Provided by
US News

The 2011-12 Best Children's Hospitals Rankings

Related Articles
Health Search

Drug Search

Explore and compare medications
Photo: Thinkstock

Seriously sick kids need a level of expertise that most hospitals don't have. At the vast majority of hospitals, all but a few inpatients are adults, and children, as medical school instructors drum into student physicians, aren't small adults. They are more vulnerable to infections because their immune systems aren't fully developed. They respond to medications faster and are more sensitive to too much or too little. Their treatment may be much different than for an adult with the same condition. Moreover, kids are smaller; operating on hearts the size of a walnut and starting IVs in tiny veins are only two of the challenges that pediatric specialists face day in and day out.

Best Children's Hospitals focuses on medical centers whose young patients come with cancer, cystic fibrosis, defective hearts, and other life-threatening, rare, or demanding conditions. The rankings showcase the top 50 children's centers—20 more than last year—in each of 10 specialties: cancer, cardiology and heart surgery, diabetes and endocrinology, gastroenterology, neonatology, nephrology, neurology and neurosurgery, orthopedics, pulmonology, and urology.

In all, 76 different hospitals are ranked in at least one specialty. The Honor Roll recognizes 11 hospitals with high scores in at least four specialties.

Many of the ranked hospitals are physically separate, freestanding children's hospitals. Most of the rest are large, multispecialty pediatric departments of major medical centers that function almost as if they were separate, with their own staffs, ORs, and other facilities—a hospital within a hospital.

Ranking children's hospitals poses unique challenges. There is no pediatric equivalent of the enormous government-run Medicare files that U.S. News mines for much of the data poured into the annual Best Hospitals adult rankings. Children's hospitals are still thrashing out standards describing the kinds of data that should be collected to determine quality of care and how to analyze the information. The health reform law requires development of such performance standards, but it is likely to take several years for pediatric versions to take shape.

So U.S. News has reached out directly to the hospitals. Since 2007, when quality-related data was first added to the rankings, children's hospitals have been asked to fill out a lengthy clinical survey—95 pages long for the 2011-12 rankings. Most of the 177 facilities surveyed for the new rankings are members of the National Association of Children's Hospitals and Related Institutions (NACHRI) and fit the description of standalone centers or a hospital within a hospital. A small number of specialty and non-NACHRI hospitals were added because they were previously ranked or were recommended by trusted sources. In addition, surveyed hospitals had to verify that they had at least one physician in certain specified categories to be eligible in a specialty.

Some survey questions, such as numbers of nurses and the extent and success of programs that prevent infection, touched on all 10 specialties. Others, such as kidney biopsy complications and the success of treatment for a type of cancer, were specialty-specific. The latest survey was updated and enhanced with the help of 115 medical directors, department chairs, infection specialists, and other experts, grouped into specialty-related task forces. RTI International, a large North Carolina research and consulting firm that also oversees the Best Hospitals rankings, reviewed the recommendations, directed the survey, and analyzed the results. One hundred hospitals turned in the survey.

Whether a hospital was ranked, and if so how high, depended on its showing in three areas: reputation among pediatric specialists, clinical outcomes such as cancer survival, and care-related indicators of quality such as the number of patients, nurse staffing, and availability of specialized programs. The outcomes and care-related indicators were made up of scores of fine-grained measures, listed in the glossary. How we analyzed the data and put it together is fully described in the Best Children's Hospitals Methodology Report, a downloadable PDF file. Here are the fundamentals of the three major areas:

Outcomes. Nothing is more important than outcomes—keeping kids alive, protecting them from infections and surgical complications, and improving their quality of life. More research and better data collection and analysis have boosted the amount and reliability of outcome-related information that goes into the rankings. Examples of this year's measures include survival from a particular childhood cancer and from a complicated kind of heart surgery, rates of bloodstream infection in intensive care units, complications from a kidney biopsy, and successful management of chronic conditions like cystic fibrosis. Outcomes counted as 35 percent of the final score, up from 25 percent last year and just 10 percent or less the year before that.

Reputation. In each of the 10 specialties, RTI randomly selected 150 pediatric physicians credentialed in the specialty from a national database and sent them a survey that asked them to name the five best hospitals for children with serious or difficult problems, without considering location or expense. Three years' worth of survey responses comprised 25 percent of a hospital's score. The relatively low weighting of reputation—down from 35 percent last year and 50 or 60 percent, depending on specialty, the year before that—continues a trend toward greater emphasis on clinical measures, especially those tied to outcomes. More than 51 percent of the surveyed physicians submitted responses, an extremely high rate for such a survey.

Various care-related indicators. Surgical volume, nurse-patient ratio, and efforts to combat hospital-acquired infections are a few examples of an assortment of 41 measures, many with numerous submeasures, that were used across the 10 specialties. Collectively, they accounted for 40 percent of the score in all specialties.

THE HONOR ROLL

The 11 Honor Roll hospitals excelled in at least four specialties. They are ordered by points

Best Children's Hospitals Honor Roll

Rank

Hospital

Points*

Specialties

1

Children's Hospital Boston 

20

10

1

Children's Hospital of Philadelphia 

20

10

3

Cincinnati Children's Hospital Medical Center 

16

10

4

Texas Children's Hospital, Houston 

13

9

5

Children's Hospital Colorado, Denver 

7

6

5

Johns Hopkins Children's Center, Baltimore 

7

6

7

Seattle Children's Hospital 

6

5

8

Childrens Hospital Los Angeles 

4

4

8

Children's Hospital of Pittsburgh of UPMC 

4

4

8

New York-Presbyterian Morgan Stanley-Komansky Children's Hospital 

4

4

8

St. Louis Children's Hospital-Washington University 

4

4

*1 point per specialty for scoring 1 standard deviation above the mean, 2 points for a score 2 standard deviations above the mean.

Follow Yahoo Health on and become a fan on

Follow @YahooHealth on
Related Health News