• 6/6/2004
  • By Avery Comarow

No matter how friendly the ads and cheery the redecorated rooms, hospitals are not hotels. Patients aren’t pampered, especially with nurses and other key hospital workers in short supply. Besides, would you go to a hotel if told you had a 1 in 30 or so chance of not emerging? That’s true for many surgical procedures. Even great hospitals have their tragedies. A year ago, in June, a healthy 24-year-old woman died after volunteering for a study at Johns Hopkins Hospital in Baltimore. Last January, a healthy man who had donated part of his liver to his ailing brother died at Mount Sinai Medical Center in New York; his surgeon is tops at live-donor liver transplants.

Face it: People who check into hospitals are there because they are too ill, or need treatment that is too ambitious or difficult, to be outpatients. Elite in a grim way, they are a class in decline. In 1980, about 1 hospital patient in 7 stayed overnight. By 1990 that had dwindled to 1 in 10 and by 2000 to a scant 1 in 16.

The sicker the patient, the more pressing the need for the best care–which is why U.S. News is publishing its 13th annual edition of “America’s Best Hospitals.” They rank 205 top medical centers, winnowed from 6,045, in 17 specialties.

These hospitals excel partly because their doctors perform large numbers of tricky and risky procedures. Study piled upon study has shown the critical role of volume. In April, for example, a paper in the New England Journal of Medicine found that elderly patients had a death rate of 4 percent at hospitals that did many pancreatic cancer surgeries compared with 16 percent at hospitals that did relatively few. Ranked hospitals tend to adhere more closely to advanced treatment guidelines, to incorporate new findings into patient care, and to conduct research that gives desperately ill patients more options.

In 13 of the 17 specialties, a hospital first must meet one of three standards to be considered: membership in the Council of Teaching Hospitals, affiliation with a medical school, or availability of at least nine of 17 specified items of medical technology. That whittled the 6,045 hospitals down to 1,958. In each specialty, a hospital must perform a given number of procedures or had to be cited by at least one physician in the past three years of U.S. News surveys. These hospitals received a score (the U.S. News Index) that equally weighs reputation, mortality, and a group of care-related factors such as nursing. Each specialty’s 50 highest-scoring hospitals are listed. For cancer the list of these hospitals is located on the resources page of the Oral Cancer Foundation’s web site.

Hospitals in the four remaining specialties (eyes, pediatrics, psychiatry, and rehabilitation) are ranked solely on reputation and did not have to meet an eligibility requirement. That is because mortality data are unavailable in pediatrics and are largely irrelevant in the three other specialties.

The “America’s Best Hospitals” methodology was devised in 1993 by the National Opinion Research Center at the University of Chicago, which carries it out and refines it. This year’s rankings were produced by Colm O’Muircheartaigh, Joseph Murphy, and Whitney Moore. The U.S. News Index accounts for:

Reputation. In each specialty, 180 board-certified physicians were selected at random and asked to list up to five hospitals they consider tops in their specialty regardless of cost or location. The score shows the percentage of responding doctors in 2000, 2001, and 2002 who picked the hospital. The number of doctors surveyed was raised by 30 per specialty this year; a total of 8,160 physicians were surveyed for the three-year period.

Mortality. This ratio compares the number of deaths of Medicare patients with specified conditions in 1998, 1999, and 2000 with the number expected. A ratio below 1.00 is better than expected; above 1.00 is worse. Adjustments for severity were derived from 3M Health Information Systems software (All Patient Refined Diagnosis Related Group).

Other factors.Most remaining data came from the 2000 annual survey of hospitals by the American Hospital Association. This year hospice and palliative care were added to certain specialties because of the increasingly recognized importance of end-of-life issues and pain management. How a particular hospital fares in these rankings should not be taken as the final word–but it is a good place to start the search for the level of care you or a loved one deserve when it is most needed.

OCF link to list Click Here