Wednesday, November 30, 2016 Researchers: A City's 'Stress Level' Could Affect Local Hospital Ratings Could it be that when it comes to the Centers for Medicare and Medicaid's (CMS) star rating system, no hospital is an island? Some researchers are wondering just that, after finding a high correlation between a city's level of "stress" among residents and lower overall ratings for local hospitals. The report, published as a research letter in the November 28 edition of JAMA Internal Medicine (abstract only available for free), compares CMS hospital ratings with the results of a recent study that compiled demographic, health, and financial data on residents of 150 cities across the US. The CMS star system, posted at its Hospital Compare website, bases its ratings on factors such as readmission rates, surgical mortality, and hospital-acquired infection. The stress study, sponsored by WalletHub, looked at 5 categories of stress: work, money, family, health/safety, and coping mechanisms. Using data that touched on a range of issues including, among others, poverty levels, divorce rates, suicide rates, average hours of sleep per night, binge drinking, and number of psychologists per capita, WalletHub researchers assigned an overall "stress level" score to each city. Authors of the JAMA letter compared the star ratings of 657 hospitals with the stress ratings of the 150 cities in which they were located. They found that the less stressed a city is, the more likely it would be to contain hospitals with higher overall star ratings. For example, 2 of the most highly stressed cities in the US—Detroit, Michigan, and Newark, New Jersey—also contained hospitals with relatively lower star ratings. The same was true at the other end of the spectrum: low-stress cities such as Madison, Wisconsin, and Sioux Falls, South Dakota, tended to have hospitals with higher star ratings. Researchers for the JAMA article estimate that "around 20% of the variance in the star ratings can be explained by community characteristics such as poverty or unemployment rate." The correlation may cast the CMS rating system in a somewhat different light, say researchers—one that isn't entirely related to factors within the hospital's control. "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 shortage," authors write. "On the other hand, the star rating component measures may be affected by community factors such as poor public transportation or limited social support services through causal pathways other than hospital quality." Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.