Best Hospitals 2007
A New Tack With Kids' Hospitals
Parents and others who check pediatrics first won't find the 2007 rankings in this issue. No, we haven't dropped the specialty. To the contrary—in covering health issues, evaluating the care of children with serious medical problems remains a high priority. The pediatrics rankings are absent because the methodology behind them is being reworked.
Ranking children's hospitals is challenging. Pediatrics is not a specialty in the way that oncology, say, is a specialty. It is an umbrella discipline, gathering in most adult subspecialties and adding its own, such as neonatology.
Even a renowned children's hospital is bound to be better in certain of these disparate areas than in others. And some hospitals perform more than their share of demanding procedures, and do them on sicker kids.
Rankings that are based solely on reputation and that assess pediatrics in its entirety, as has been the case since the first Best Hospitals issue in 1990, cannot make such distinctions.
Hard data could—if they were available. It would be especially valuable to know death rates and volumes for specific procedures at individual hospitals. But no database exists that is comparable to the federal government's mortality and volume statistics on Medicare patients—critical information that we use to rank other Best Hospitals specialties. Leading pediatric researchers say that because of disagreement within the medical community about such issues as a standard way to calculate the severity of a child's condition, it could be five years or more before a database appears.
That's too long. Last year we began to explore the feasibility of developing our own approach, even running the idea by an outside advisory board convened in October to critique our methodology across the board. We were urged to proceed.
So, working with RTI International (our Best Hospitals contractor) and the National Association of Children's Hospitals and Related Institutions, we launched an initiative.
We intend to introduce revisions in stages. This spring we directly surveyed a large number of centers and have assessed the information they provided. Some will be used in the first updated rankings, to appear later this year. More will follow. Meanwhile, please consult the 2006 rankings on this page. They are still useful.
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