Methodology: U.S. News & World Report Best Children’s ...

Methodology: U.S. News & World Report Best Children's Hospitals 2019-20

Murrey G. Olmsted Rebecca Powell Joe Murphy Denise Bell

Marshica Stanley Rebekah Sanchez

August 5, 2019

To Whom It May Concern: U.S. News & World Report's "Best Children's Hospitals" study is the sole and exclusive property of U.S. News & World Report, L.P., 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 Best Children's Hospitals" and must include the following credit line: "Copyright ? 2019 U.S. News & World Report, L.P. Data reprinted with permission from U.S. News." For permission to cite or use, contact permissions@. For custom reprints, please contact Wright's Media at 877-652-5295 or usnews@.

Executive Summary

Pediatrics has been an element of Best Hospitals ever since 1990, when U.S. News & World Report published the first annual "America's Best Hospitals" rankings, as they were then called. The initial evaluations, in 12 specialties, comprised short lists of centers that were identified through a survey of physician specialists as providing the best care for the most challenging patients.

For the first time, patients and families had a tool to help narrow their search for a hospital particularly skilled in performing difficult procedures, treating serious conditions and otherwise demonstrating an especially high level of care. While that core mission has not changed, U.S. News broadened its scope in 2015 by adding ratings of some 4,600 hospitals in relatively commonplace procedures and conditions such as heart bypass surgery, knee and hip joint replacement and COPD.

By 1993 hard data had been incorporated into most Best Hospitals specialty rankings, but until 2007 the pediatric rankings continued to rely entirely on an annual survey of pediatric specialists because hard data comparable to the MedPAR files for Medicare recipients was unavailable. Pediatric-specific data were critical. Benchmarking and data generated from adult patients, to the extent that such information existed at all, could not be applied to children. Structuring coordinated care for congenital conditions such as spina bifida and cystic fibrosis, determining drug dosages and minimizing vulnerability to infection are a few of many factors that make pediatric patients unique.

Lacking robust pediatric data bases, U.S. News elected to collect data directly from children's hospitals through a comprehensive clinical and operational survey. The first rankings to incorporate data from such a survey, developed by RTI International*, were published in 2007 in the form of the top 30 children's centers in General Pediatrics. Specialty rankings were not included.

In the years that followed, data collection was broadened and deepened. The current methodology continues to include reputational survey results (expert opinion) as well as supplemental information from resources such as the National Cancer Institute. Best Children's Hospitals now ranks the top 50 centers in 10 specialties: Cancer, Cardiology & Heart Surgery, Diabetes & Endocrinology, Gastroenterology & GI Surgery, Neonatology, Nephrology, Neurology & Neurosurgery, Orthopedics, Pulmonology & Lung Surgery and Urology.

To provide parents with information about more centers and demonstrate transparency, pediatric centers below the line ? that is, those that are not nationally ranked ? are now displayed.

* RTI International is the trade name of Research Triangle Institute.

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Pediatric centers that provided sufficient data to receive an overall U.S. News Score but fell short of the top 50 are displayed with their calculated metrics but without rank or score.

Each of the 191 facilities surveyed for the 2019-20 Best Children's Hospitals rankings is either a freestanding children's hospital or a "hospital within a hospital" ? a large, essentially autonomous multidisciplinary pediatric department within a major medical center. Most are members of the Children's Hospital Association (CHA).

RTI International collects and analyzes the data for the "Best Children's Hospitals" rankings. The methodology reflects clinical outcomes, such as patient survival, infection rates and complications; the level and quality of hospital resources directly related to patient care, such as staffing, technology and special services; delivery of healthcare, such as programs that prevent infections and adherence to best practices; and expert opinion among pediatric specialists.

In the 2019-20 rankings, 84 of the 191 surveyed hospitals were ranked among the top 50 in at least one specialty. The 2019-20 Best Children's Hospitals Honor Roll recognizes the 10 hospitals with the highest rankings across all specialties.

The National Association for Children's Hospitals and Related Institutions (NACHRI) was renamed the Children's Hospital Association in 2012. See for details. RTI International is the trade name of Research Triangle Institute.

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Table of Contents Executive Summary................................................................................................................... 1 I. Introduction ................................................................................................................... 1 II. Eligibility........................................................................................................................3

A. General Eligibility ......................................................................................................................3 B. Specialty-Specific Eligibility......................................................................................................3

III. Pediatric Hospital Survey ..............................................................................................4 IV. Structure .........................................................................................................................5

A. Structural Measures....................................................................................................................6 Accredited by FACT (Cancer) .................................................................................................6 Active Fellowship Program (All Specialties)..........................................................................6 Adoption of Health Information Technology (All Specialties) ..........................................8 Adult Congenital Heart Program (Cardiology & Heart Surgery)........................................9 Advanced Clinical Services Offered (All Specialties)............................................................9 Advanced Technologies (All Specialties)..............................................................................17 Bone Marrow Transplant Services (Cancer) ........................................................................20 Clinical Support Services Offered (All Specialties) .............................................................20 Commitment to Clinical Research (All Specialties) ............................................................22 Commitment to Quality Improvement (All Specialties) ....................................................25 Congenital Heart Program (Cardiology & Heart Surgery).................................................26 ECMO Availability (Neonatology)........................................................................................27 Enlists Families in Structuring Care (All Specialties)..........................................................27 Has Fulltime Subspecialists Available (All Specialties).......................................................28 Heart Transplant Program (Cardiology & Heart Surgery).................................................34 Help for Families (All Specialties) .........................................................................................34 Liver Transplant Program (Gastroenterology & GI Surgery)...........................................35 Lung Transplant Program (Pulmonology & Lung Surgery) ..............................................35 Neonatal Transport (Neonatology).......................................................................................36 Nurse Staffing (All Specialties) ..............................................................................................37 Percent of Dialysis Patients Who Had Transplants (Nephrology)...................................37 Provides Advanced Palliative Care Program (Cancer) .......................................................37 Recognized as Nurse Magnet Hospital (All Specialties).....................................................38 Specialized Clinics and Programs (Cancer, Cardiology & Heart Surgery, Diabetes & Endocrinology, Gastroenterology & GI Surgery, Neonatology, Neurology & Neurosurgery, Orthopedics, Urology)..........................................................38 Success in Helping Patients Manage Their Asthma (Pulmonology & Lung Surgery) ...................................................................................................................................... 40 Success in Managing Neuromuscular Weakness Disorder (Pulmonology & Lung Surgery) ...........................................................................................................................41 Tracking Growth Metrics for Treated Patients (Neonatology) ........................................41 Volume of Patients (All Specialties)......................................................................................41

B. Normalization...........................................................................................................................54 C. Weighting ..................................................................................................................................54

V. Process .........................................................................................................................57

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