Sonoma County's health care system has been ranked among the best in the nation, and local leaders are crediting a family medicine training program in Santa Rosa and a large network of community health clinics as key factors.
A new report ranks the county sixth among 306 U.S. communities, based on such criteria as preventive care, mortality rates and the portion of residents with insurance coverage.
The report by the Commonwealth Fund, a New York foundation that studies health-care delivery, specifically cites Sonoma County, San Francisco and Victoria, Texas, as the only communities in the nation where the infant mortality rate was less than four deaths per 1,000 live births.
In contrast, some areas of the South have a rate of 13 to 14 infant deaths per 1,000 live births.
Local health care leaders said the county benefits from a focus on primary care medicine, including seven decades of training doctors at the Santa Rosa Family Medicine Residency Program. Studies have concluded that primary care provides a more cost-effective approach to many health care needs.
"You get better care, better outcomes and all at a reduced cost," said Dr. Mary Maddux-Gonzalez, the county's former public health officer and now chief medical officer and interim CEO of a collection of clinics and health centers known as the Redwood Community Health Coalition.
The report's 306 communities included two dozen from California, and none ranked higher than Sonoma County. San Mateo County ranked ninth; San Luis Obispo, 21st; San Jose, 25th; and Contra Costa County, 32nd. Among other communities, San Francisco ranked 50th; Sacramento, 61st; and Los Angeles, 225th.
The five top-ranking communities in the nation were St. Paul, Minn.; Dubuque, Iowa; Rochester, Minn.; Minneapolis; and Appleton, Wis.
"Where you live in this country largely determines, for better or worse, the kind of health care you will receive," said Commonwealth Fund President Karen Davis.
She said communities "can, and must, do better to assure all Americans have the opportunity to live long, healthy lives."
Local medical officials said Sonoma County's high ranking didn't surprise them and validates the work of the county's health-care system.
"It's a significant finding, and it speaks that we are on the right track," said Dr. Gary Greensweig, chief medical officer of St. Joseph Health System in Sonoma County.
Greensweig and others said the county has benefited by a series of collaborative efforts among hospitals and other care providers. One example is the county health department's Sonoma Health Action, which seeks for Sonoma to become "the healthiest county in California" by 2020.
Peter Rumble, director of health policy for the county Department of Health Services, said hospitals and other care providers have shown a willingness to "put potentially competitive interests aside" and work together.
Both the family medicine residency program and the health clinics and centers are examples of such collaboration. A number of health care institutions support the residency program, including the network of health centers.
One benefit is that many of the family practice doctors remain here after they graduate the residency program.
A 2010 county study found that a third of the community's family practice physicians are graduates of the residency program. And about 16 percent of all the family care doctors in the county are working in the community health centers, said Pedro Toledo, director of community and government relations at Redwood Community Health Coalition.
Those health centers serve about 110,000 county residents, more than one-fifth of the population, Toledo said.
Dr. Walt Mills, president-elect of the Sonoma County Medical Association and a family medicine physician for Kaiser Permanente in Santa Rosa, said the health centers provide primary care early so residents don't seek far costlier treatment at hospitals when a health problem becomes unbearable.
Patients get treated at the centers, Mills said, "instead of showing up at the emergency rooms."
Dr. Kirk Pappas, physician-in-chief at Kaiser Permanente, said the county also benefits from an advanced level of patients whose medical records are electronic. Those records can help doctors avoid ordering duplicate tests and be better informed on the treatment of patients.
The Commonwealth Fund looked at geographic areas known as Hospital Referral Regions. The Santa Rosa region includes hospitals in Petaluma, Sebastopol, Healdsburg and Sonoma as well as Santa Rosa.
The report, the group's first extensive look at care at the local level, gave rankings based on 45 criteria in four broad areas: Access, prevention and treatment, potentially avoidable hospital use and healthy lives.
Sonoma County ranked within the top quartile in each area. It placed third among all communities for avoidable hospital use and 11th for healthy lives.
Leaders here suggested the high rankings might be explained partly because of socioeconomic factors, including education levels and drug-related infant mortality.
Most of the data came from 2007 to 2010.
You can reach Staff Writer
Robert Digitale at 521-5285 or robert.digitale@pressdemocrat.
com.
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