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Best Hospitals 2011-12: the Methodology PDF Print E-mail

Our intent when we published the first Best Hospitals annual rankings in 1990 was to help people who find themselves in need of unusually skilled inpatient care, and that mission hasn't changed in Year 22. The Best Hospitals rankings judge medical centers on their competence in exactly such high-stakes situations. For example, a hospital ranked in cardiology and heart surgery—one of 16 specialties in which centers were evaluated—likely has the expertise and experience to replace a faulty heart valve in a man in his 90s. Most hospitals would decline to perform major surgery on elderly patients, as they should if they aren't up to speed on the special techniques and precautions required and don't see many such patients. A ranked hospital in gastroenterology can probably offer the most appropriate care to a patient whose inflammatory bowel disease flares up. At hospitals ranked in neurology and neurosurgery, surgeons face more spinal tumors in a couple of weeks than most community hospitals see in a year.

By contrast, other hospital ratings and rankings for the most part examine how well hospitals treat relatively unthreatening conditions or perform fairly routine procedures, such as hernia repair and uncomplicated heart bypass surgery. The majority of hospital patients need such ordinary care, so for them that approach to evaluating hospitals works fine. But it falls short for patients who are especially at risk because of age, physical condition, infirmities, or the challenging nature of the surgery or other care they need.A good way to determine how well a hospital deals with a medical challenge is to evaluate its performance across a range of challenges within the specialty. U.S. News ranks hospitals in 16 different specialties, from cancer to urology. This year, only 140 of the 4,825 hospitals that we evaluated performed well enough to rank in even one specialty. And of the 140, just 17 qualified for a spot on the Honor Roll by ranking at or near the top in six or more specialties.

In 12 of the 16 areas, whether and how high a hospital is ranked depended largely on hard data, much of which comes from the federal government. Many categories of data went into the rankings. Some are self-evident, such as death rates. Others, such as the number of patients and the balance of nurses and patients, are less obvious. A survey of physicians, who are asked to name hospitals they consider tops in their specialty, produces a reputation score that is also factored in.

Hospitals in the four remaining specialties—ophthalmology, psychiatry, rehabilitation, and rheumatology—were ranked solely based on their reputation among specialists. Most of the care in these specialties is delivered on an outpatient basis, and so few patients die that mortality data, which carry heavy weight in the 12 other specialties, mean little.

To be in the running for a ranking in any of the 12 data-driven specialties, a hospital had to meet any of four criteria: It could be a teaching hospital, it could be affiliated with a medical school, it could have at least 200 beds, or it could have at least 100 beds plus four or more of eight key medical technologies, such as a PET/CT scanner and certain precise radiation therapies. This year, 2,196 hospitals, or 46 percent of the initial number, met that test.

Eligibility in a particular specialty required hospitals to meet a volume requirement. The threshold was a specific number of Medicare inpatients, different for each specialty, who were discharged in 2007, 2008, and 2009 (the three most recent years for which data are available), based on a defined set of specialty-related procedures and conditions. The minimum number of cancer discharges, for example, was 254, of which 48 had to have been surgery patients; in neurology and neurosurgery the corresponding numbers were 341 total and 86 surgical. A hospital that fell short still could make it through the gate if nominated by at least 1 percent of the physicians in a specialty who responded to the 2009, 2010, and 2011 reputational surveys. That left 1,879 hospitals eligible in at least one specialty. But only slightly more than 7 percent of them performed well enough to be ranked in any specialty.

In each specialty in which a hospital was a candidate, it received a U.S. News Score from 0 to 100 that was based on four elements: reputation, patient survival, patient safety, and care-related factors such as nursing and patient services. The 50 top performers were then ranked. Scores and data for all qualifying hospitals in each specialty are also posted. (Use of electronic health records did not factor into any specialty ranking. But see our separate list of Most Connected Hospitals.) The four elements and their weightings, in brief:

Read more http://www.usnews.com/articles/health-news/best-hospitals/2011/7/18/best-hospitals-2011-12-the-methodology.html?s_cid=rss:best-hospitals-2011-12-the-methodology