Good Help, Close to Home
The renowned Mayo Clinic in Rochester, Minn., isn't that far from Mauston, Wis., where Don Wilke lives--only about a 2 1/2 hour drive. But when the 51-year-old bricklayer needed hip replacement surgery last March, he didn't need to make that trip. He went instead to a small hospital in Viroqua, Wis., a little over 50 miles away. Wilke was walking within days after orthopedist Jeffrey Lawrence implanted a metal joint in his left hip, and after a month he was feeling spry enough to make his annual spring turkey-hunting trip. "It's night and day," he says. "Before, when I came home from work, I just sat down. Now I can go out to the woodshop, garden, mow the lawn, or do whatever."
As Wilke and millions of others have learned, community hospitals can be just as good for some patients, even for those who need serious attention, as any glittery big-name center. "There's a lot of community hospitals that deliver excellent care," says David Flum, an associate professor of surgery at the University of Washington School of Medicine in Seattle who studies surgical outcomes. But not all community hospitals offer good care for all conditions. How can you tell whether a local hospital is right for you or when you should pack your bags? By getting information relevant to your illness or procedure, say Flum and other experts, about the hospital's performance and the doctor's experience.
Another name for community hospitals is primary-care facilities--a first stop for medical and surgical help, with few or no ties to academia or research. They are the mainstays of American hospital care. Of more than 35 million patients admitted in 2004, about 85 percent were to a community facility. That is where most hip and knee replacements, appendix removals, and some colon and prostate surgeries are now done. And like those in other demanding careers, many fine physicians who work in community hospitals do so because they traded big-city bustle and academic stress for a lower-velocity life.
Many people prefer local care, and there are measurable medical benefits from having family and friends close at hand. Studies show that people who have just had open-heart surgery have less pain and are quicker to get out of bed when they feel supported by others. "They just emotionally feel better if they have someone they could rely on," says Kathleen King, a professor of nursing at the University of Rochester's School of Nursing and author of one such investigation. "It's the day-to-day stuff that really helps people recover."
Obtaining the kind of information that experts like Flum want you to have probably won't be a snap. California, Maryland, New York, Pennsylvania, and Texas are among the handful of states that do put performance data about individual hospitals for some procedures, such as heart bypass surgery, on state health department websites. Many of the links to such sites are available at healthcarechoices.org for free. A $15 hospital performance report can be purchased from HealthGrades.com, but evaluations for procedures and conditions are in the form of broad star ratings rather than numbers. And while some community hospitals do appear in the "America's Best Hospitals" rankings--a tribute to their quality--primary-care centers are not the main focus.