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A Move to Judge Psychiatric Hospitals
Tweet Share on Facebook July 22, 2008 Comment (5)Of all hospital services, psychiatric services may be less likely than most to be thought about in advance. If a family member needed to be hospitalized because of mental illness, would insurance coverage be the only consideration for choosing a facility? Is useful information about inpatient psychiatric care even available?
The usual answer to the first question is yes, at least in part because the answer to the second question is no. That's why the America's Best Hospitals psychiatry rankings rely solely on reputation among board-certified specialists.
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Your 'Best Hospitals' Questions Answered
Tweet Share on Facebook July 15, 2008 Comment (9)Comments and questions have piled up since the release of the latest America's Best Hospitals rankings and articles. I'll respond to some of them here.
I take issue with using reputation as a benchmark. Many "reputations" are falsely inflated or are the result of professional or academic alignments.
It would be wrong if reputation was all we considered, but it is only one third of the score in most of the ranked specialties. Because we (a) only survey board-certified physicians, (b) emphasize that we want their recommendations for hospitals for the most difficult patients and procedures in their specialty, and (c) ask them not to consider location or expense when naming a hospital, we believe the survey is a decent form of peer review. We also request that the physicians not name hospitals where they have privileges, and when we match up respondents with their hospitals, it seems that the majority comply. -
New Hospital Rankings From 'U.S. News'
Tweet Share on Facebook July 10, 2008 Comment (6)It's that "America's Best Hospitals" time of year again. Shortly after midnight tonight, the new rankings will blink into existence. You'll also find feature articles, a photo essay that follows an ER nurse through her 12-hour shift, and a video with Health Editor Bernadine Healy of the grueling rehabilitation process after a Tiger Woods-type ACL knee repair.
The big change this year is that we've swung the door wide open. Rather than providing information only on the 170 hospitals ranked in one or more specialties, we have posted the same data and scores online for more than 1,500 hospitals (out of a total of 5,453 analyzed) that were good enough to meet our basic standards for qualification but came up short of being ranked. It's a group that probably takes in most hospitals with at least a couple of hundred beds (small by big-city standards), so most readers will be able to find information of interest about a few centers that might someday, or sooner, be a medical destination for them or someone close to them.
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How Hospitals Treat Women
Tweet Share on Facebook June 24, 2008 Comment (3)Today HealthGrades.com, which rates individual hospitals on an assortment of relatively routine procedures such as heart bypass surgery and C-sections, issued its fifth annual report on how well hospitals treat women when they give birth and when they have heart disease. As in previous years, it shows a gap between top-performing hospitals and those at the bottom in complications following vaginal and C-section births and in deaths following cardiovascular procedures such as bypass surgery and stent insertion.
I thought I'd take a look, partly out of curiosity—I hadn't spent much time with the previous reports—and partly because of the proliferation of Web-based report cards on hospitals. If hospitals were patients, they'd be spending much of their time being poked and questioned and examined. The Agency for Healthcare Research and Quality, a federal body, currently tabulates 68 online report cards (including the U.S. News Americas Best Hospital's rankings) that use different combinations of clinical data, patient surveys, and other information (on patient safety, for example) to put hospitals—nationally, regionally, by state—through the mill.
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What Medicine Can Learn From Business
Tweet Share on Facebook June 17, 2008 Comment (1)It has been 14 years since Betsy Lehman, then the Boston Globe's chief medical columnist, died of a massive chemotherapy overdose at Dana-Farber Cancer Institute. Her case seized headlines, but oft-cited statistics from the Institute of Medicine suggest that from 44,000 to 98,000 hospital patients die every year the way she did, because of safety lapses and incompetent care, meaning a toll since the publication of the IOM report in 1999 of perhaps 400,000 to 900,000 people—or from roughly the population of Oakland, Calif., to that of Detroit. The IOM estimate is highly questionable, representing assorted leaps of faith from selected studies, but if the actual count were 300,000 or 100,000, how much less horrifying would that be?
Attention has been paid. The Best Practice—How the New Quality Movement Is Transforming Medicine, to be published next month, is in part an account of the shock wave the 1999 IOM report sent through hospital boardrooms and clinics and in part a recitation of remedies that enlightened healthcare organizations are putting in place. The book, by journalist Charles Kenney, isn't nearly as wonkish as its title suggests. It's a great read, as exemplified by a passage describing a visit to Japan a few years ago by top administrators at Virginia Mason Medical Center in Seattle, to see if Toyota's vaunted management and production techniques could work at the hospital.
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Pediatric Hospitals Make Errors, Too
Tweet Share on Facebook June 11, 2008 Comment (1)Having just shepherded the 2008 "America's Best Children's Hospitals" rankings to completion, I've still got young patients on my mind, and a study in the latest issue of Pediatrics caught my attention. It is a poignant reminder that while adults comprise the vast majority of inpatients and consequently suffer from a greater number of mistakes and instances of shoddy care, young patients, too, are accidentally punctured, develop infections, have surgical sponges left in their bodies, and are otherwise victimized by mishaps that are almost always preventable.
