Someone diagnosed with a deadly brain tumor is likely to seek out one of the U.S. News Best Hospitals. But let's be honest. If you suffer from diabetes or even breast cancer—and certainly if you're in an ambulance battling a heart attack or stroke—you're going to head for a hospital in town.
How to choose among the ones near you? Research shows that most people ask friends and relatives, especially those in the medical profession, says Eric Schneider, associate professor of medicine at Harvard Medical School and a senior scientist at the Rand Corp. But growing consumer demand for measures that are more objective has professional groups scrambling to provide official certifications for hospital programs that meet standards for treating specific diseases. The American Heart Association, for example, recognizes institutions that treat heart attacks or strokes according to specific evidence-backed guidelines, while a consortium led by the American College of Surgeons flags breast cancer centers that go the extra mile. To qualify, hospitals typically report in categories from physician credentials to patient testing to medication timing—in other words, how closely they adhere to practice guidelines established by the top medical groups in the field. Next comes a visit by the certifying group's outside experts.
Certifications can be valuable tools for consumers because they encourage participating hospitals to find (and presumably fix) systemic problems, Schneider says. Moreover, those taking the trouble to get these stamps of approval (aside from considerable time, applying can run from several thousand dollars to as much as $50,000) likely specialize in treating the specific disease. And the fact that outside experts peer over the hospital wall means patients can assume at least minimal standards of care.
Still, minimal is often a far cry from excellent, cautions Charles Kilo, chief medical officer at the Oregon Health and Science University and an expert on healthcare improvement. Critics also charge that to ensure enough hospitals will qualify, certifying groups typically set the bar to screen out awful institutions, a level that does not truly signify top quality. And because data on patient outcomes are still hard to come by, most programs examine how things are done in hospitals rather than how patients actually fare. Finally, holding on to the certification is not as difficult as acquiring it. "We're a little more flexible with programs that have been around a while. They have 12 months to correct any deficiencies we uncover," acknowledges David Winchester, a surgical oncologist at North Shore University-Evanston Hospital in Illinois, and medical director for the Commission on Cancer, which gives its imprimatur to hospital cancer programs.
In other words, check for any relevant certifications as you choose a hospital—but phone that physician-cousin, too. Here are some of the most prevalent labels you're likely to encounter:
Primary Stroke Center
Certifying group: Joint Commission
The organization that has long accredited most of the nation's hospitals now also offers "advanced certification" in treatment for stroke and several other clinical areas including chronic kidney disease, inpatient diabetes, chronic obstructive pulmonary disease, and heart failure. Hospitals must prove they adhere to stringent, comprehensive practice standards. For stroke, for example, they must demonstrate they can perform X-rays and other tests within 45 minutes of an order, and that they have clot-busting drugs on hand. For diabetes, they must have written glucose monitoring protocols, plans for treating both low and high blood sugar events, and education programs to help patients manage the disease. A crucial question—how many additional lives are saved—is not factored in. Still, advanced certifications do seem to keep hospitals on their toes. The University of California, Irvine Medical Center, for one, found that its doctors conducted important lipid profile testing 15 percent more often and gave clot-busting drugs three times more frequently after the medical center got its stroke certification.