How and Why: A 2013-14 Best Children's Hospitals FAQ

The facts and methodology behind our current pediatric rankings.

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What is the significance of the Honor Roll?

It recognizes the small number of hospitals that are unusually competent not just in one or two specialties but across at least three. A hospital received one point for every specialty in which it was ranked in the top 10 percent of all hospitals considered for ranking in a specialty and two points if in the top 5 percent. No hospital ranked first in every specialty.

How were the evaluated children's hospitals chosen?

Selection was based largely on membership status in the Children's Hospital Association, which has worked with U.S. News for many years first to help establish and then to improve the rankings. Roughly one-fourth of the hospitals asked to submit a detailed clinical survey are freestanding facilities. Most of the rest are major medical-center pediatric departments that are so large they function almost as if they are a separate hospital within a hospital, with their own staffs, operating rooms and other support services.

How many children's hospitals were surveyed and how many responded?

For the 2013-14 rankings, U.S. News requested medical data and other information from 179 facilities; 110 turned in enough data to be evaluated.

How many hospitals were ranked?

Of the 110 that submitted data, 87 ranked in at least one specialty.

Are there big changes from last year?

We constantly look for ways to improve our approach, and any alteration in the analysis affects the rankings. Overall, about the usual number of hospitals went up and down in 2013-14. Neonatology was a modest exception; we changed our methodology for the specialty this year to limit eligibility to hospitals that meet requirements for treating the riskiest infants. That led to modification of a heavily weighted measure in that specialty, prevention of ICU bloodstream infections, which may have been largely responsible for bumping 12 hospitals out of the rankings. None of them, however, had been ranked in the top 10 in 2012-13. We also added a new measure, the ability of hospitals to prevent pressure ulcers, in five specialties (cancer, cardiology and heart surgery, gastroenterology and GI surgery, nephrology, and pulmonology). This did not seem to have a significant effect.

How does U.S. News decide what changes to make to its methodology?

The methodology was created in 2006 by RTI International, a large North Carolina-based research and consulting firm that also generates the Best Hospitals rankings. Each year, working with experts organized into specialized task forces, RTI revisits and updates the methodology pending review and approval by U.S. News.

Why does U.S. News ask hospitals for data?

Evaluating children's hospitals poses unique challenges. No pediatric equivalent exists of the Medicare database called MedPAR, which U.S. News mines for the mortality, safety and volume information that is vital to the annual Best Hospitals adult rankings. Children's hospitals were in the process of developing standards for data collected to determine quality of care and for the best ways in which to analyze the results in 2006, when U.S. News began looking into ranking pediatric centers. And it is still true. The Affordable Care Act requires development of such performance standards, but it is likely to take several years for pediatric versions to take shape.

So in 2006 U.S. News asked RTI to put together a clinical survey for children's hospitals. Some questions, such as nursing data and the extent and success of programs that prevent infection, touch on all 10 specialties. Others, such as the complications rates of kidney biopsies and three-year survival rates for several types of cancer, are specialty-specific. The latest survey was updated and enhanced with the help of 74 medical directors, department chairs, infection specialists and others in 12 working groups.

What is the approach behind the rankings?

Whether and how high a hospital ranked depended on its showing in three areas: outcomes, process and structure. Each makes up one-third of a hospital's score.