The study identified more than 6,600 such significant slipups at 38 stand-alone children's hospitals during 2006 out of a total of about 430,000 children treated. It is not too much of an oversimplification to conclude that 1 child out of every 65 admitted to these hospitals—arguably the crème de la crème source of pediatric care—had something go seriously wrong.
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Are Hospitals Overdosing on Intensive Care?
Tweet Share on Facebook June 2, 2008 Comment (3)If you are very, very sick—so sick you have to be admitted to an intensive care unit, draped with tubes and IVs and catheters and sensors, fluids going in and coming out—what kind of physician should be at your side? An intensivist, of course. Many studies, including an exhaustive 2002 analysis in the Journal of the American Medical Association of the value of these specialists (pulmonologists, internists, and other physicians with specific training in critical-care medicine) concluded that the greater their role in the ICU, the lower the risk of death. This makes sense. Intensivists are experts in managing such fragile patients.
Then how to explain an unsettling study, out Tuesday in the Annals of Internal Medicine, that reaches exactly the opposite conclusion? The paper, which analyzed the care of more than 100,000 patients in 123 ICUs at U.S. hospitals, found that the chance of death was higher for ICU patients whose care was handled by critical-care specialists than for patients overseen by the admitting surgeon or other physicians lacking specialized training. Researchers adjusted for age, sex, severity of illness, length of stay prior to the ICU, and other factors. They call their results "surprising and completely contrary to previously published findings." No kidding.
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A Different Way of Ranking Hospitals
Tweet Share on Facebook May 30, 2008 Comment (3)Consumer Reports, the venerable publication from Consumers Union that rates everyday products, from cars and computers to TVs and laundry detergents, has now turned its analytical eye on hospitals, yesterday releasing first-time rankings of 2,857 centers. Access is free. An article will appear in the July issue. (Disclosure: I was the magazine's Washington editor in the early '80s.)
Unlike the magazine's trademark tables with little filled-in colored circles showing how well hospitals perform various procedures or deliver types of care, these rankings show how aggressively or conservatively—longer or shorter stays, more or fewer tests and specialist visits—patients are treated at a hospital relative to all other hospitals. The rankings are based on Medicare patients in the last two years of their lives who had been hospitalized any number of times during that period for any of nine chronic conditions—heart failure, dementia, and coronary artery disease are three. Adjustments were made to compensate for some patients being sicker than others.
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U.S. News Ranks Children’s Hospitals in Six Specialties
Tweet Share on Facebook May 30, 2008 Comment (1)As you know if you've stopped by our "America's Best Children's" Hospitals page, we have ranked pediatric hospitals for the first time in individual specialties—cancer, digestive disorders, heart and heart surgery, neonatal care, neurology and neurosurgery, and respiratory disorders. We got lots of help from the pediatric community, and considering that not all of them would be beneficiaries—they realized that their hospital wouldn't necessarily be ranked—it is important to salute their willingness to pitch in, a form of professional bravery.
I hope you've had a chance to read the stories of children who got the best possible care at some of these hospitals. One of them was Makenna Franks, who will shortly turn 5. I watched last August as she underwent open-heart surgery for the third time. We ran a photo essay on the Web and in the print magazine, and when we were planning this year's issue, I wanted to let readers know how she's been doing.
Pure coincidence: A few hours before "Best Children's Hospitals" was posted online, I received an E-mail from a reader who wanted an update on Makenna. It seems the reader's niece has a baby with the same condition—hypoplastic left heart syndrome—who had been born the month Makenna had her surgery. I let her know we would be posting an update. "Please give our best to Makenna and her family," she wrote back. We will.
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Uncle Sam Wants You (to Look at Hospitals)
Tweet Share on Facebook May 21, 2008 Comment (6)This morning, large ads in 58 newspapers are giving readers the skinny on their local hospitals, or at least enough of it to make them want more. The ad campaign is the federal government's equivalent of whacking a mule with a two-by-four to get its attention.
The folks at the federal agency that handles Medicare, the Centers for Medicare and Medicaid Services, are happy that traffic to its Hospital Compare Web page, which gives consumers information about thousands of hospitals, is way up since March. That's when CMS added consumer satisfaction indicators to 26 existing indicators of clinical quality. I wasn't a big fan of this, as I wrote the day the satisfaction measures came out—if you need critical medical attention, do you really care whether a hospital kept the noise down around your room? And after playing around with the site, I saw ways that the information could be misinterpreted. A few days later I expressed surprise that hospitals with good satisfaction ratings weren't going all out to toot their own horns.
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.
