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.
Get With the Guidelines
Certifying group: American Heart Association
Crucial, timely interventions when a patient is rushed to the hospital with heart disease or a stroke may mean the difference between life and death. Yet "without a systematic program, with very busy clinicians and multiple physicians and nurses caring for patients, some of these therapies get overlooked," says Gregg Fonarow, professor of cardiovascular medicine at the Ronald Reagan UCLA Medical Center and immediate past chair of the Get With the Guidelines committee. This program prods hospitals to create checklist-style orders so patients are more likely to get necessary therapies, and at the appropriate time. (Angioplasty candidates, for example, benefit most by undergoing the procedure within 90 minutes of arrival.)
Hospitals can participate in the stroke, heart failure, or coronary artery disease modules, or all three. A study last fall found that 355 high-complying hospitals in the program had slightly lower 30-day mortality rates for heart failure and heart attack patients than nonparticipants, which would translate into 1,800 to 3,500 lives saved a year if all U.S. hospitals met the same standards. Still, the program doesn't mean you're guaranteed lifesaving treatments: Of the 1,800 hospitals that have agreed to participate, fewer than a third are currently on the high-compliance gold or silver honor rolls—and for this achievement they are required to meet these standards only 85 percent of the time.
National Accreditation Program for Breast Centers
Certifying group: American College of Surgeons and 15 partnering organizations
Good breast cancer care goes well beyond having eagle-eyed radiologists and competent surgeons. The best comprehensive breast centers also provide social and emotional support. The 27 standards of the NAPBC span the range, from diagnosing with standard-of-care needle biopsies rather than open surgery, to having a team of doctors assess each case before treatment is initiated, to ensuring that every patient is assigned a nurse to help her navigate the system. Still, critics complain that some standards aren't sufficiently rigorous; after initial involvement, the American College of Radiology declined to lend its support because the group felt there was not enough emphasis on the quality of the imaging machines. (The ACR certifies radiology departments only via its own program, the Breast Imaging Center of Excellence.)
Magnet Recognition Program
Certifying group: American Nurses Credentialing Center
Anyone who has had a stint in the hospital won't be surprised to hear that patients fare better at institutions that have happier RNs. One study analyzing 168 hospitals in Pennsylvania, for example, found that a patient's odds of dying were 14 percent lower in hospitals with more supportive nursing environments. The credentialing group, an arm of the American Nurses Association, identifies 88 requirements for nursing empowerment and care, ranging from involvement with hospital decision-making to the implementation of patient-care innovations.
Clinical outcomes (primarily patient falls and pressure ulcer rates) count, and must be better than the national average. "About a third of the hospitals applying don't score high enough on their written documentation to go on to the outside team visit, and another third don't pass the visit to get the designation," says Karen Drenkard, director of the program.
Surprisingly, the nurses union, National Nurses United, opposes the program. "Putting nurses on hospital governance committees diverts them from their core role as patient advocates to become advocates for the institution, which may not have the same agenda. Hospitals can better use the huge amount of money they spend on certification to improve patient care by hiring more bedside nurses," says NNU executive board member Geri Jenkins.
Cancer Program Accreditation
Certifying group: Commission on Cancer
The granddaddy of disease accreditation programs, this one began early in the 20th century when the American College of Surgeons decided that patients needed better protections during cancer surgery. Since then, dozens of other top cancer organizations have joined this consortium dedicated to improving care and research, and the criteria have expanded way beyond the operating room. The 36 standards range from diagnosis and rehabilitation to counseling and support.
Because the program has been around for decades, some 70 to 80 percent of all cancer patients currently get their care at hospitals with this designation. Accredited hospitals must submit patient survival and other data that are measured against national standards. One weakness: Institutions underperforming their peers are educated about how to improve their numbers, but rarely lose their seal of approval.
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