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Best Hospitals 2011-12

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Best Hospitals 2011-12: the Honor Roll

For clinical excellence, these 17 hospitals possess a rare blend of breadth and depth

A place on the Best Hospitals Honor Roll is reserved for medical centers that demonstrate unusually high expertise across multiple specialties, scoring at or near the top in at least six of 16 specialties. Just 17 of the nearly 5,000 hospitals evaluated for the 2011-12 rankings qualified. Hospitals with the highest scores in a given specialty received 2 Honor Roll points; those with slightly lower scores received 1 point.* Honor Roll standing was determined by the total number of Honor Roll points across all 16 specialties.

Rank

Hospital

Points

Specialties

1

Johns Hopkins Hospital, Baltimore

30

15

2

Massachusetts General Hospital, Boston

29

15

3

Mayo Clinic, Rochester, Minn.

28

15

4

Cleveland Clinic

26

13

5

Ronald Reagan UCLA Medical Center, Los Angeles

25

14

6

New York-Presbyterian University Hospital of Columbia and Cornell, N.Y.

22

12

7

UCSF Medical Center, San Francisco

20

11

8

Brigham and Women's Hospital, Boston

18

12

9

Duke University Medical Center, Durham, N.C.

18

10

10

Hospital of the University of Pennsylvania, Philadelphia

17

12

11

Barnes-Jewish Hospital/Washington University, St. Louis

16

11

12

UPMC-University of Pittsburgh Medical Center

14

8

13

University of Washington Medical Center, Seattle

13

9

14

University of Michigan Hospitals and Health Centers, Ann Arbor

10

6

14

Vanderbilt University Medical Center, Nashville

10

6

16

Mount Sinai Medical Center, New York

8

6

17

Stanford Hospital and Clinics, Stanford, Calif.

7

6

* 2 points for scores 4 or more standard deviations above the mean, 1 point for scores from 3 to 4 standard deviations above the mean.

The Methodology

Our intent when we published the first Best Hospitals annual rankings in 1990 was to help people who find themselves in need of unusually skilled inpatient care, and that mission hasn't changed in Year 22. The Best Hospitals rankings judge medical centers on their competence in exactly such high-stakes situations. For example, a hospital ranked in cardiology and heart surgery—one of 16 specialties in which centers were evaluated—likely has the expertise and experience to replace a faulty heart valve in a man in his 90s. Most hospitals would decline to perform major surgery on elderly patients, as they should if they aren't up to speed on the special techniques and precautions required and don't see many such patients. A ranked hospital in gastroenterology can probably offer the most appropriate care to a patient whose inflammatory bowel disease flares up. At hospitals ranked in neurology and neurosurgery, surgeons face more spinal tumors in a couple of weeks than most community hospitals see in a year. 

By contrast, other hospital ratings and rankings for the most part examine how well hospitals treat relatively unthreatening conditions or perform fairly routine procedures, such as hernia repair and uncomplicated heart bypass surgery. The majority of hospital patients need such ordinary care, so for them that approach to evaluating hospitals works fine. But it falls short for patients who are especially at risk because of age, physical condition, infirmities, or the challenging nature of the surgery or other care they need.

A good way to determine how well a hospital deals with a medical challenge is to evaluate its performance across a range of challenges within the specialty. U.S. News ranks hospitals in 16 different specialties, from cancer to urology. This year, only 140 of the 4,825 hospitals that we evaluated performed well enough to rank in even one specialty. And of the 140, just 17 qualified for a spot on the Honor Roll by ranking at or near the top in six or more specialties.

In 12 of the 16 areas, whether and how high a hospital is ranked depended largely on hard data, much of which comes from the federal government. Many categories of data went into the rankings. Some are self-evident, such as death rates. Others, such as the number of patients and the balance of nurses and patients, are less obvious. A survey of physicians, who are asked to name hospitals they consider tops in their specialty, produces a reputation score that is also factored in.

Hospitals in the four remaining specialties—ophthalmology, psychiatry, rehabilitation, and rheumatology—were ranked solely based on their reputation among specialists. Most of the care in these specialties is delivered on an outpatient basis, and so few patients die that mortality data, which carry heavy weight in the 12 other specialties, mean little.

To be in the running for a ranking in any of the 12 data-driven specialties, a hospital had to meet any of four criteria: It could be a teaching hospital, it could be affiliated with a medical school, it could have at least 200 beds, or it could have at least 100 beds plus four or more of eight key medical technologies, such as a PET/CT scanner and certain precise radiation therapies. This year, 2,196 hospitals, or 46 percent of the initial number, met that test.

Eligibility in a particular specialty required hospitals to meet a volume requirement. The threshold was a specific number of Medicare inpatients, different for each specialty, who were discharged in 2007, 2008, and 2009 (the three most recent years for which data are available), based on a defined set of specialty-related procedures and conditions. The minimum number of cancer discharges, for example, was 254, of which 48 had to have been surgery patients; in neurology and neurosurgery the corresponding numbers were 341 total and 86 surgical. A hospital that fell short still could make it through the gate if nominated by at least 1 percent of the physicians in a specialty who responded to the 2009, 2010, and 2011 reputational surveys. That left 1,879 hospitals eligible in at least one specialty. But only slightly more than 7 percent of them performed well enough to be ranked in any specialty.

In each specialty in which a hospital was a candidate, it received a U.S. News Score from 0 to 100 that was based on four elements: reputation, patient survival, patient safety, and care-related factors such as nursing and patient services. The 50 top performers were then ranked. Scores and data for all qualifying hospitals in each specialty are also posted. (Use of electronic health records did not factor into any specialty ranking. But see our separate list of Most Connected Hospitals.) The four elements and their weightings, in brief:

Survival score (32.5 percent). A hospital's success at keeping patients alive was judged by comparing the number of Medicare inpatients with certain conditions who died within 30 days of admission in 2007, 2008, and 2009 with the number expected to die given the severity of illness. Hospitals were scored from 1 to 10, with 10 indicating the highest survival rate relative to other hospitals and 1 the lowest rate. A software program used by many researchers in the field, 3M Health Information Systems MS-DRG Grouper, took each patient's condition into account.

Patient safety score (5 percent). Harmful blunders occur at every hospital; this score reflects how hard a hospital works to prevent six of the most egregious types. A 3 puts a hospital among the 25 percent of those that were best in this regard, a 2 in the middle 50 percent, and a 1 in the lowest 25 percent. Examples of the six kinds of medical episodes factored in are deaths of patients whose conditions should not have put them at significant risk and surgical incisions that reopen.

Reputation (32.5 percent). Each year, 200 physicians per specialty are randomly selected and asked to list hospitals they consider to be the best in their specialty for complex or difficult cases. A hospital's reputational score is based on the total percentage of specialists in 2009, 2010, and 2011 who named the hospital. This year some physicians were asked to list up to five hospitals, the rest to list up to 10.

Other care-related indicators (30 percent). These include nurse staffing, technology, and other measures related to quality of care. The American Hospital Association's 2009 survey of all hospitals in the nation was the main source.

In the rankings based only on reputation, hospitals were listed on the basis of responses to the most recent three years of physician surveys. Ranked hospitals were cited by at least 5 percent of responding physicians.

The rankings were produced for U.S. News by RTI International, a leading research organization based in Research Triangle Park, N.C. Be sure to add your own fact-gathering to ours; no hospital is best for every patient.

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