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2009 Methodology: “America's Best Hospitals”

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2009 Methodology: “America's Best Hospitals” 2009 Methodology: “America’s Best Hospitals” Emily McFarlane Joe Murphy Murrey G. Olmsted Edward M. Drozd Craig Hill To Whom It May Concern: U.S. News & World Report’s “America’s Best Hospitals” study is the sole and exclusive property of U.S. News & World Report, which owns all rights, including but not limited to copyright, in and to the attached data and material. Any party wishing to cite, reference, publish, or otherwise disclose the information contained herein may do so only with the prior written consent of U.S. News. Any U.S. News-approved reference or citation must identify the source as “U.S. News & World Report’s America’s Best Hospitals” and, with the exception of academic journals, must include the following credit line: “Data reprinted with permission from U.S. News & World Report.” For permission to cite or use in any other way, contact [email protected] or send a written request to Permissions Department, c/o Mary Lu Meixell, U.S. News & World Report, 1050 Thomas Jefferson Street, NW, Washington, DC 20007-3837. For custom reprints, please contact Wright's Reprints at 877.419.5725 or email . Table of Contents I. Introduction....................................................................................................................... 1 A. Index of Hospital Quality........................................................................................... 2 Structure..................................................................................................................... 3 Process ....................................................................................................................... 3 Outcomes ................................................................................................................... 4 B. Reputation-Only Rankings......................................................................................... 4 C. Report Outline............................................................................................................ 4 II. The Index of Hospital Quality ......................................................................................... 5 A. Eligibility ................................................................................................................... 5 B. Structure..................................................................................................................... 9 AHA Annual Survey.................................................................................................. 9 External Organizations ............................................................................................ 17 Trimming ................................................................................................................. 19 Weighting................................................................................................................. 20 C. Outcomes ................................................................................................................. 20 Mortality Methodology............................................................................................ 23 Mortality Scoring..................................................................................................... 25 Recoding Mortality Values for Hospitals with Low Volume.................................. 25 D. Process ..................................................................................................................... 26 Sample for the 2009 Survey..................................................................................... 26 Survey Procedure..................................................................................................... 27 Survey Response Weighting.................................................................................... 30 E. Patient-Safety Index................................................................................................. 32 Background.............................................................................................................. 32 Development of the Patient Safety Measure............................................................ 32 F. Calculation of the Index........................................................................................... 34 III. Reputation-Only Specialties........................................................................................... 36 A. Eligibility ................................................................................................................. 36 B. Process ..................................................................................................................... 37 C. Calculation of the Rankings..................................................................................... 37 IV. The Honor Roll................................................................................................................ 37 V. Summary of Changes, 2005–2009.................................................................................. 38 VI. Future Improvements..................................................................................................... 40 Contact Information.......................................................................................................... 40 VII. References........................................................................................................................ 41 i List of Tables Table 1. Minimum Discharges by Specialty................................................................................... 7 Table 2. Eligible Hospitals That Did Not Meet Minimum Discharge Criteria but Were Eligible under the Non-Zero Reputation Rule................................................................. 7 Table 3. Key Technologies by Specialty ...................................................................................... 13 Table 4. Patient Services by Specialty.......................................................................................... 17 Table 5. Percentage (%) of Structural Score by Specialty............................................................ 21 Table 6. Physician Sample Mapping ............................................................................................ 28 Table 7. Physician Survey Mailing Schedule ............................................................................... 29 Table 8. Yearly Response Rate by Specialty (2007–2009) .......................................................... 30 Table 9. Response Rates by Region and Specialty, 2009............................................................. 31 Table 10. Comparison of the AHRQ PSI Index and the Best Hospitals Patient-Safety Index .............................................................................................................................. 33 Table 11. Means and Standard Deviations for the IHQ-Driven Specialties ................................. 36 Table 12. Means and Standard Deviations for the Reputation-Only Specialties.......................... 37 List of Figures Figure 1. Eligibility and Analysis Process for the IHQ-Driven Specialties ................................... 8 List of Appendices Appendix A 2009 Sample Physician Questionnaire............................................................... A-1 Appendix B 2007–2008 Sample Physician Questionnaire..................................................... B-1 Appendix C Structural Variable Map .................................................................................... C-1 Appendix D 2009 Diagnosis Related Group (DRG) Groupings, by Specialty .................... D-1 Appendix E 2009 Changes to DRG Groupings for Mortality .............................................. E-1 Appendix F 2009 Index of Hospital Quality (IHQ) Scores, by Specialty..............................F-1 Appendix G 2009 Reputation-Only Rankings........................................................................G-1 Appendix H The 2009 Honor Roll...........................................................................................H-1 ii I. Introduction For families faced with a serious or complex medical problem, the choice of hospital can be critical. Yet they had few tools or resources beyond a doctor’s recommendation to inform their decision until 1990, when U.S. News & World Report introduced “America’s Best Hospitals.” Initially, the annual assessments took the form of alphabetized lists in 12 specialties, but in 1993 and thereafter, hospitals were ranked within each specialty. This year’s “America’s Best Hospitals” draws from a universe of 4,861 medical facilities.* In 12 of the 16 adult specialty rankings, hospitals receive a composite score that is based on data from multiple sources. (“America’s Best Children’s Hospitals,”† which ranks hospitals in 10 pediatric specialties, is a separate project.) The rankings and key portions of the accompanying data are published in a print edition; both ranked and unranked hospitals, with additional data, are published online at http://health.usnews.com/sections/health/best-hospitals/index.html. It is important to understand that the rankings were developed and the specialties chosen explicitly to help consumers determine which hospitals provide the best care for the most serious or complicated medical conditions and procedures—pancreatic cancer or replacement of a heart valve in an elderly patient with comorbidities, for example. Medical centers that excel in relatively commonplace conditions
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