At Texas Children’s Hospital, the difference is life changing.™ That belief is reflected in our place as a leader in pediatric care, recognized as #3 in the country by U.S. News & World Report’s 2023–24
Best Children’s Hospitals rankings. For the 7th year in a row, Texas Children’s Hospital is ranked #1 in pediatric cardiology and heart surgery. All 10 of our specialties are ranked in the top 10 for the 2nd year in a row, including:
Cardiology & Heart Surgery
Pulmonology
Nephrology (kidney disorders)
Neurology & Neurosurgery
Diabetes & Endocrinology
Neonatology
Cancer
Gastroenterology & GI Surgery
Urology
Orthopedics
CHAPTER TWO
12 A New Era of Health Care
Now that the pandemic has ended, changes are coming to key areas like Medicaid and telehealth.
36 Health Equity Is in Our Hands
Better use of data and changes to medical care are among the ways we can boost health parity.
40 Where Did All the Doctors Go?
More must be done to ease the burden of primary care physicians and increase their numbers.
42 Best Hospitals for Maternity Care
These 297 hospitals earned top marks for maternity care.
50 Confronting the Maternal Health Crisis
Meet four experts leading the fight for better outcomes for our country’s mothers and their babies.
56 Treating the Trauma that Underlies Addiction
Trauma-informed care could help address the nation’s opioid crisis.
Patient Power
78 7 ways to Prevent Medical Errors
Take control of your medical care with these doctor-approved tips.
82 Surgery Planned? Read This First. 12 steps to take before you walk into the operating room.
88 Homeward Bound
Before you’re discharged from the hospital, take the time to set yourself up for a healthier future.
92 Is Ozempic the Answer?
Doctors say that the weight loss medication has its drawbacks.
98 Best Diets of 2023
Your goal: to find the plan that will work for you.
101 8 Mind-Blowing Benefits of Exercise
Working out can impact mental wellbeing in wonderful ways. 12
NCI
Designated Comprehensive Cancer Center
The National Cancer Institute recognizes only the nation’s most elite cancer centers as Comprehensive Cancer Centers for their groundbreaking research, innovative clinical trials, scientific leadership, resources, and impact on their community. Rutgers Cancer Institute of New Jersey in partnership with RWJBarnabas Health is New Jersey’s only NCI-designated Comprehensive Cancer Center. With locations across the state, NCI-designated cancer care is never far from home. Visit rwjbh.org/beatcancer or call 844-CANCERNJ
2023 Recognizing Great Achievements
The American College of Cardiology applauds the hospitals and health care facilities that achieve the HeartCARE Center distinction and the work of the CV champions who provide leadership in this great accomplishment.
The unwavering support of the many dedicated physicians and care team members, including credentialed Fellows and Associates of the ACC, is essential to each HeartCARE Center achievement.
To further spotlight this achievement, the Find Your Heart a Home tool located on CardioSmart.org includes the mention of the HeartCARE Center award as part of an awarded hospital’s profile.
Please visit
to learn how your facility can achieve ACC’s HeartCARE Center recognition.
Adventist HealthCare Shady Grove Medical Center
Rockville, MD
Kevin Richman, MS, AACC
Dennis Friedman, MD, FACC
Bayhealth Hospital, Kent Campus Dover, DE
Benjamin Louis Collins, MBA, BSN, RN, AACC
John W. Shuck, MD, FACC
Christiana Care Health System
Newark, DE
Jennifer Oldham, MSN, RN, AACC
Neil Wimmer, MD, FACC
Conemaugh Memorial Medical Center, LLC
Johnstown, PA
Sarah Vasilko, PA-C, AACC
Dinesh Sharma, MD, FACC
Einstein Medical Center Philadelphia Philadelphia, PA
Yolanda Nixon, ACNP-BC, CRNP, MSN, AACC
Sumeet K. Mainigi, MD, FACC
Hackensack University Medical Center
Hackensack, NJ
Tammy Russo, ACNP, AACC
Vaidya J. Pranaychandra, MBBS, FACC
Jersey Shore University Medical Center Neptune, NJ
Jennifer Heck-Kanellidis, DNP, AACC
Brett Sealove, MD, FACC
John F. Kennedy Medical Center Edison, NJ
Jodelle Gold, ACNP-BC, AACC
Raj Ballal, MD, FACC
Lahey Hospital and Medical Center Burlington, MA
Shauna L Holden, NP-C, AACC
Frederic S. Resnic, MD, FACC
Lawrence General Hospital Lawrence, MA
Kathy Caredeo, RN-BSN, MM, AACC
Sunit Mukherjee, MD, FACC
Ocean Medical Center Brick, NY
Sara Belajonas, MSN, MBA, CCRN, APN-C, AACC
Ali Moosvi, MD, FACC
Penn Medicine Chester County Hospital West Chester, PA
Ralph Smith, RN, BSN, AACC
Timothy Boyek, MD, FACC
Regional Hospital of Scranton Scranton, PA
Debra Jadick, CNS, AACC
Thomas Dzwonczyk, MD, FACC
Riverview Medical Center Red Bank, NJ
Elvira Baquerizo, MSN, MBA, APN, NP-C, CCRN, AACC
Ravi Diwan, MD, FACC
St. Elizabeth Medical Center Utica, NY
Stephanie Mathias, CCRN, AACC
Hugh MacIsaac, MD, FACC
St. Francis Hospital and Heart Center Roslyn, NY
Kristin Michele Pasquarello, MPAS, AACC
Thomas W. Pappas, MD, FACC
UPMC Altoona Altoona, PA
Kristi Montrella, ACNP-BC, AACC
George Jabbour, MD, FACC
MIDWEST
Bryan Medical Center Lincoln, NE
Sarah Schroeder, PhD, ACNP-BC, AACC
John Allen Steuter, MD, FACC
Lutheran Hospital of Indiana Fort Wayne, IN
Amanda Lutter, AGPCNP-BC, AACC
Vijay Chilakamarri, MD, FACC
Spectrum Health Butterworth Hospital
Grand Rapids, MI
John Mulder, MPAS, AACC
David Wohns, MD, FACC
Summa Health System - Akron Campus
Akron, OH
Rebecca L. Angerstein, CNS, AACC
Roger B. Chaffee, MD, FACC
SOUTH
AdventHealth Carrollwood Tampa, FL
Joy Sherry Viars, ARNP, AACC
Humberto Coto, MD, FACC
AdventHealth Dade City
Dade City, FL
Deborah Moore, MSN, RCIS, RN, AACC
Aung Tun, MBBS, FACC
AdventHealth North Pinellas
Tarpon Springs, FL
Belinda Michelle Spahn, BSN, CCRN, AACC
Norman S. Abbott, MD, FACC
AdventHealth Ocala
Ocala, FL
Lynn Smith, RN, AACC
Robert L. Feldman, MD, FACC
AdventHealth Sebring
Sebring, FL
James Leicht, RCIS, AACC
Deepti Bhandare, MD, FACC
AdventHealth Tampa, Pepin Heart Institute
Tampa, FL
Richard N. Dance, PharmD, AACC
Charles R. Lambert, MD, PhD, MBA, FACC
AdventHealth Wesley Chapel
Wesley Chapel, FL
Allison K. Sutton, APRN, FNP-C, AACC
Asad Sawar, MBBS, FACC
AdventHealth Zephyrhills Zephyrhills, FL
