Outcomes. This means keeping kids alive and safe by protecting them from infections and surgical complications, and improving quality of life of children with chronic conditions. For example, we evaluate survival from three types of childhood cancers, bloodstream infections caused by urinary catheters, and success in managing serious asthma cases. For the 2013-14 rankings, prevention of pressure ulcers was added as an outcomes measure in four specialties.
Process. The intent of the U.S. News process measure is to evaluate how well and efficiently a hospital goes about the day-to-day business of delivering care. That was determined in part by compliance with widely endorsed "best practices," such as regular morbidity and mortality conferences to explore unanticipated deaths or complications, and commitment to infection control, such as having a staff "infection preventionist" and tracking the correct use of antibiotics prior to surgery.
Asking hospitals about particular programs and policies that affect care delivery, however, isn't enough. Having a program is not the same as making it succeed. So most of the process measure's weight — 25 percent of a hospital's score — is based on the opinions of pediatric specialists and subspecialists. Each year U.S. News randomly surveys 150 of these physicians in each specialty, 1,500 in all. They are asked to name the 10 best hospitals for children with serious or difficult medical problems in their area of expertise, ignoring location and expense considerations. In 2013, more than 52 percent of the surveyed physicians responded. The latest three years of responses were averaged.
Structure. Think of this as a measure of the resources a hospital makes available to patients. The number of on-staff nurses is one obvious example. But we also collect information about 28 other elements, many of them relevant in every specialty and others specific to just one. Examples include the availability of surgery for heart defects or liver transplants, specialized clinics for children with diabetes or kidney disease and services for families that ease the anxiety of a child's hospital stay.
All of the individual measures are defined in the terms. Detailed information about the data analysis is available as a viewable and downloadable PDF, the 2013-14 Best Children's Hospitals Methodology Report.