Best Children's Hospitals: Understanding the Methodology
For routine ailments and procedures, hometown care is fine. For a child like Steven McDonough, who developed a rare spinal cord tumor, or Celli Sears, who needed new lungs because of an unusual condition, only a stand-alone children's hospital or a large multispecialty pediatric service in a medical center will do.
Good luck finding out which ones truly excel. Children's facilities are way behind their adult counterparts in weighing individual performance against consensus benchmarks. Experts can't agree on how to do it. That is why U.S. News is now gathering data to rank children's hospitals by specialty, as adult institutions are in "America's Best Hospitals."
Last year, in a first step, the top 30 pediatric centers overall were ranked using death rates, information about technology in place, and other data supplied by the hospitals, as well as a survey of board-certified pediatricians. Now the 30 top-ranked hospitals in cancer, digestive disorders, heart and heart surgery, neonatal care, neurology and neurosurgery, and respiratory disorders are highlighted along with the top 30 in general pediatrics.
For advice on the information to get and how to use it, we turned to a roster of nearly 50 experts—medical directors, department chairs, and quality-assessment specialists at top U.S. children's hospitals. They were divided into specialty panels and about two months later had developed recommendations for each specialty. The proposals were reviewed by RTI International, which oversees the Best Hospitals methodology and collects the data for the rankings, and an online survey was prepared.
Hospitals were asked for information that ranged from volume of cystic fibrosis patients (in respiratory disorders) to the number of children who had moderately to very difficult heart surgery. Responses were received from 113 of the 143 hospitals invited to complete the survey. Most are members of the National Association of Children's Hospitals and Related Institutions, although several non-NACHRI members were added because of known expertise or other factors.
The basis for all of the rankings is a blend of reputation, outcome (where available), and care-related measures such as volume, nursing, and credentialing. (Terms are defined on here; a complete methodology report is available at health.usnews.com/pediatrics (.pdf).) A quick overview:
Reputation. A total of 1,100 pediatricians were surveyed by mail and asked to name up to five centers they believe to be most successful with difficult cases in their specialty. They were chosen at random from the database of the American Board of Medical Specialties, 200 for general pediatrics and 150 for each of the six specialties. In cancer, for example, only pediatric oncologists and hematologists were surveyed. Slightly more than half responded. Depending on specialty, reputation counted for 50 or 60 percent of the final score.
Outcome. Inpatient death rate is employed in heart and heart surgery and in neurology and neurosurgery. It does not work for specialties that focus on outpatients—cancer, digestive disorders, and respiratory disorders. Neonatal measures are in progress. Where available, outcome counted for 10 percent of the final score.
Care-related measures. Examples include nurse staffing, the availability of important technologies, and patient volume. These measures counted for 40 percent of a hospital's score.
Reader Comments
The Children's list?!?
The Children's ranking is great, although how about going a step further and offering that list separately so that we who are searching only for childrens specialties dont have to look through all top hospitals to find the top Childrens facilities??
Having delivered a baby last year at a community hospital with great doctors and nurses after not feeling well cared for in one of your "top-rated" hospitals, let's just say that the patient's view of things does have great bearing on the perceived level of care if not actual care. Though they had all the gadgets, the doctors I had contact with at the big hospital made me feel brushed off, even while they explained that my baby would die! I would now be very reticent to take any child to that facility because of the way I was talked to, and decisions that were made without me, not due to any medical treatment issue.
We now face another gravely serious medical issue and are having a great deal of difficulty choosing a team to care for me and our next child. Even though we live in a major metro area, the choices in pregnancy care and pediatrics dont seem to be nearly what they are for adults.
Opinions used to establish BEST rankings?
My cousin arrived at Children's Memorial Hermann Hospital in Houston, TX after being told the hospitals in Oklahoma and Dallas could do nothing more for him. He hadn't eaten in weeks; his mother was force feeding him yogurt through a straw. He could no longer sit or stand on his own. When he was carried through the door of the Emergency Center, weak, emaciated, and actively seizing he was immediately ushered into a room.
He had a total of 5 surgeries to remove the areas of his brain which were causing his seizures and leading him to a slow death.
The fantastic team at Children's Memorial Hermann Hospital, championed by Dr. James Baumgartner and Dr. Gretchen Von Allmen, worked miracles for my cousin. He is now a happy-go-lucky kiddo who walks with help, is well-nourished, and had his first visit to the beach this year.
Without the determination and intense passion with which the doctors and nurses at Children's Memorial Hermann Hospital provide care, my cousin would not be with us today. His condition, Sturge-Weber Syndrome, is rare and not well understood.
We are eternally grateful to the team of doctors and nurses at Children's Memorial Hermann Hospital.
methodology
I wish you could try to improve on your methodology for ranking childrens hospitals-needs to be finer tuned. I have reviewed the methodology details provided at the link and am surprised by some of the factors included (and lack thereof). Even though one can understand that given the current lack of availability of pediatric-specific outcomes data etc. it is far from an excact science. Yet there is a growing amount of awareness and research in pediatric outcomes, which needs to be looked into and included for your report.
Also, for the sake of all your readers [many of whom are lay people], PLEASE ensure that readers can put the info. that you present into perspective:
the needs of a family whose child has a rare disease or 'special health-care' needs or needs unusual surgery is quite different from other children, whose medical care depends on the following elements (my opinion)each of which plays an important role:
1. interaction of the personality and behavioral qualities of parents of the child with health care giver(s)
2. effective communication between parent/child and health care provider
3. Health care facilities and systems that allow for quality and safe care of children and effectively employ technologies that ensure the same
4.Competent and caring professionals (this includes the physicians and all other health care team members) who take the time and every effort to listen to parents, their concerns and strive to provide good medical care that exceeds "community standards"
All of these are (in my opinion) crucial elements.
The size of a medical center, the high-tech amenities, or the experience of few parents and opinion of small survey of pediatricians, the volume of cases, presence of fellowship programs etc. may not be the best predictors of best health care.
advertisement