Deborah Moore, MSN, RCIS, RN, AACC
Aung Tun, MBBS, FACC
Augusta Health Fishersville, VA
Willie Roden, MBA, BSN, RN, AACC
Shalendra K. Varma, MD, FACC
Baptist Health Lexington Lexington, KY
Megan Switzer, MSN, APRN, AACC
Azhar Aslam, MD, FACC
Baptist Health Paducah Paducah, KY
Blair Brockman, NP, AACC
Craig Beavers, PharmD, FACC
CarolinaEast Medical Center
New Bern, NC
Laura Peters, BS, RT, AACC
Alex Kirby, MD, FACC
Baylor St. Luke’s Medical Center Houston, TX
Seth Stephens, ACNP-BC, APRN, CPHQ, DNP, AACC
Emerson C. Perin, MD, FACC
CHRISTUS Highland Medical Center
Shreveport, LA
Sheena Youngblood, DNP, APRN, AGACNP-BC, FNP-C
Paul Davis, MD, FACC
CHRISTUS Mother Frances Hospital Tyler, TX
Jamie Moore, BSN, RN, AACC
Oscar Paniagua, MD, FACC
CHRISTUS St. Frances Cabrini Hospital Alexandria, LA
144 Kids’ Food Allergies: A Racial Divide Racial disparities in food allergies are multiple and complex, and the consequences can be devastating for children and their parents.
148 Fighting for Better Youth Mental Health Support When it comes to solving the mental health crisis facing our country’s teens, it truly takes a village.
152 The Great Multivitamin Debate Do kids need supplements – or can their nutritional needs be met through the food on their plates?
The U.S. News Rankings
Hospitals
184 Getting Care Near Home
Read about how U.S. News identified and ranked top hospitals in each state. 186 The
See how nearby hospitals performed in areas of specialty care and in common procedures and conditions.
202 Best Regional Children’s Hospitals A region-by-region ranking based on performance in 10 specialties.
Here’s What’s @usnews.com
You’ll find a wealth of advice on staying well and finding care
NUTRITION & LIFESTYLE
Best Diets
A look at some of the most popular and most researched diets, with reviews by a panel of health experts. Discover the top diets for weight loss, diabetes management and heart health, as well as the best plant-based and commercial diets. usnews.com/bestdiets
Eat + Run
Eating healthfully and staying in shape can be tough to manage. We regularly serve up expert advice to support you. usnews.com/eat-run
INSURANCE
Best Medicare
Advantage Plans
State-by-state ratings of insurers offering Medicare Advantage and Medicare Part D plans, plus tips on choosing one of these plans vs. original Medicare. usnews.com/medicare
POPULATION HEALTH
Healthiest Communities
An interactive platform featuring news, analysis and county-level rankings that examine how social factors shape America’s health and well-being. usnews.com/ healthiestcommunities
BEST HOSPITALS HONOR ROLL
A Tour of the Top 22
See the best of the Best Hospitals –22 centers that lead the pack in a host of specialties, procedures and conditions, excelling in both breadth and depth of care. usnews.com/hospitalphototour
In Specialties, Procedures & Conditions
We’ve evaluated more than 5,000 hospitals on 21 common procedures and conditions, including hip replacement, knee replacement, heart bypass surgery, colon cancer surgery, diabetes and stroke, as well as 15 medical specialties from cancer care and orthopedics to cardiology and heart surgery. usnews.com/best-hospitals
SENIOR CARE
Best Nursing Homes
An analysis of government data and published ratings of nearly 15,000 nursing home facilities throughout the United States. usnews.com/nursinghomes PHARMACIST PICKS
Top Recommended Health Products
Which over-the-counter products do pharmacists prefer? Check out Top Recommended Health Products to make your next trip to the drugstore easier. usnews.com/tophealthproducts
PHYSICIAN SEARCH TOOL
Doctor Finder
A searchable directory of more than 750,000+ doctors. Patients can find and research doctors who have the training, certification, practical experience and hospital affiliation they want – and can see ratings based on other patients’ experience. With free registration, physicians can update the profile patients see. usnews.com/doctors
BEST HOSPITALS
Meet Levi, a two-year-old Bronchopulmonary Dysplasia patient. He's one of thousands of children traveling to Nationwide Children's Hospital for life-saving care. As America's largest neonatal network, every patient receives the highest level of personalized care from our internationally-recognized team of researchers and physicians. Expert care from bench to bedside.
Welcome to Nationwide Children’s Hospital. Guided by an unwavering belief in tomorrow’s potential, we invest in groundbreaking research that paves the way for revolutionary medical breakthroughs, benefiting children everywhere.
Our mission is to provide hope and help to families facing the most daunting childhood diseases and the very best care to the most critically ill young patients.
We take pride in being one of the nation’s oldest and largest not-for-profit freestanding pediatric health care institutions. Our team of 16,000 dedicated professionals is second to none — committed to delivering the finest care while challenging the boundaries of what others consider impossible.
A New Era of Health Care
Now that the COVID emergency has ended, changes are coming to key areas like Medicaid and telehealth
HE BIDEN administration’s termination of the COVID-19 public health emergency on May 11, 2023 signified the end of an era as the nation confronted its third year of a still-present but muted pandemic. With cases, deaths and hospitalizations all largely trending downward since the beginning of 2023, it’s not surprising that we saw associated health care changes. For example, while the availability of no-cost COVID-19 vaccinations is expected to continue (at least while supplies purchased by the federal government last), the end of the COVID emergency does mean a potential end to free COVID-19 tests.
But the end of the crisis will affect health care far beyond access to vaccinations and PCR tests. It carries broader health implications as well: A number of regulatory shifts that expanded health coverage or access to services during COVID are scheduled to sunset, while others will continue on. Read on for a look at three key health care areas at the onset of a new era.
