Impact
Expert data collection and analysis to inform individual health care decisions and drive improvements in quality of care
Objective:
Provide information about how the nation’s hospitals perform in an array of medical specialties.
Approach:
Integrated survey data for evaluating health care quality based on structure, process, and outcomes.
Impact:
The rankings inform individual consumer health care decisions and drive improvements in quality of care by hospitals.
U.S. News & World Report has become known for its rankings and research as well as its reporting. Among the news outlet’s most-anticipated rankings each year is Best Hospitals, a roundup of how the nation’s hospitals perform in an array of medical specialties. The ranking began in 1990 as a purely expert opinion-based survey. By 1993, the survey integrated hard data organized around the Donabedian framework for evaluating health care quality based on structure, process, and outcomes.
Best Hospitals is a high-profile list with high-stakes decisions riding on it. Patients and families use it to make decisions about where to seek care, and medical professionals and institutions look to it when comparing themselves to others in terms of quality and improvement over time. In the early 2000s, U.S. News selected RTI as its new partner to take on the behind-the-scenes work of managing the project. The first full set of RTI-managed rankings was published in 2005.
Continuous Refining of Methodology to Produce Clear and Accurate Rankings
Since taking over the Best Hospitals rankings project, RTI has constantly refined the project methodology. Some years bring significant changes, others more subtle ones, but the goal is to produce better rankings that spur improvement throughout the health care system. For example, one helpful change was the switch from counting in-hospital mortality to 30-day mortality, so that deaths occurring shortly after patients go home from the hospital would be included in the measure.
Expanding the Project to Include Children’s Hospitals
The largest expansion of the project to date—the addition of Best Children’s Hospitals in 2007—has also been a key driver of innovation. This separate survey came about after a health care summit in which leaders in the field lamented the lack of a system to evaluate pediatric care. But with no sources of data comparable to what was available from the Centers for Medicare and Medicaid Services (CMS) used in ranking adult hospitals, RTI and U.S. News had to create their own solution.
The result is a comprehensive survey of more than 100 pages, written with the help of experts from children’s hospitals around the country, measuring the quality of care in ten pediatric specialties. The Best Children’s Hospitals rankings, published separately from the adult hospital list (Best Hospitals), are meant for families of children with serious illnesses, who may be traveling many miles to get the best care available.
The introduction of rankings to the pediatric side of the health care industry was unprecedented. Feedback from experts in the field over the past decade indicates that Best Children’s Hospitals has changed the way practitioners and researchers seek to measure and improve quality.
The Best Children’s Hospitals rankings are also informed by working groups of physicians, nurses, and health data systems professionals who advise the project on which measures are meaningful when evaluating pediatric healthcare.
“These groups help us keep up to date with the latest in healthcare and what is relevant when evaluating quality,” said Dr. Murrey Olmsted, the RTI project director.
Looking toward the future, the project is also exploring the addition of new measures in behavioral/mental health and addressing important issues related to health equity, disparities, and inclusion for both patients and providers in children’s hospitals.
Health Care and Survey Experts with Genuine Stake in the Project
RTI’s extensive experience in the health care sector puts us in a unique position to assess the quality of the nation’s hospitals. And our long history of rigorous survey methodology and study design ensures the strength of the rankings themselves.
But it’s the long-term, collaborative working relationship between RTI and U.S. News that truly makes the Best Hospitals project stand out, said Ben Harder, the Chief of Health Analyses at U.S. News & World Report. Over the years, Harder said, his RTI colleagues have helped refine the rankings, adding new and more relevant measures while removing those that are less valuable.
“It really feels more like an extension of our staff than it does working with a disinterested contractor,” Harder said. “It feels like RTI has a genuine stake in the product.”
Informing Individual Decisions and Elevating the Quality of Health Care
With more than 3 million readers visiting the Best Hospitals website each month, our work reaches a large, worldwide audience. Sheer numbers, though, are only the beginning. The rankings generate their own news and are frequently cited in academic and professional literature.
Leaders in the health professions also respect the rankings and the science behind them. Hospital officials, skeptical at first of being ranked at all, now use the results in advertisements, PR messages, and internal quality-improvement efforts.
Most importantly of all, the rankings are available to patients and families making crucial health care decisions.
