Birth of a New Methodology
We've added death rates, nursing, and other ways to look at care
In July, America's Best Hospitals turned 18. From the very first, U.S. News has ranked hospitals in pediatrics, identifying medical centers that excel at helping the sickest young patients. We've heard reassuringly few complaints through the years that one or another of the ranked hospitals might not merit such distinction.
Still, improving the usefulness and relevance of the rankings in this important specialty has been a long-standing goal. Mortality data and other information factored into various adult specialty rankings cannot be obtained for children's hospitals. In pediatrics, therefore, the rankings have always relied solely on a facility's reputation among an annual sampling of board-certified physicians in various pediatric specialties. We've long wanted to move beyond reputation.
We also want to rank children's hospitals in subspecialties such as heart, cancer, and respiratory disorders, as we do for adult hospitals. But pediatric experts are currently wrangling over how best to define, collect, and verify the kind of data that have real meaning as measures of the quality of pediatric centers. It's no easy assignment. Coming to agreement might take an additional three to five years.
The rankings shown here signal that U.S. News chose not to wait. Instead, we enlisted our Best Hospitals contractor, RTI International, in devising an enhanced approach. It is the first in a series of planned improvements to the pediatrics rankings methodology that will be introduced in stages. The second stage is planned for next spring.
A medical facility was considered eligible for this year's rankings if classified by the National Association of Children's Hospitals and Related Institutions as a free-standing children's hospital or as a children's "hospital within a hospital"--a large, multidisciplinary pediatric service within a medical center. As of March 1, 2007, 122 hospitals met this standard.
Reputation has been supplemented with data obtained by directly surveying the 122 eligible U.S. children's hospitals, 113 of which responded. The rankings, like their adult Best Hospitals counterparts, now reflect a three-part mix of reputation, death rate, and care-related factors such as volume, nursing care, advanced technology, and recognition by outside organizations. (Details are described in the glossary below.) The three parts break down as follows:
Reputation. For the 2007 rankings, 200 board-certified pediatricians, adolescent medicine specialists, and (for the first time) neonatologists were randomly selected from the American Medical Association's Masterfile of more than 850,000 U.S. physicians. Those doctors were mailed a survey form asking them to name five hospitals they consider best for a child in need of the highest level of care; they were instructed not to consider geography or cost and not to name hospitals where they practice. The "reputation" column in the rankings indicates the percentage of responding physicians in 2005, 2006, and 2007 who named the ranked hospitals. Slightly less than half of the physicians surveyed over the three years provided responses. Reputation counted as two thirds of each hospital's overall score.
Death rate. Hospitals were asked to report their patient volume and number of inpatient deaths in the most recent 12 months for three procedures: a complex heart repair (of a defect called tetralogy of Fallot), bone marrow transplant, and removal of a cancerous brain tumor. A hospital could receive up to 6 points--0, 1, or 2 for each of the three procedures--depending on the number of procedures and the death rate. No adjustments were made for patient severity. Death rate counted as one sixth of the score.
Care-related factors. We asked hospitals for the total number of inpatients treated in the most recent year (not counting healthy newborns), the total number of nurses, and availability of the kinds of advanced care expected from a "best" pediatric hospital, such as key imaging technologies and a formal palliative-care program. We also weighed certification as a Nurse Magnet hospital by the American Nurses Credentialing Center and designation by the Foundation for the Accreditation of Cellular Therapy for cell transplantation. Care-related factors counted as one sixth of the score.
This story appears in the September 3, 2007 print edition of U.S. News & World Report.