Changes to Medicaid
During a time when people desperately needed health coverage, the Families First Coronavirus Response Act was passed to assist. Under the congressional legislation, states were able to receive additional funding for providing continuous Medicaid coverage to enrollees, which put eligibility
renewals and redeterminations on hold. States who got the funding also couldn’t cut Medicaid coverage. This provision helped guarantee that people would be able to get the care they needed during the pandemic and also allowed states to prioritize enrolling people who lost their job during the COVID emergency.
An analysis from the Kaiser Family Foundation found that Medicaid/ Children’s Health Insurance Program (CHIP) enrollment increased almost 30% from February 2020 to December 2022. Originally, continuous enrollment was to stay in effect until the end of the COVID-19 public health emergency. But Congress delinked the provision from the emergency with the passage of the Consolidated Appropriations Act in December 2022, which allowed states to begin removing ineligible individuals from the program as of April 1, 2023. At the time of print, the increased Medicaid that funding states were receiving will reportedly be phased out by the end of December 2023.
The inflection point comes after the United States’ uninsured rate hit a historic low of 8% early last year. States are taking different approaches as to how and when they plan to address the “unwinding” of continuous enrollment, but the Kaiser Family Foundation estimates that between 8 and 24 million people could be disenrolled from Medicaid during this unwinding.
Some people removed from the Medicaid rolls “will be able to get insurance under the health exchanges, but when states do those redeterminations, we’re going to find a lot of people who will lose coverage,” says Dr. Georges Benjamin, executive director of the American Public Health Association.
An improved labor market may offer a buffer. Matthew Buettgens, a senior fellow in the Health Policy Center at the Urban Institute, a nonprofit think tank, says a reason many people may lose Medicaid coverage is because of new employment.
“For a lot of them, the reason why they are no longer eligible for Medicaid is because their income has increased and they have gotten new jobs,” Buettgens says. “So we’ve seen employment largely recover from where it was early in the pandemic.”
In a research report predating the final approval of the congressional appropriations package but assuming an expiration of the public health emergency in April, Buettgens and colleague Andrew Green estimated Medicaid enrollment would drop by 18 million over a period of 14 months, but that 9.5 million would gain or transition solely to employer-sponsored insurance. More than 3 million children would likely transition from Medicaid to coverage under a separate Children’s Health Insurance Program, per the report, which also projected more than 1 million
people would access health insurance through the nongroup market, which includes marketplaces created under the Affordable Care Act.
Overall, an estimated 3.8 million people would be newly uninsured, according to the report, though of that total, 1.5 million would be eligible for tax credits to get marketplace plans. “If you can get more people enrolled into the marketplace, you can reduce the number of people who end up uninsured even further,” Buettgens says.
Still, Jennifer Tolbert, director of state health reform and an associate director for the Program on Medicaid and the Uninsured at the Kaiser Family Foundation, points out that as many as 6.8 million people who are otherwise eligible to remain on Medicaid could lose coverage in the wake of continuous enrollment’s end due to what federal officials call “administrative churning.” These enrollees could face hurdles such as problems navigating the renewal process, or states may struggle to get in touch with them due to a change of address.
“For those individuals, they’re still eligible for Medicaid and they don’t have anywhere else to go to get coverage,” Tolbert says. “So their only option is to either get back on Medicaid, if they can, or they will become uninsured.”
Changes to Telehealth
When the pandemic started, many visits to the doctor stopped. To help prevent the spread of the virus, millions of check-ups and doctor visits were either postponed or canceled entirely. But telehealth – health care visits conducted via phone or video calls – gave patients another way to connect with their doctors.
Prior to the pandemic, telehealth care was only available to a small group of Medicare patients, such as those in rural areas. But in an effort to expand access and allow people to continue receiving needed services, telehealth grew in use during the COVID emergency thanks to the waiving of certain restrictions. In the first year of the pandemic, 44% of continuously enrolled Medicare fee-for-service beneficiaries had a telehealth visit – compared with 1% before the pandemic– and the share leveled off to between 13% and 17% by July 2021, according to a report by the Bipartisan Policy Center.
Authorities clearly have acknowledged the boom. The federal Centers for Medicare & Medicaid Services (CMS) notes that many of the Medicare telehealth flexibilities created during the pandemic have been extended through December 2024, such as allowing some services to be delivered using an audio-only platform and permitting patients in any area of the U.S. – not just those in rural areas – to use telehealth services. Physical therapists, occupational therapists, speech-language pathologists and audiologists can also still provide telehealth services. Other flexibilities have been made permanent, including allowing beneficiaries to receive mental or behavioral health care via telehealth in their home. (Most private insurance providers cover at least some form of telehealth.)
buprenorphine were relaxed to allow for clinicians to prescribe it via telemedicine or by phone without the need for an initial in-person visit. In a similar move, federal authorities cleared the way for certain patients to take home an increased amount of up to 28 doses of methadone to treat opioid use disorder.
A study published in JAMA Psychiatry found the use of telehealth for opioid use disorder services was associated with better medication retention among Medicare patients and lower risk of medically treated overdose. And despite potential for abuse, another study did not find a link between increased take-home doses of methadone and negative treatment outcomes.
In February 2023, the Drug Enforcement Administration (DEA) announced a proposal to make the buprenorphine rule change permanent, but to limit
Telehealth changed the patient experience.
the amount of buprenorphine providers are allowed to prescribe to a 30-day supply. As a result, 38,000 comments on the proposed telemedicine rules poured in. In response, the DEA issued a temporary extension of telemedicine flexibilities for prescribing controlled medications through November 2023 and said that they will review this feedback seriously and consider it carefully.
It’s too soon to know what will happen after the December 2024 extension deadline, but Benjamin feels the benefits of telehealth were proved throughout the pandemic and that many of the regulatory flexibilities put in place should stay. “We very well demonstrated the value of telemedicine, and we learned a lot,” he says. “I think the dam has been broken on the use of telemedicine.”
Changes to Addiction Treatment
Many credit the growth of telehealth with increasing the access to mental health and substance use disorder treatment during the pandemic: Telehealth went from making up less than 1% of such outpatient visits before the pandemic to 40% at the peak of the pandemic, according to a Kaiser Family Foundation analysis. Meanwhile, the number of reported drug overdose deaths was rising dramatically.
In response to this public health emergency, rules regarding the distribution of the addiction treatment medication
Brandee Izquierdo, director of behavioral health programs for The Pew Charitable Trusts, says having the ability to prescribe buprenorphine through telehealth has been extremely impactful for people in recovery, lessening their risk of a relapse. She says she is worried the DEA’s proposed rules that effectively would require patients to have an in-person visit within 30 days of their initial prescription in order to get a refill could create barriers for some to continue their treatment.
