America’s Best Hospitals 2008 Methodology 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 [email protected]. 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..................................................................................................................... 7 AHA Annual Survey.................................................................................................. 9 External Organizations ............................................................................................ 16 Trimming ................................................................................................................. 18 Weighting................................................................................................................. 19 C. Outcomes ................................................................................................................. 21 2008 DRG Groupings .............................................................................................. 21 Refinements to the Mortality Methodology ............................................................ 22 Mortality Scoring..................................................................................................... 24 Recoding Mortality Values for Hospitals with Low Volume.................................. 25 D. Process ..................................................................................................................... 26 Sample for the 2008 Survey .................................................................................... 27 Survey Procedure..................................................................................................... 29 Survey Response Weighting.................................................................................... 30 E. Calculation of the Index........................................................................................... 33 III. Reputation-Only Specialties........................................................................................... 34 A. Eligibility ................................................................................................................. 34 B. Process ..................................................................................................................... 35 C. Calculation of the Rankings..................................................................................... 35 IV. The Honor Roll................................................................................................................ 35 V. Summary of Changes for 2005–2008............................................................................. 36 VI. Future Improvements..................................................................................................... 37 VII. References........................................................................................................................ 39 i List of Tables Table 1. Minimum Discharges by Specialty................................................................................... 6 Table 2. Eligible Hospitals That Did Not Meet Minimum Discharge Criteria but Were Eligible under the Non-Zero Reputation Rule................................................................. 7 Table 3. Advanced Technologies by Specialty............................................................................. 12 Table 4. Patient Services by Specialty..........................................................................................17 Table 5. Percentage (%) of Structural Score by Specialty............................................................ 20 Table 6. Physician Sample Mapping ............................................................................................ 28 Table 7. Physician Survey Mailing Schedule ............................................................................... 30 Table 8. Yearly Response Rate by Specialty (2006–2008) .......................................................... 31 Table 9. Response Rates by Region and Specialty, 2006–2008................................................... 32 Table 10. Means and Standard Deviations for the IHQ-Driven Specialties................................. 34 Table 11. Means and Standard Deviations for the Reputation-Only Specialties.......................... 35 List of Figures Figure 1. Eligibility and Analysis Process for the IHQ-Driven Specialties ................................... 8 Figure 2. Effect of Winsorization at the 90th Percentile vs. Inverse Logit Transformation......... 19 Figure 3. Effect of Recoding Mortality for Low-Volume Hospitals ............................................ 26 List of Appendixes Appendix A 2006 Sample Physician Questionnaire................................................................... A-1 Appendix B 2007–2008 Sample Physician Questionnaire ......................................................... B-1 Appendix C Structural Variable Map ......................................................................................... C-1 Appendix D 2008 Diagnosis Related Group (DRG) Groupings, by Specialty........................... D-1 Appendix E 2008 Changes to DRG Groupings for Mortality .....................................................E-1 Appendix F 2008 Index of Hospital Quality (IHQ) Scores, by Specialty ...................................F-1 Appendix G 2008 Reputation-Only Rankings............................................................................ G-1 Appendix H The 2008 Honor Roll.............................................................................................. H-1 ii I. Introduction For families faced with a serious or complex medical problem, the choice of hospital can be critical. Until 1990, patients and healthcare providers had few tools or resources beyond their doctor’s recommendation to help focus their decision. That changed in 1990, when U.S. News & World Report initiated annual assessments of U.S. hospitals in the form of lists collectively titled “America’s Best Hospitals.” Each summer, U.S. News identifies and ranks hospitals of exceptional quality, this year drawing from a universe of 5,453 community hospitals.* Hospitals are assigned a composite score and ranked at the specialty level, based on data from multiple sources. The rankings and their associated data appear in the print magazine and online at http://health.usnews.com/sections/health/best-hospitals/index.html. The National Opinion Research Center (NORC) at the University of Chicago devised the underlying methodology for U.S. News in the early 1990s, then collected the data and compiled the rankings from 1993 to 2004. In 2005, RTI International† in Research Triangle Park, N.C., began producing the rankings. The methodology has been refined as research has indicated areas for improvement and change. Larger-scale adjustments are under constant consideration and will be adopted if they clearly enhance the usefulness, quality, and robustness of the rankings. For 2008, hospitals are ranked in 16 specialties: • Cancer • Neurology and Neurosurgery • Ear, Nose, and Throat • Ophthalmology • Endocrinology • Orthopedics • Gastrointestinal Disorders • Psychiatry • Geriatric Care • Rehabilitation • Gynecology • Respiratory Disorders • Heart and Heart Surgery • Rheumatology • Kidney Disease • Urology The rankings were developed and