What does a Best Hospital ranking mean to a hospitalist?

U.S. News & World Report just came out with its list of “America’s Best Hospitals – 2008,” with hospitals ranked based on factors within 16 specialties, from cancer to urology. Do they mean anything?

U.S. News & World Report

USNWR

USNWR

() just came out with its list of “America'€™s Best Hospitals - 2008,” with only 170 of 5,453 scoring high enough by ’s standards to appear in any of 16 specialty rankings; hospitals were ranked based on factors within 16 specialties, from cancer to urology. Just 50 were ranked, and only 19 made the “honor roll,” having ranked high in six of the specialties:

The Honor Roll

1. Johns Hopkins Hospital (30 points in 15 specialties)

2. Mayo Clinic, Rochester (28 in 15)

3. Ronald Reagan UCLA Medical Center (25 in 14)

4. Cleveland Clinic (25 in 13)

5. Massachusetts General Hospital, Boston (24 in 12)

6. New York-Presbyterian Univ. Hosp. of Columbia and Cornell (22 in 12)

7. University of California, San Francisco Medical Center (21 in 11)

8. Brigham and Women's Hospital, Boston (tie)

Duke University Medical Center, Durham, NC (18 in 11)

10. Hospital of the University of Pennsylvania, Philadelphia (tie)

University of Washington Medical Center, Seattle (18 in 10)

12. Barnes-Jewish Hospital/Washington University, St. Louis (17 in 11)

13. University of Michigan Hospitals and Health Centers, Ann Arbor (14 in 9)

14. UPMC-University of Pittsburgh Medical Center (13 in 8)

15. Vanderbilt University Medical Center, Nashville (12 in 7)

16. Stanford Hospital and Clinics (10 in 7)

17. University of Chicago Medical Center (9 in 8)

18. Cedars-Sinai Medical Center, Los Angeles (8 in 7)

19. Yale-New Haven Hospital (8 in 6)

-Military and veterans’ hospitals are excluded.

Data and scores are available online for all the hospitals at the USNWR site by clicking on the hospital name in the ranking. Also, the top five hospitals in each of the 16 rankings are listed.

How they were ranked

Of the 16 specialty rankings, 12 were driven mostly by hard data, with the other four based on three years of nominations by surveyed specialists. Only hospitals that met one of three requirements—membership in the Council of Teaching Hospitals, affiliation with a medical school, or availability of at least six of 13 key technologies such as robotic surgery—were considered for the data-driven rankings, leaving out nearly two-thirds of all US hospitals.

USNWR

To be eligible, a hospital had to have performed a certain number of procedures that varied by specialty—for example 294 procedures for orthopedics—on Medicare inpatients in 2004, 2005, and 2006. Or, it had to have been nominated by at least one doctor who participated in the USNWR surveys in 2006, 2007, or 2008. The remaining 1,569 hospitals that were eligible to be ranked were then given a score from 0-100 based on the following:

• Reputation: A random sampling of 200 doctors for each of the 16 specialties listed the five hospitals they considered the best in their specialty, without considering cost or location

• Mortality index: Compares the number of Medicare inpatients with certain conditions who died within 30 days of admission with the number that would have been expected after adjusting for severity.

• Other care-related factors: Looks at technology, volume, nurse staffing, and other patient-related information.

A hospitalist—high rank correlation?

USNWR

USNWR

USNWR

Johns Hopkins—ranked number one by the has eight physicians in its hospitalist program, whereas the University of Michigan Hospital and Mott’s Children’s Hospital—part of the University of Michigan Hospitals and Health Centers, which ranked 13th—together have 40 full- or part-time hospitalists, significantly more than the top-ranking Hopkins. Is there a correlation between a ranking and a commitment to hospitalist medicine and the focus on quality and continuity of care that comes with it? Does the presence of a hospitalist program, regardless of the number of physicians within it, do anything to put a hospital at the top of the list? Does the presence of a hospitalist program inherently elevate the quality of a hospital?

Does it matter?

USNWR

USNWR

Are these rankings even useful? Are they leaving so many other factors out of consideration that they don’t mean anything? What are these factors? Should your hospital have ranked higher? Was a hospital not even ranked because of some of the exclusions set by , leaving off an otherwise excellent facility? Do patients look at these rankings and request to their physician to undergo a procedure at a given hospital accordingly? Is Johns Hopkins really that good (ranked at the top for 18 years running), or is the ranking system flawed and/or biased in some way? How badly does a focus on specialties, not on general/internal medicine, hurt the quality of the rankings?