Gee, what a nice present. With this year's Best Hospitals rankings due to come out in less than a week, our annual exercise has just received an endorsement of sorts from one of the American Medical Association's most widely read journals, the Archives of Internal Medicine. In a study appearing today, a team of researchers based at the Yale University School of Medicine concluded that heart-attack patients who went to the 50 hospitals that U.S. News ranked tops in cardiology and cardiac surgery in 2003 had death rates about 11 percent lower than similar patients at nonranked hospitals did.
In fact, the researchers found that when they grouped the 50 ranked hospitals and 3,813 nonranked hospitals into four levels by death rate, 70 percent of the ranked hospitals but only 24 percent of the nonranked hospitals fell into the lowest-mortality category. Not all the heart hospitals in the rankings performed as well—8 percent, or four hospitals, wound up in the highest-mortality group. But 25 percent of the nonranked facilities wound up there.
Validation is always nice, of course. Today's is particularly interesting, because our rankings were put up against a standard that has very little to do with their purpose, which hasn't changed at all since the first rankings came out in 1990. The rankings aren't meant to suggest where to go for emergency care. Nor are they meant for outpatient care or even routine elective inpatient surgery.
We publish the rankings to help people who have the kinds of conditions or who need the kinds of procedures that should be addressed only at an excellent medical center. I'm talking about someone with brain cancer or a pancreatic tumor, an elderly man looking at his third round of coronary artery bypass surgery, a woman facing a tricky diagnosis for an intestinal problem. These are people for whom "good" isn't enough.
I have another problem that is a little more subtle. Behind the study lurked a presumption that hospitals that are good at doing the kinds of tough things that go into the rankings should also be good at treating heart attacks. Who says they're related? Caring for heart-attack patients involves emergency-department skills that must be brought to bear quickly. Putting in a new heart valve, transplanting a heart, treating a severely inflamed heart—these are tasks, especially in patients who may have other things wrong with them, that demand honed, precise medical and surgical skills. Here's a question for the researchers, all M.D.'s and Ph.D.'s: If you were looking for the best place for a difficult operation—let's say an aortic aneurism that is expanding week by week—would you even check the heart-attack death rates at hospitals that you put on the list of candidates?
By the way, let's also remember that rankings in the study were from 2003. I'd like to think the methodology we use has gotten better in four years. But heck, it's nice to see that numbers generated by skeptics—which describes the team behind the Archives study—reinforce what we've tried to do for 18 years.
U.S. News's Avery Comarow has been editor of the America's Best Hospitals annual rankings since they first appeared in 1990. His reporting on clinical medicine, from the latest cholesterol guidelines to robotic surgery, has been driven by the question: What does this mean to patients? And that is the perspective he brings to his observations and commentaries on the increasing number of programs by hospitals and other healthcare providers to improve care and patient safety.
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