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Some 18 percent of nonsurgical patients, the highest rate, are readmitted within a month in the New York City borough of the Bronx. Rates are nearly that high in Detroit, Lexington, Ky., and Worcester, Mass.

Yet the readmission rate in Ogden, Utah, is just 11.4 percent. Half a dozen other areas _ including Salt Lake City, Muskegon, Mich., and Bloomington, Ill. _ keep those rates below 13 percent.

For surgical patients, Bend, Ore., gets readmissions down to 7.6 percent.

Some studies suggest part of the variation is because certain hospitals care for sicker or poorer patients, especially in big cities. Yet Minneapolis, for example, has readmission rates just below the national average. Goodman said whether local doctors’ stress outpatient care over hospitalization, and how many hospital beds an area has play big roles, too.

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Readmissions don’t always happen because the original ailment gets worse. It could be a new problem _ the pneumonia patient who’s still weak and falls, breaking a hip.

Yale University researchers recently reported in the Journal of the American Medical Association that people face a period of overall vulnerability to illness right after a hospitalization, because of weakness, sleep deprivation, loss of appetite and side effects of new medications.

But ask returning patients what went wrong, and Coleman, the readmissions expert, said nonmedical challenges top the list.

New York’s Montefiore Medical Center now sends uninsured patients home with two weeks’ worth of medication so they don’t have to hunt an affordable place to fill a prescription right away, said Dr. Ricardo Bello, a cardiac surgeon.

In the nation’s capital, Dr. Kim Bullock recalled her frustration with a diabetic hospitalized nine times in one year in part because of transportation. He felt too lousy to ride two buses and the subway to the nearest Medicaid clinic for regular care.

“Start from their reality,” said Bullock, an emergency room doctor and family physician. Without the right community connections, “they will just stumble along.”

The Dartmouth study also found that fewer than half of patients saw a primary care doctor within two weeks of leaving the hospital.

Barbara McCoy tried. A New York hospital lowered the 44-year-old diabetic’s dangerously high blood sugar and told her to call her own doctor immediately about how to prevent a recurrence. But she couldn’t get an appointment until the following month. A week later, McCoy’s blood sugar soared again, and she raced back to the emergency room.

This time, the hospital pulled out the stops during a weeklong stay. A nutritionist offered intense diet advice. An endocrinologist changed her medications. She was taught how to safely adjust her own insulin.

“But they waited `til it spiked again to do these things,” McCoy said. “Why couldn’t they have done all that the first time? I don’t understand.”

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