What data were used to reveal these qualities?
Centers at the top of the Best Hospitals rankings had very high reputations among diabetes specialists who responded to U.S. News surveys over the last three years asking where they would send their most difficult diabetes patients if money and geography were not considerations. Almost two-thirds of the physicians, for example, nominated the Mayo Clinic and almost half named Massachusetts General Hospital. Beyond the top 10 hospitals or so, however, reputation wasn't that important. Ten of the 50 ranked hospitals didn't get a single nomination. What put them in the rankings were low death rates (generally at least one-third below the expected rate for patients with serious diabetic conditions and other endocrine disorders after taking into account the patients' condition when they were admitted and other risk factors), strong nursing standards (more than half are "Nurse Magnet" hospitals, formally recognized by the American Nurses Credentialing Center for their high-quality nursing care), and a full roster of patient services that U.S. News has defined as important (such as wound-management services, which are of special significance to diabetics because of skin problems and nerve damage).
How will I know if I need one of these hospitals?
Such a moment might involve a decision that affects your quality of life. About 70,000 diabetics a year, for example, have a foot or leg amputated because of impaired circulation, infection, or other causes. To put it another way, doctors tell nearly 200 diabetic patients on a typical day that amputation is necessary. But the best hospitals for diabetics are less likely to deliver that message. They are more experienced in restoring circulation or at finding other ways to preserve the limb. Top diabetes centers are also better than others at identifying and treating complications before drastic measures like amputation are necessary. Someone whose diabetes is unusually hard to control or whose heart, circulatory, or other diabetes-related complications are progressing might want a consult at a ranked facility within a reasonable distance from home. That shouldn't be overly difficult in most parts of the country. The 50 U.S. News-ranked diabetes hospitals are in 35 different cities across 29 states and the District of Columbia.
Can I get into a ranked hospital?
Almost always. Patients can often do it themselves by calling a patient referral number or sending an E-mail; information on both will be on the hospital's website. You should first check to see if your health insurance carrier will cover the cost. If there is any doubt, your physician should make the referral. He can deal with push back from a health insurer better than you can—he's used to it.