“That’s a very scary place to be when we’re dealing with a lot of different challenges,” explains Izquierdo, who says she herself at one time was in recovery for substance use disorder for a number of years. “It can become very difficult for individuals to access that treatment.” Izquierdo feels the past three years have proved that a relaxation of the rules governing the administration of medication-assisted treatment for substance use is an effective means of expanding access. “It’s imperative that we eliminate these barriers,” she says. l
4 More Post-Pandemic Health Care Changes
Take a look at the advancements and updates already taking place and those that we can expect to see.
1
Employers may step up their benefits offerings. A recent Mercer survey found that 70% of all large employers are planning to enhance their health care benefits next year, such as by placing more emphasis on benefits for hourly and low-wage workers or by offering virtual behavioral health care.
2
Younger adults are turning to mental health tools. Considering that 50% of adults ages 18-24 report having anxiety and depression symptoms, it’s not surprising that they seek mental health services more than any other age group, according to PwC’s Health Research Institute. And compared to the average person with mental health needs, they’re also three times as likely to use virtual tools (such as emotional support apps and online support groups).
3
Scheduling doc visits may get easier. Convenience is king, according to a 2021 Experian Health survey that found that 73% of patients want online self-scheduling for their appointments with physicians. A 2022 report shows that 30% of health care organizations that don’t yet have self-scheduling in place plan to implement it within the next two years.
4
Health care is extending beyond hospital walls. Out-of-hospital care, from telehealth to remote patient monitoring, may be the future of health care. Extending care beyond hospital walls is also a top priority for health care leaders, according to a 2022 Philips Future Health Index report.
Indeed, 40% of hospitals are expected to have shifted one-fifth of their beds to their patients’ homes by 2025, while survey data from PwC found that more than 75% of consumers said they are willing to get in-home care for well visits, sick visits and injuries, chronic disease management, and more. l
The Road to a Healthy Heart Starts Here
How to find heart and stroke care near you, measured by the American
Heart Association.
Every patient deserves access to high-quality heart and stroke care, regardless of where they live. Each year, the American Heart Association recognizes hospitals across the country – from rural areas to the most populated cities – for consistently following up-to-date, research-based treatment guidelines for cardiovascular disease. These hospitals maintain unrelenting standards to help patients live longer, healthier lives and have the opportunity for a higher quality of life. Read more about this recognition from the American Heart Association and find an award-winning hospital near you.
This content is produced by or on behalf of our sponsor; it is not written by and does not necessarily reflect the view of U.S. News & World Report editorial staff. Learn more at mediakit.usnews.com.
A Big Thanks to Our Sponsors.
These organizations are sponsors of American Heart Association’s health care quality improvement programs.
Every 40 seconds, someone in America has a stroke or heart attack.
In 2020, more people died from cardiovascular disease than in any year since 2003, with people of color most significantly impacted.
More than 2,800 hospitals participate in Get With The Guidelines, a 20-plus year effort to bring research-based, equitable care to heart and stroke patients.
The American Heart Association strives to advance cardiovascular health for all, including identifying and removing barriers to health care access and quality.
To find out more, visit usnewsbrandfuse.com/ AmericanHeartAssociation.
These hospitals are recognized for two or more consecutive calendar years of 85% or higher adherence on all achievement measures and 75% or higher adherence to an additional set of quality measures in heart failure and/or stroke.
Gold Achievement A A A A
These hospitals are recognized for adherence for two or more consecutive calendar years of 85% or higher adherence on all achievement measures applicable to each program.
Silver Plus Achievement D D
These hospitals are recognized for one calendar year of 85% or higher adherence on all achievement measures and 75% or higher adherence to an additional set of quality measures in heart failure and/or stroke.
Silver Achievement C C C C
These hospitals are recognized for one calendar year of 85% or higher adherence on all achievement measures applicable to each program.
* These hospitals received Get With The Guidelines®-Resuscitation awards from the American Heart Association for two or more patient populations. These hospitals are recognized for 10 or more consecutive calendar years of Gold Plus achievement in Get With The Guidelines®-Stroke and/or Get With The Guidelines®-Heart Failure.
STEMI: Gold Plus Receiving or Silver Plus Receiving B D
These hospitals are recognized for compliance to FMC at or before first hospital arrival to PCI ≤ 120 minutes for transferred STEMI patients for two or more consecutive, calendar years (Gold Plus) or one calendar year (Silver Plus), in addition to current Gold or Silver Mission: Lifeline status.
STEMI: Gold Receiving or Silver Receiving A C
These hospitals are recognized for two or more consecutive, calendar years (Gold) or one calendar year (Silver) of 75% compliance on each performance measure and 50% on arrival to first facility to PCI ≤ 120 minutes for patients transferred for primary PCI.
STEMI: Gold Plus Referring or Silver Plus Referring B D
These hospitals are recognized for compliance to Door In / Door Out in 30 minutes or less for transferred STEMI patients for two or more consecutive, calendar years (Gold Plus) or one calendar year (Silver Plus), in addition to current Gold or Silver Mission: Lifeline status.
STEMI: Gold Referring or Silver Referring A C
These hospitals are recognized for two or more consecutive, calendar years (Gold) or one calendar year (Silver) of 75% or higher compliance on each performance measure.
NSTEMI: Gold or Silver A C
These hospitals are recognized for achieving 65% adherence to Dual Antiplatelet prescription at discharge and 85% or higher compliance on each of the four performance measures for two or more consecutive calendar years (Gold) or one calendar year (Silver).
Target: Heart FailureTM Honor Roll G
These hospitals are recognized for 50% or higher adherence to all relevant Target measures in addition to their current Gold or Silver Get With The Guidelines®-Heart Failure status.
Target: StrokeTM Honor Roll Elite Plus F
These hospitals are recognized for treating 75% or more of their eligible stroke patients in 45 minutes or less∆ AND 50% of their eligible stroke patients in 30 minutes or less,∆ in addition to their current Gold or Silver Get With The Guidelines®-Stroke status.
Target: StrokeTM Honor Roll – Elite E
These hospitals are recognized for treating 85% or more of their eligible stroke patients in 60 minutes or less∆ in addition to their current Gold or Silver Get With The Guidelines®-Stroke status.
Target: StrokeTM Honor Roll G
These hospitals are recognized for treating 75% or more of their eligible stroke patients in 60 minutes or less,∆ in addition to their current Gold or Silver Get With The Guidelines®-Stroke status.
Target: StrokeTM Honor Roll Advanced Therapy J
In addition to participating in Get With The Guidelines®-Stroke measuring, these hospitals are recognized for Door To Device (DTD) times in at least 50% of applicable patients within 90 minutes for direct arriving and within 60 minutes for transfers.
