Entries for July 2008

"Abuse?" Or "mistake?" As reported widely today the death rate from perfectly legal medications, both prescription and over the counter, jumped 360 percent between 1983 and 2004. Many of the deaths involved a mix of alcohol and drugs, which has led some of the coverage to refer to drug abusers.

That's wrongheaded. In the first place, the researchers who analyzed all of the nearly 50 million U.S. death certificates filed from 1983 to 2004 excluded deaths caused by street drugs alone, such as heroin, methamphetamine, and crack cocaine. The aim was to find out whether the steadily growing numbers of patients taking multiple medications—many of which originally were available only by prescription but then moved to the other side of the counter—and getting less medical supervision were suffering the consequences of this potentially deadly combination. They were, especially when alcohol was involved; deaths from medications plus alcohol rocketed from 92 in 1983 to 3,792 in 2004, a bounce of nearly 3,200 percent.

Of all hospital services, psychiatric services may be less likely than most to be thought about in advance. If a family member needed to be hospitalized because of mental illness, would insurance coverage be the only consideration for choosing a facility? Is useful information about inpatient psychiatric care even available?

The usual answer to the first question is yes, at least in part because the answer to the second question is no. That's why the America's Best Hospitals psychiatry rankings rely solely on reputation among board-certified specialists.

Comments and questions have piled up since the release of the latest America's Best Hospitals rankings and articles. I'll respond to some of them here.

I take issue with using reputation as a benchmark. Many "reputations" are falsely inflated or are the result of professional or academic alignments.
It would be wrong if reputation was all we considered, but it is only one third of the score in most of the ranked specialties. Because we (a) only survey board-certified physicians, (b) emphasize that we want their recommendations for hospitals for the most difficult patients and procedures in their specialty, and (c) ask them not to consider location or expense when naming a hospital, we believe the survey is a decent form of peer review. We also request that the physicians not name hospitals where they have privileges, and when we match up respondents with their hospitals, it seems that the majority comply.

It's that "America's Best Hospitals" time of year again. Shortly after midnight tonight, the new rankings will blink into existence. You'll also find feature articles, a photo essay that follows an ER nurse through her 12-hour shift, and a video with Health Editor Bernadine Healy of the grueling rehabilitation process after a Tiger Woods-type ACL knee repair.

The big change this year is that we've swung the door wide open. Rather than providing information only on the 170 hospitals ranked in one or more specialties, we have posted the same data and scores online for more than 1,500 hospitals (out of a total of 5,453 analyzed) that were good enough to meet our basic standards for qualification but came up short of being ranked. It's a group that probably takes in most hospitals with at least a couple of hundred beds (small by big-city standards), so most readers will be able to find information of interest about a few centers that might someday, or sooner, be a medical destination for them or someone close to them.