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Shopping for a Hip Replacement in Florida? Go by the Numbers
Tweet Share on Facebook December 28, 2012 CommentEach year, nearly 300,000 people have one or both hips replaced. Most of the time the results are dramatically for the better, allowing patients to cast off pain and immobility. About one in 15 patients, however, suffers complications that can be severe, among them infection, nerve damage, blood clots, and failure of the implanted artificial joint, according to a 2010 report in the American Journal of Orthopedics. And these problems can be prevented. Some hospitals have consistently shorter stays, fewer complications and readmissions, and lower mortality than others do.
Data tell the story; data that are recent and decent can help patients make informed choices about where to get surgery. Yet few patients can look at these important statistics. Few hospitals reveal them, and most states don't publish hospital-specific data, often blaming tight budgets and pushback from local hospitals and doctors.
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Birth of a Ranking: Which Hospitals Are Best at Delivering Babies?
Tweet Share on Facebook November 16, 2012 CommentMost of the roughly 4 million babies born in the U.S. each year are delivered in hospitals, the vast majority without significant incident to the infant. But hospital choice matters. Depending on her choice of hospital and, of course, provider, an expectant mother may be much more or less likely to undergo induction of labor, surgery, or other interventions intended to assist delivery and ensure a healthy child.
Her providers, moreover, may include a midwife (or not) and may be highly experienced—or not. They may or may not have a specialists in neonatal care at their disposal, if need for such expertise arises. These and other differences among hospitals might affect the costs and medical consequences of delivery, even one that produces a healthy infant.
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Doctor Referrals: A Foundation for Evaluating Performance?
Tweet Share on Facebook November 15, 2012 CommentCould a doctor's professional network—the pattern of referrals to and from other doctors—say something important about the quality of care he gives his patients? Health IT expert Fred Trotter thinks so, and he's been amassing data to see whether he's right. Does a primary care doctor choose wisely when he is referring patients for complex care, or does he send some of them to a colleague with a record of medical or ethical lapses? Does a specialist handle mostly routine referrals from local colleagues, or is she a superspecialist to whom doctors refer their most challenging patients?
Trotter, author of Hacking Healthcare: A Guide to Standards, Workflows and Meaningful Use (O'Reilly Media), believes that referrals at least suggest the level of care the doctor provides, if not a precise measure of quality. He readily acknowledges that even if he's right, referral patterns fall short of hard data that would allow every doctor's performance to be evaluated. "I've been looking for an objective way to rank doctors for a long time," he says.
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At New York Hospitals, Heart Patients' Death Rates Are an Open Book
Tweet Share on Facebook October 18, 2012 CommentSeveral weeks ago we set out our intent to create new hospital ratings that will accompany the Best Hospitals rankings. They will differ by focusing not on the sickest patients, as Best Hospitals does, but on more typical consumers who need relatively routine procedures such as heart bypass surgery and hip replacement. Since some such procedures frequently involve patients younger than 65, federal Medicare data alone won't take us as far as we'd like to go. We will have to find other resources and, of course, develop a credible methodology. Your thoughts on both are encouraged.
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Hospital Leaders, U.S. News Editors Hold Summit on Best Hospitals Rankings
Tweet Share on Facebook October 2, 2012 Comment"These rankings are not static." The affirmation by U.S. News & World Report editor and chief content officer Brian Kelly underscored the point of a summit on hospital rankings that U.S. News and Mount Sinai Medical Center co-hosted at Mount Sinai on September 27. The summit convened medical thought leaders from around the country for a four-hour discussion about the methodology behind the U.S. News Best Hospitals rankings. At the summit, hospital presidents and clinical leaders shared ideas, suggestions, and critiques of the U.S. News rankings. There seemed to be a consensus that the U.S. News methodology is as sound as any in existence. Multiple panelists and participants referred to its "face validity"; several called it the "gold standard."
"No methodology is perfect," said Kenneth Davis, president and CEO of Mount Sinai Medical Center, who delivered the summit's opening and concluding remarks. "This [U.S. News] methodology is certainly superior." And he saluted U.S. News for being "open to feedback."
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Broadening the Mission of Best Hospitals
Tweet Share on Facebook September 27, 2012 CommentIn the coming months, this column will open a window into a new Best Hospitals initiative: to rate hospitals according to their success at providing specific types of routine care, such as labor and delivery, total hip replacement, and heart bypass surgery. We will offer up our thoughts and invite comments.
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Hospital Leaders Support Expanded U.S. News Rankings
Tweet Share on Facebook September 26, 2012 CommentAn overwhelming majority of hospital chief medical officers responding to a newly released national survey by U.S. News & World Report support a broad expansion of the U.S. News Best Hospitals rankings. The U.S. News rankings should evaluate individual hospital performance in routine care across a wide range of individual medical conditions and procedures, according to 93 percent of the respondents. Obstetrics, transplant medicine, palliative care, trauma and emergency medicine were among the areas of care that respondents indicated U.S. News should examine.
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Milwaukee's Rankings: a Missing Zip Code
Tweet Share on Facebook July 19, 2012 CommentOur Best Hospitals and Best Regional Hospitals rankings apply a methodology to a mix of complicated clinical data, such as survival of certain patients with specific conditions and the numbers of staff nurses per shift separately assigned to inpatients and outpatients, and identifying information, such as hospital addresses.
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Further Correction, Best Children's Hospitals 2012-13
Tweet Share on Facebook July 17, 2012 CommentIn this column on June 14, we called attention to programming errors that required corrections to the Best Children's Hospitals 2012-13 rankings. We subsequently learned from our contractor about an additional error that affected the rankings of hospitals in Nephrology. Correcting the error changed 31 hospitals' Nephrology rankings. No hospitals left or entered the rankings as a result of the correction. The Honor Roll was unaffected.
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Behind the Curtains of the Best Hospitals Rankings
Tweet Share on Facebook July 3, 2012 CommentThe carmine-red cover of the April 30, 1990, issue of U.S. News & World Report marked the debut of “America’s Best Hospitals.” The concept was a breakthrough—hospitals had never been publicly rated before—but the first effort was decidedly modest, listing eight to 16 hospitals in a dozen specialties based on a survey of 400 physicians. At that time, apples-to-apples clinical data showing how well hospitals delivered care didn’t exist, so out of necessity the U.S. News evaluation relied solely on hospitals’ reputations.
Much has changed. While reputation continues to play an important role in the Best Hospitals rankings, clinical data such as patient outcomes and processes of care have become central. We moved away from relying on reputation alone in 1993, adding mortality, nurse staffing, and other hard measures with a direct link to the quality of patient care. Clinical yardsticks now make up nearly 70 percent of a hospital’s score in most specialties. The evolution of the methodology toward broader and deeper use of objective measures has been possible because the federal government and the healthcare community have slowly but steadily opened important data vaults to public scrutiny.
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