Target: Type 2 DiabetesTM Honor Roll I
A national honor roll program for hospitals participating in Get With The Guidelines® (HF, Stroke) to reinforce evidence-based guidelines with hospitals that qualify for a Silver level or higher achievement award in the related Get With The Guidelines module. These hospitals must be able to demonstrate adherence for 12 consecutive months (calendar year) for the “Overall Diabetes Cardiovascular Initiative Composite Score” measure in the selected module.
Alta Bates Summit Medical Center | Summit Campus, Oakland
Hospital Medical Center, San Diego ..................................
Hospital, Montebello
Hospital Medical Center, Los Angeles
Pacific Medical Center | Davies & Van Ness Campuses, San
Marina del Rey Hospital, Marina del Rey
Medical Center, Los Angeles
Centinela Hospital Medical Center, Inglewood
Hollywood Presbyterian Medical Center, Los Angeles
Chinese Hospital, San Francisco
Chino Valley Medical Center, Chino
CHOC Children’s Hospital, Orange
Community Hospital of the Monterey Peninsula, Monterey
Community Memorial Hospital, Ventura
Community Regional Medical Center, Fresno
Dameron Hospital, Stockton
Desert Regional Medical Center, Palm Springs
Desert Valley Hospital, Victorville .........................................................
Dignity Health Bakersfield Memorial Hospital, Bakersfield
Dignity Health Dominican Hospital, Santa Cruz
Dignity Health French Hospital Medical Center, San Luis Obispo
Dignity Health Marian Regional Medical Center, Santa Maria
Dignity Health Mercy Hospital of Folsom, Folsom
Dignity Health Mercy Hospitals of Bakersfield, Bakersfield ..................
Dignity Health Mercy Medical Center Merced, Merced
Dignity Health Mercy Medical Center Redding , Redding
Dignity Health Northridge Hospital Medical Center, Northridge
Dignity Health Saint Francis Memorial Hospital, San Francisco
Dignity Health Sequoia Hospital, Redwood City
Dignity Health Sierra Nevada Memorial Hospital, Grass Valley ..............
Dignity Health St Bernardine Medical Center, San Bernardino
Dignity Health St Joseph’s Medical Center, Stockton
Dignity Health St. John’s Hospital Camarillo, Camarillo
Dignity Health St. John’s Regional Medical Center, Oxnard
Dignity Health St. Mary’s Medical Center, San Francisco
Doctors Medical Center Modesto, Modesto .......................................
Eden Medical Center, Castro Valley
Eisenhower Health, Rancho Mirage
El Camino Health, Mountain View and Los Gatos
Emanate Health-Queen of the Valley Hospital, West Covina
Encino Hospital Medical Center, Encino
Enloe Medical Center, Chico .................................................................
Fairchild Medical Center, Yreka
Fountain Valley Regional Hospital, Fountain Valley
Garden Grove Hospital Medical Center, Garden Grove
Garfield Medical Center, Monterey Park
Good Samaritan Hospital, San Jose
Hemet Global Medical Center, Hemet.................................................................
Henry Mayo Newhall Hospital, Valencia
Hoag Hospital Irvine, Irvine
Hoag Memorial Hospital Presbyterian, Newport Beach
Huntington Beach Hospital, Huntington Beach
Huntington Hospital, Pasadena
JFK Memorial Hospital, Indio ........................................................................
John Muir Medical Center - Concord, Concord
John Muir Medical Center - Walnut Creek , Walnut Creek
Kaiser Foundation Hospital - Antioch, Antioch
Kaiser Foundation Hospital - Fremont , Fremont
Kaiser Foundation Hospital - Fresno, Fresno........................................
Kaiser Foundation Hospital - Manteca, Manteca ................................................
Kaiser Foundation Hospital - Modesto, Modesto
Kaiser Foundation Hospital - Oakland, Oakland
Kaiser Foundation Hospital - Redwood City, Redwood
Kaiser Foundation Hospital - Richmond, Richmond
Kaiser Foundation Hospital - Roseville, Roseville .........................
Kaiser Foundation Hospital - Sacramento, Sacramento ...............
Kaiser Foundation Hospital - San Francisco, San Francisco
Kaiser Foundation Hospital - San Jose, San Jose
Kaiser Foundation Hospital - San Leandro, San Leandro
Kaiser Foundation Hospital - San Rafael, San Rafael
Kaiser Foundation Hospital - Santa Clara , Santa Clara
Kaiser Foundation Hospital - Santa Rosa , Santa Rosa .......................
Kaiser Foundation Hospital - South Sacramento, Sacramento
Kaiser Foundation Hospital - South San Francisco, South San Francisco
Kaiser Foundation Hospital - Vacaville, Vacaville
Kaiser Foundation Hospital - Vallejo, Vallejo ........................................
Kaiser Foundation Hospital - Walnut Creek , Walnut Creek
Kaiser Permanente Baldwin Park Medical Center, Baldwin Park
Kaiser Permanente Downey Medical Center, Downey
Kaiser Permanente Fontana Medical Center, Fontana
Kaiser Permanente Los Angeles Medical Center, Los Angeles
Kaiser Permanente Moreno Valley Medical Center, Moreno Valley ...........
Kaiser Permanente Ontario Medical Center, Ontario
Kaiser Permanente Orange County, Anaheim
Kaiser Permanente Panorama City Medical Center, Panorama City
Kaiser Permanente Riverside Medical Center, Riverside
Kaiser Permanente San Diego Medical Center, San Diego B
Kaiser Permanente South Bay, Harbor City .............................................
Kaiser Permanente West Los Angeles, Los Angeles
Kaiser Permanente Woodland Hills, Woodland Hills
Kaiser Permanente Zion Medical Center, San Diego
Kaweah Delta Health Care District, Visalia
Keck Hospital of USC, Los Angeles
Kern County Hospital Authority, Bakersfield.............................................
La Palma Intercommunity Hospital, La Palma
Lakewood Regional Medical Center, Lakewood
Loma Linda University Children’s Hospital, Loma Linda A
Loma Linda University Medical Center Murrieta, Murrieta
Loma Linda University Medical Center, Loma Linda
Long Beach Medical Center, Long Beach...................................
Center, Placerville
Hospital Los Banos, Los Banos
Medical Center, Modesto, Modesto ..........................................
Medical Center,
E
Providence Little Company of Mary Medical Center - San Pedro, San Pedro .............................................................................................
Providence Little Company of Mary Medical Center - Torrance, Torrance
Providence Petaluma Valley Hospital, Petaluma ...........................................
