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Hospital Competence: Which Ones Rank Best

Since 1990, U.S. News has identified the best hospitals to go to for specialized healthcare in such areas as cancer, geriatrics, heart, and kidney treatment. This year, they have looked at 6,116 hospitals and narrowed it down to 168 hospitals which offer healthcare in 17 different services. The Early Show will be looking at the best hospitals which offer treatment of cancer and heart disease as well as which hospitals offer the best specialized care overall.

To be ranked, a hospital first must either belong to the Council of Teaching Hospitals, be affiliated with a medical school, or have at least nine technology services out of a prescribed list of 17. Eligibility for ranking in 13 of the 17 specialties depends on performing a specified number of defined procedures during the past 3 years for which data is available or being named by at least one physician in U.S. News surveys during the past 3 years.

Here's how the ranking works. Hospitals that meet the above requirements receive a score, or U.S. News Index, that combines reputation, mortality, and a group of other factors related to patient care, such as nursing and technology. The 50 hospitals with the highest scores in each of the 13 specialties appear in this issue.

Every year U.S. News asks 150 board-certified physicians at random in each specialty--2,550 in all--to name up to five hospitals they consider tops in their specialty regardless of cost or location. The reputational score shows the percentage of the doctors surveyed over the past three years who named a hospital.

The mortality figure shows a ratio that compares actual deaths of Medicare patients with the number expected, so higher than 1.00 is worse than expected and less than 1.00 is better. Solucient, Inc., an Evanston, Illinois, supplier of healthcare data, calculated the ratios, adjusting for severity by using a 3M Health Information Systems program called All Patient Refined Diagnosis Related Group.

Most of the remaining information comes from annual surveys by the American Hospital Association of its member institutions.

Here is a list of the specialities considered for ranking each hospital:

  • Cancer.
  • Digestive disorders.
  • Ear, nose, and throat.
  • Geriatrics.
  • Gynecology.
  • Heart.
  • Hormonal.
  • Kidney.
  • Neurology.
  • Orthopedics.
  • Respiratory.
  • Rheumatology.
  • Urology.
  • Eyes.
  • Pediatrics.
  • Psychiatry.
  • Rehabilitation.

The top five hospitals on the honor roll for having the best specialized care are

  • Johns Hopkins Hospital.
  • Mayo Clinic.
  • Massachusetts General Hospital.
  • Cleveland Clinic.
  • UCLA Medical Center.

The top five cancer hospitals are as follows:

  • Memorial Sloan-Kettering Cancer Center.
  • University of Texas, M.D. Anderson Cancer Center.
  • Johns Hopkins University.
  • Dana-Farber Cancer Institute.
  • Mayo Clinic.

The tp five heart hospitals:

  • Cleveland Clinic.
  • Mayo Clinic.
  • Massachusetts General Hospital.
  • Johns Hopkins Hospital.
  • Brigham and Woman's Hospital.

The Early Show spoke with Avery Comarow, senior writer at U.S. News and World Report, about how these lists were compiled.

How did you come up with this list?
The honor roll list is a snapshot of hospitals that do a lot of things very well. To be on the honor roll, you have to rank very high in at least six of the 17 specialties in which we rank hospitals. So this is a very select group.

To rank the individual specialties, we start by looking at all hospitals in the country. Then to be ranked, the hospital has to either be a teaching hospital or affiliated with a teaching hospital or it has to have a lot of technology. Then we do the numbers. We look at the death rate at each of these hospitals. We look at the hospital's reputation among specialists, and we look a things that have a lot to do with the way patients are treated. For example, the number of nurses compared to the number of patients. Then we list the top 50 by score after combining the different numbers from above.

Why do you do this?

We do this because there are people who at some point in their lives need the best level of medical help whether it is diagnosis or treatment. Most of us will never need it, but when you need it, you really need it. The hospitals in these ranking are most likely to provided the kind of service you need.

Do you do any on-site evaluations of the hospital?

No, we get all of our data from other sources. Most of it from the federal government and the American Hospital Association. With the exception of reputation we run our own survey.

Were there any surprises?
There weren't, and in fact one of the interesting things that I've seen after doing this for 12 years is that I would worry if there were any surprise because we know that hospitals don't change all that rapidly.

Were there any changes from last year?

Yes, the honor roll had 15 hospitals ranked last year. This year, there were 16.

You always get little changes. This year in cancer, there has been a back and forth between Memorial Sloan-Kettering in New York and M.D. Anderson in Texas. They tend to trade first and second positions. Last year M.D. was number 1. This year Memorial Sloan-Kettering is number 1.

What are the criteria used to score each hospital?

Reputation. Mortality--meaning we looked at death rate--and we looked at other things that define a hospital: how many procedures they did in cancer, how many nurses they had per bed, and technology. Each criterion is considered equal in scoring. The top hospital in each specialty a score of 100 and the others scaled down from that.

What does the score mean?

It means that these are relative wayof looking at different hospitals. It doesn't mean that a hospital with a score of 35 or 40 is only 35% or 40% as good as the hospital at the top of the list. All of the hospitals on these lists are excellent hospitals. There are a lot of hospitals not on this list that are terrific, too.
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