Hospitals in stressed cities — cities with high poverty, unemployment rates, divorce rates and poor health conditions — tend to have lower overall star ratings from CMS than hospitals in less-stressed areas, according to a study in JAMA Internal Medicine.
Researchers looked at a ranking of most and least stressed cities in the U.S., based on 27 metrics, including divorce rate, credit scores, average weekly work hours, overall health and suicide rate. They then linked 657 hospitals' star ratings to the stress ranking of the 150 cities where they are located. For cities with more than one hospital, the star ratings for each hospital were weighted by bed size.
Cities with a higher stress ranking tended to have, on average, hospitals with lower star ratings compared to cities with lower stress rankings.
For instance, Detroit was the most-stressed city in the analysis. There, the average star rating for hospitals is less than two stars. Newark, N.J., is the ninth most-stressed city, and hospitals there have an average star rating of barely more than one star.
Alternatively, Madison, Wis., was one of the least-stressed cities and hospitals there had an average star rating of nearly five stars.
"On one hand, hospitals in stressed cities might provide care of lower quality on average, perhaps because of inability to invest in needed clinical or technological infrastructure or staff shortages," the authors posited. "On the other hand, the star rating component measures may be affected by community factors such as poor transportation or limited social support services through causal pathways other than hospital quality."
Study authors called further explanation into the issue "essential."