Providence Saint John’s Health Center, Santa Monica
Providence Saint Joseph Medical Center, Burbank
Providence Santa Rosa Memorial Hospital, Santa Rosa
Providence St. Mary Medical Center, Apple Valley
Queen of the Valley Medical Center, Napa .....................................................
Redlands Community Hospital, Redlands
Regional Medical Center of San Jose, San Jose
Riverside Community Hospital, Riverside
Riverside University Health System-Medical Center, Moreno Valley
Ronald Reagan UCLA Medical Center, Los Angeles
Saint Agnes Medical Center, Fresno ..............................................................
Salinas Valley Memorial Healthcare System, Salinas
San Antonio Regional Hospital, Upland
San Dimas Community Hospital, San Dimas
San Joaquin General Hospital, French Camp
Santa Barbara Cottage Hospital, Santa Barbara ............................................
Santa Clara Valley Medical Center, San Jose ............................................
Santa Monica-UCLA Medical Center Orthopedic and Hospital, Santa Monica
Scripps Green Hospital, La Jolla
Scripps Memorial Hospital Encinitas, Encinitas
Scripps Memorial Hospital La Jolla , La Jolla
Scripps Mercy Hospital Chula Vista, Chula Vista
Scripps Mercy Hospital San Diego, San Diego
Sharp Chula Vista Medical Center, Chula Vista .........................................
Sharp Coronado Hospital, Coronado
Sharp Grossmont Hospital, La Mesa
Sharp Memorial Hospital, San Diego
Shasta Regional Medical Center, Redding
Sherman Oaks Hospital, Sherman Oaks
Sierra View Medical Center, Porterville ..........................................................
Sierra Vista Regional Medical Center, San Luis Obispo
Southwest Healthcare System-Inland Valley Medical Center and Rancho Springs Medical Center, Wildomar
St. Elizabeth’s Community Hospital, Red Bluff
St. Francis Medical Center, Lynwood
St. Joseph Hospital, Orange .....................................................................
St. Jude Medical Center, Fullerton
St. Louise Regional Hospital, Gilroy
St. Mary Medical Center, Long Beach
St. Rose Hospital - Hayward, Hayward
Stanford Childrens Health, Palo Alto
Stanford Health Care Tri-Valley, Pleasanton..............................................
Stanford Health Care, Stanford
Sutter Davis Hospital, Davis
Sutter Delta Medical Center, Antioch
Sutter Medical Center, Sacramento, Sacramento
Sutter Roseville Medical Center, Roseville ............................................
Sutter Santa Rosa Regional Hospital, Santa Rosa ....................................
Sutter Solano Medical Center, Vallejo
Sutter Tracy Community Hospital, Tracy
Temecula Valley Hospital, Temecula
Torrance Memorial Medical Center, Torrance
Tri-City Medical Center, Oceanside
Twin Cities Community Hospital, Templeton
UC San Diego Health, San Diego
UCI Health, Orange
University of California San Francisco (UCSF), San Francisco ..............
University of California, Davis Medical Center, Sacramento
USC Arcadia Hospital, Arcadia
USC Norris Comprehensive Cancer Center, Los Angeles
VA Loma Linda Hospital, Loma Linda
Ventura County Medical Center/Santa Paula Hospital, Ventura ...............
Washington Hospital Healthcare System, Fremont
West Anaheim Medical Center, Anaheim
Wilma Chan Highland Hospital Campus, Oakland
Woodland Memorial Hospital, Woodland
COLORADO
Boulder Community Health Foothills Hospital, Boulder
Centura Health - Avista Adventist Hospital, Louisville
Centura Health - Castle Rock Adventist Hospital, Castle Rock
Centura Health - Littleton Adventist Hospital, Littleton
Centura Health - Longmont United Hospital, Longmont
Centura Health - Parker Adventist Hospital, Parker ..................................
Centura Health - Penrose Hospital, Colorado Springs
Centura Health - St. Anthony Hospital, Lakewood
Centura Health - St. Anthony North Hospital, Westminster
Centura Health - St. Francis Medical Center, Colorado Springs
Good Samaritan Medical Center, Lafayette
North Colorado Medical Center, Greeley ..................................................
North Suburban Medical Center, Thornton
Parkview Medical Center, Pueblo
Platte Valley Medical Center, Brighton
Presbyterian/St. Luke’s Medical Center, Denver
Medical Center, Denver
Saint
Mary’s Regional Medical Center, Grand Junction
Medical Center, Englewood
The Medical Center of Aurora , Aurora
UCHealth Highlands Ranch Hospital, Highlands
UCHealth Medical Center of the Rockies, Loveland
UCHealth Memorial Hospital North, Colorado Springs
UCHealth Memorial Hospital, Colorado Springs
UCHealth Poudre Valley Hospital, Fort Collins
CONNECTICUT
Charlotte Hungerford Hospital, Torrington
Connecticut Children’s Medical Center, Hartford
Danbury Hospital, part of Nuvance Health, Danbury
Day Kimball Hospital, Putnam ............................................................................
Henry Ford West Bloomfield Hospital, West Bloomfield............................
Medical Center, Flint
Lake Huron Medical Center, Port Huron
McKenzie Health System, Sandusky
Bay Region, Bay City
Greater Lansing, Lansing
Lapeer Region, Lapeer
McLaren Northern Michigan, Petoskey
McLaren Port Huron Hospital, Port Huron
Memorial Healthcare, Owosso
Mercy Health Partners d/b/a Trinity Health Muskegon Hospital, Muskegon ............................................................................................
Metro Health – University of Michigan Health, Wyoming
Munson Medical Center, Traverse City
MyMichigan Medical Center Midland, Midland
MyMichigan Medical Center West Branch, West Branch
ProMedica Charles and Virginia Hickman Hospital, Adrian
ProMedica Monroe Regional Hospital, Monroe ........................................
Sparrow Hospital, Lansing
Spectrum Health Blodgett Hospital, part of Corewell Health, Grand Rapids
Spectrum Health Butterworth Hospital, part of Corewell Health, Grand Rapids
Spectrum Health Ludington Hospital, part of Corewell Health, Ludington
G Target: Heart FailureTM Honor Roll F Target: StrokeTM Honor Roll Elite Plus
E Target: StrokeTM Honor Roll Elite
G Target: StrokeTM Honor Roll
Spectrum Health United Hospital, part of Corewell Health, Greenville .....
