Patients with heart failure who are discharged from the hospital are more likely to have other health problems and complications if they live in Missouri's largest cities, according to a study by the health research company Dexur.
Complications are usually seen as a way to gauge a population's overall well-being. Experts say the heart failure data indicates urban populations have more untreated health problems than other areas of the state.
Hospitals with the highest amounts of complications and other untreated conditions were clustered in St. Louis, Kansas City and Springfield — the state’s three largest population centers. For example, at Saint Louis University Hospital, only 6 percent of heart failure patients had no other problems when they were discharged from the hospital.
Dexur studied discharge rates for Medicare patients at 28 Missouri hospitals from 2013 to 2016.
“I found the highest rates of complications were in the biggest cities in Missouri,” Dexur analyst James Pitt said.
Even though Pitt studied discharge rates only for Medicare patients, he said those rates are usually indicative of hospital’s overall case loads.
The hospitals with fewer complications were more spread out. St. Luke’s East Hospital in Lee’s Summit, Poplar Bluff Regional Medical Center and Saint Francis Medical Center in Cape Girardeau had the highest number of Medicare patients with no complications or conditions that occurred alongside the main diagnosis.
Such conditions and complications don’t have to be related to the heart failure. They could be anything from diabetes to kidney problems.
When a hospital treats many patients with multiple conditions, that isn't a reflection on how well or poorly it treats patients. Instead, it points to the health of a city's population, said Michael Lim, a cardiologist at Saint Louis University Hospital.
“They’re totally indicative of a general or overall assessment of someone’s overall health,” Lim said.
The data re-enforces multiple studies that prove health outcomes differ across regions. In some cases, for example, life expectancy can vary by more than 10 years between census tracts a few miles from each other.
“The most economically deprived areas across the country are associated with people who have the worst health in our country, the most number of ongoing conditions that aren’t treated well, and the lowest life expectancy,” he said.
St Louis does have lower health outcomes than other parts of the state (A recent report from the Robert Wood Johnson Foundation ranked the city of St. Louis third from last in a ranking of health outcomes in all 115 Missouri counties.) Pitt said federal reimbursement rates are based on how serious patients’ problems are, and health systems have been known to tweak their reporting. That means hospitals could also be manipulating their reporting of serious patients in order to get more money, he said.
“The problem is there is a little bit of leeway in how to report,” Pitt said. “There is evidence that some hospitals report sicker patients than others do, maybe spuriously.”
Rural hospitals also send more complicated patients to larger cities, which can skew discharge rates, Lim said.
For example, he said, SLU Hospital receives many patients from the Poplar Bluff hospital, which had one of the lowest rates of complications.
“My guess in all this is we actually get credit for those patients with the complexity,” he said. “My viewpoint, it reflects how health systems are supposed to work. Not every hospital should have the ability to take care of everything and everyone to the same degree, you have partnerships with other hospitals and physicians to take care of patients that exceed that threshold.”
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