housing, nutrition and income-support programs, relative to health care, have better health outcomes than people in states with less focus on public health and social supports.

    What are social determinants of health? Where we live, where we go to school, what we eat and drink, and our household incomes all factor into your health. In addition, not smoking, exercising, getting needed vaccines and social and economic opportunities help determine our health, as do our social relationships. Our goal as a nation should be “to create physical and social environments that promote good health for all.”  And, some states do better than others on this front.

    A new study published in Health Affairs on variation in health outcomes among states finds that higher state investments in social services relative to health care lead to fewer obese people and people with asthma, as well as lower death rates for type 2 diabetes, lung cancer and heart attacks and fewer reported mentally unhealthy days and days with physical limitations. Your community matters!

    The study could not establish causality between greater investments in social supports and public health and better health outcomes. But, the data suggest it is worth looking more deeply at investing in social supports as a possible way to lower health care usage and improve population health. Past research has shown that seven in 10 of some cancer cases, eight in 10 of heart disease cases and nine in 10 of stroke cases result in some part from environmental, behavioral and social causes.

    The United Health Foundation’s 2015 Health Rankings looked at quality of health care, percentage of primary care doctors, prevalence of diseases, obesity rates, chronic drinking, and preventable deaths among other factors in the 50 states.  It ranked Hawaii as the healthiest state, Vermont as the second healthiest and Massachusetts as the third healthiest. Louisiana was ranked as the least healthy, with Mississippi ranking almost as poorly and Arkansas and West Virginia faring only slightly better.

    A separate report looks at the healthiest and least healthy states for older adults. Hawaii and Vermont are still at the top of the list, with Vermont ranking as the most healthy and Hawaii ranking fourth after New Hampshire and Minnesota. Louisiana again ranks at the very bottom with Mississippi, Kentucky and Arizona right behind.

    Here’s more from Just Care:

     

  • U.S. underperforms in meeting basic needs of its citizenry.

    U.S. underperforms in meeting basic needs of its citizenry.

    According to the 2015 Social Progress Index, the U.S. has a lot of work to do in meeting basic needs of Americans relative to other countries. The Social Progress Index ranks 133 countries based on their quality of life and social progress. Norway, Sweden and Switzerland are at the top of the pack, ranking first, second and third in social progress respectively. The United States ranks only 16th, directly behind Austria, Germany and Japan.

    The Social Progress Index reveals that the United States is underperforming on social progress–including on health and wellness, nutrition and basic medical care–relative to peer countries of similar income.  We rank 68th overall on health and wellness and 39th on nutrition and basic medical care.

    What goes into the health and wellness assessment?  The researchers determine whether the citizens of a country lead long and healthy lives. On life expectancy, the U.S. ranks 30th.  On premature deaths from non-communicable diseases, the U.S. ranks 35th ; on the obesity rate, the U.S. ranks almost at the very bottom at 126th.  And, on the suicide rate, we rank 86th.