Spectrum Health Zeeland Hospital, part of Corewell Health, Zeeland
Trinity Health Livonia Hospital, Livonia
Trinity Health Saint Mary’s - Grand Rapids, Grand Rapids
Trinity Health St. Joseph Mercy Oakland, Pontiac
University of Michigan Health System, Ann Arbor
MINNESOTA
Abbott Northwestern Hospital, Minneapolis
CentraCare St. Cloud Hospital, Saint Cloud
District One Hospital, Faribault
Essentia Health East. St. Mary’s Medical Center, Duluth
Essentia Health-St. Joseph’s Medical Center, Brainerd ............................
Fairview Lakes Hospital, Wyoming
Fairview Northland Hospital, Princeton
Fairview Range Hospital, Hibbing
Hennepin Healthcare System, Inc., Minneapolis
M Health Fairview Southdale Hospital, Edina
M Health Fairview St. John’s Hospital, Maplewood ............................................
M Health Fairview University of Minnesota Medical Center, Minneapolis
Mayo Clinic Health System - Mankato, Mankato
Mayo Clinic Hospital, Saint Marys Campus, Rochester
Mercy Hospital, Coon Rapids
North Memorial Health Hospital, Robbinsdale
Park Nicollet Methodist Hospital, Saint Louis Park ...................................
Regions Hospital, Saint Paul
St. Francis Regional Medical Center, Shakopee
St. Luke’s, Duluth
United Hospital, Saint Paul
Woodwinds Health Campus, Woodbury
MISSISSIPPI
Baptist Memorial Hospital - DeSoto, Southaven
Baptist Memorial Hospital - Golden Triangle, Columbus
Announcing the new Target: Aortic Stenosis™ national quality recognition program, launching in 2024, with the expanded enrollment available to all hospitals starting in late 2023
Thank you to the 15 hospitals who participated in Phase 1 of Target: Aortic Stenosis. Their invaluable perspectives and contributions as the pioneering core hospitals have played a pivotal role in the program’s success.
• Barnes-Jewish Hospital
• Baylor Scott & White Heart and Vascular Hospital
• Colorado Heart and Vascular/St. Anthony Hospital
• Deborah Heart and Lung Center
• Geisinger Medical Center
• Hospital of the University of Pennsylvania
• Penn Presbyterian Medical Center
• Providence Heart Institute-Providence St Vincent Medical Center
Edwards Lifesciences is the national sponsor of American Heart Association’s Target: Aortic Stenosis
• Ronald Reagan UCLA Medical Center
• Stanford Health Care
• Thomas Jefferson University Hospital
• The University of Kansas Health System
• University of Utah Health
• Vanderbilt University Medical Center
• Wellstar Health System
STROKE:
G Target: Heart FailureTM Honor Roll
F Target: StrokeTM Honor Roll Elite Plus
E Target: StrokeTM Honor Roll Elite
G Target: StrokeTM Honor Roll
J Target: StrokeTM Honor Roll Advanced Therapy
I Target: Type 2 DiabetesTM Honor Roll
Health Equity Is in Our Hands
Better use of data and changes to medical care are among the ways we can boost health parity in the United States
THE COVID-19 pandemic demonstrated a bitter truth that not all health care is delivered equally. For many individuals, particularly in underserved and minority communities, access to high-quality medical care and the best health outcomes lag behind those of their peers. It’s clear that, as a nation, we need to improve health equity – when everyone has a fair and equal opportunity to live their healthiest life – but how?
While COVID may have been a catalyst for many to take a closer look at how to fix some of the deep inequities, a consensus prescription for what should be done is harder to come by. Proposed solutions include taking a data-intensive approach; expanding cross-sector partnerships between hospitals, public health agencies and others; exploring meaningful policy; and continuing to boost public awareness and engagement. Here, two experts weigh in with their thoughts on how to solve this pervasive issue.
“We need to advance equity by addressing health disparities”
AN OPINION BY MARGARET-MARY WILSON, M.D., EXECUTIVE VICE PRESIDENT AND CHIEF MEDICAL OFFICER OF UNITEDHEALTH GROUP
Building health equity requires a new approach. The health disparities that we see in the U.S., from infant mortality to chronic disease and lower life expectancy, are a heartbreaking reality. Generations in the making, they have become so ingrained that one’s ZIP code often says more about health than one’s genetic code.
While the COVID pandemic could further reinforce those disparities if we’re not careful, lessons learned from the last several years could also begin reversing them to improve outcomes if we double down on data to close gaps in care and broaden partnerships to address root causes of disparities.
Although disparities often eventually surface as acute health care problems, they start much earlier in the inequities of our communities. Almost 80% of a person’s health is driven by social determinants like safe neighborhoods, affordable housing, access to good jobs and schools and the presence of supportive institutions and relationships that people need. The root challenges that the most vulnerable people face – the ones that make them so much more likely to be sick – aren’t the ones that traditional health care is set up to cure.
Health care as usual, in which patients must travel to doctors to receive treatment, is a paradigm that’s more likely to exacerbate disparities than to address them. That dynamic is changing though, as the health care ecosystem gets better at using data, technology and clinical innovation to deliver higher-quality care, in the broadest sense of the word, at the right times and in the right places. With the worst of the pandemic behind us, our nation has an opportunity to continue accelerating health care transformation in ways that will build health equity so long as governments, communities and health care organizations can come together and adopt new approaches to care.
The gaps in crucial community and health data, along with the health system’s drawn-out transition toward value-based care (a system that emphasizes quality of care and prevention rather than the quantity of healthcare services rendered) and the gradual capacity-building required for comprehensive and well-coordinated care have made progress toward health equity agonizingly slow. Each hard-fought step forward has reinforced the necessity for bold, innovative, community-driven efforts to identify wholeperson and community solutions.
There’s no simple solution or one-size approach, but one strategy that UnitedHealth Group has built hinges on using the data and clinical insights we gain from serving our patients and members (in de-identified, aggregate fashion) to understand community needs combined with a national network of community-
based partnerships to field appropriate population health interventions. It’s evolving in a way that both improves individual clinical outcomes and creates a platform to build equity systemically.
This is a strategic model that’s working; one we are expanding and adapting nationwide to tackle the most complex challenges. Every community has different needs and the interventions required to address them must reflect those differences, but each will require robust data, clinical innovation and community collaboration.
Leveraging insight and collaboration to field targeted, downstream interventions may be our best chance to reverse the wide disparities and break the link between health status and ZIP code. Everyone has a stake in this success, but it’s incumbent on major health care providers and insurers – working in concert with policymakers – to take the lead in empowering community partnerships to make it happen. Let’s make sure the pandemic sparks a cycle in which improving individual and community health reinforce each other and build equity so everyone can live their healthiest life.
“To boost equity, medical care must act at the organizational, population and policy levels”
AN
OPINION BY PHILIP M.
