The Best Hospitals
An exclusive survey of more than 1,000 leading doctors yields 43 sources of top medical care
Despite dozens of private and government attempts to measure quality of care, a hospital's reputation with physicians is still the most reliable barometer. Doctors know where their patients tend to do best, and conferences and journals keep them informed on sources of the very latest care. The third annual U.S. News reputational survey of leading physicians turned up 43 top-quality hospitals in 16 specialties. The exclusive survey was conducted by the National Opinion Research Center, a renowned social-science research group at the University of Chicago. This year's hospitals survey includes one new specialty: At the behest of many readers, doctors and hospitals, hospital-based geriatrics programs were added to the list.
To select the specialists polled, NORC drew 146,125 names of board-certified physicians across the 16 specialties. The names were randomly chosen from the American Medical Association's master file of more than 560,000 AMA members and nonmembers. NORC then selected a geographically representative sample of 100 doctors per specialty, for a total of 1,600 physicians. NORC contacted them by mail and followed up as necessary by fax, express mail and phone between January and April 1992. NORC's persistence produced a remarkably high response rate of 65 percent for the confidential survey.
Each physician was asked to name the five leading hospitals in his or her specialty, regardless of location or expense and in no special order. The doctors named 389 hospitals, many in more than one specialty, out of some 6,700 U.S. institutions. For a hospital to be listed, the number of "best" citations had to be well above the mean (in statistical terms, one standard deviation above the mean) in its specialty. That produced lists of varying lengths. The percentage of doctors who named each hospital is included in the lists on the following pages.
Any institution that made a list should be considered a leading center, no matter where it appears. And the survey does not imply that other hospitals cannot or do not deliver excellent care; these are simply the hospitals about which there is the strongest consensus among U.S. physicians. There are 18 new entries among the various specialties, and 19 hospitals on last year's lists are absent this time around. But different doctors were surveyed in each of the two years, which can subtly shift the statistical cutoff that determines whether a hospital makes the list.
In order to make the rankings more objective, this year's survey also asked doctors to indicate the relative importance of various attributes of good care. These ranged from the quality of the medical staff and the availability of state-of-the-art technology to competent discharge planning and the degree of emotional support for patients and their families.
The answers provided NORC with a variety of promising indicators, all of which can be expressed objectively. Among them are the ratios of registered nurses and of interns and residents to patient beds and membership in the Council on Teaching Hospitals, which requires that applicants meet high educational and research standards. As a first step toward building in an objective approach, that information is provided for each hospital listed in the directory starting on Page 89. Those and other emerging signposts to hospital quality care will be incorporated into future surveys.
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