ALBERTI, PH.D., SENIOR DIRECTOR FOR HEALTH
EQUITY
RESEARCH AND POLICY AT THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES (AAMC)
Science asserts that medical care accounts for only about 15-20% of a person’s health. The rest is genetics and a conglomeration of basic, vital conditions for health we all need to thrive – reliable transportation, humane housing, meaningful work and freedom from discrimination, to name a few.
If health is not produced in a doctor’s office, then neither is health equity. But we can all be forgiven when we conflate health and medical care – our policymakers do it all the time. The U.S. puts most of its health eggs in the medical care basket, even though its spending does not result overall in longer, healthier lives or more equitable health relative to other wealthy nations. Adding to the confusion, as new health inequities emerged during the COVID-19 pandemic, the experts addressing the issue were primarily physicians working mainly outside the relevant field of population health. Most medical experts have training, perspective, practice and expertise that is more “one-patient-at-a-time” than whole-population-focused.
Medical care – like all sectors contributing to health – can help us attain health equity. Our challenge is to clearly define the role the field can play.
For medical care, health equity action involves three interconnected levels of work: creating equity within the medical care organization itself (organizational equity), ensuring all patient populations have
equitable access to high-quality medical care (health care equity) and contributing to equitable community access to the vital conditions mentioned above, largely through policy and partnerships (health equity).
How equitably a medical care (or any) organization treats its staff, administrators and, if applicable, faculty and students is fundamental to getting its own house in order. A medical care organization that prioritizes internal equity provides a model that helps ensure all patient populations it serves will be treated equitably and with respect. But ensuring health care equity also means erasing racism and discrimination from medical textbooks, algorithms and clinical decision-making tools.
Achieving health care equity also demands policy changes that create equitable access to medical care in the first place. For example, eliminating population gaps in insurance coverage or educating and distributing medical care professionals in ways that meaningfully address health workforce shortage areas and medically underserved areas.
Policy change is also key to achieving community health equity. Some such changes are at the organizational level and focus on the medical establishment’s commitment to local economic development, such as prioritizing area businesses in procurement or investing discretionary dollars in local entrepreneurship. Health care, though, has an outsize voice at all external advocacy tables – federal, state and local.
In addition to referring patients to housing services, hospitals could advocate for policies promoting the creation of local affordable housing units. For example, beyond hosting a farmer’s market in a hospital parking lot, health systems can advocate for zoning changes and subsidies attracting supermarkets to food deserts. Health systems can legally register anyone who walks through their doors to vote – a littleknown fact, and perhaps the most significant health equity intervention of all.
To develop a meaningful health equity agenda, hospitals must demonstrate they are worthy of their communities’ trust. That means recognizing community wisdom regarding priorities and tactics, for that knowledge is as crucial as the clinical, scientific and financial resources medical care can contribute.
Health equity is not created in a doctor’s office one patient at a time. It can happen for entire populations all at once, though, with the stroke of a policy pen. Indeed, to achieve health equity, medical care must advocate for health, not just health care. l
Where Did All the Doctors Go?
More must be done to ease the burdens of primary care practitioners and encourage medical students to enter the field
HERE IS A HIDDEN HEALTHCARE crisis in America, and it’s hurting patients and doctors alike. The problem: Too few U.S. medical school students are choosing to go into primary care, and as a result, the current primary care physician workforce is not growing fast enough.
TPrimary care doctors are critical to our healthcare system. Not only do they help manage everyday health concerns and needs, but they provide valuable preventive care that ultimately lowers medical costs. But it’s clear why the career has lost its appeal: The healthcare system simply doesn’t support primary care doctors.
While there’s a good deal of talk about “burnout” in the healthcare profession, this term has limited application to what is actually happening to primary care physicians in our country. Burnout implies a failing on the part of an individual—someone is exhausted, overwhelmed and unable to handle job demands. A better term would be “moral injury.”
An important reframing
The term “moral injury” was used to describe service members who returned from the Vietnam War with PTSD-like symptoms, but didn’t respond to standard treatment. Turns out they didn’t fear for their physical
safety – like those with PTSD did – but instead were questioning their morality after being forced to act in ways not aligned with their beliefs (killing civilians, for example).
In medicine, moral injury shifts the focus to the suboptimal work environments our health care system creates for physicians. It emphasizes that the shortage of primary care physicians is not a matter of individual failure, but instead of a larger system breakdown.
For example, modern health care systems require primary care doctors to spend too much time behind a computer screen dealing with electronic medical records and clerical tasks at the expense of seeing and helping patients. This kind of workplace has limited appeal for medical school students choosing how they would like to spend their careers.
Data bears this out. The supply of key primary care physicians in the U.S. has not kept up with increasing demand. While supply projections for advanced practitioners such as nurse practitioners and physician assistants in primary care are surging well past expected demand, there are persistent gaps between projected amounts of needed family and internal medicine practitioners and those expected to be in the workforce.
Primary care doctors need more support.
At the same time, recent years have seen declining shares of U.S. allopathic, or M.D., medical school students filling internal and family medicine positions for their residency. Others, like osteopathic physicians, can fill such slots, yet the Association of American Medical Colleges has projected a shortage of 17,800 to 48,000 primary care doctors in the U.S. by 2034.
Following the money
The structural problems within our primary care system extend to financial incentives. The appealing aspects of primary care – developing long-term relationships with patients and families, focusing on prevention and wellness, working with a diverse patient population – hold less sway with new medical school grads saddled with hundreds of thousands of dollars of debt. It makes sense that aspiring doctors may choose to pursue more financially lucrative medical specialties, such as surgery or dermatology.
Indeed, survey data indicates the lowest-paying sectors for physicians to work in are public health and preventive medicine. Physicians who choose to work with the most vulnerable populations, particularly patients receiving Medicaid and Medicare, receive less reimbursement for their services, as rates for these insurance programs generally fall well below those of commercial insurance.
In addition to inequitable pay, primary care physicians also work long hours and see far too many patients (around 20 a
day, according to a 2018 survey), with an average visit length of 18 minutes. This does not allow enough time to establish relationships with patients and address their complex needs – which increasingly include chronic disease management along with psychiatric and social concerns – much less complete their administrative tasks. The COVID-19 pandemic magnified this problem.
Because of these demands, primary care physicians often feel they cannot provide their best care to patients. One recent study found that primary care physicians who were not part of teambased care would need an impossible 26.7-hour shift to follow the recommended guidelines for care.
Solving the crisis
Getting more doctors to enter – or stay –in primary care is a complicated challenge, but a good start would be to invest more in the public health care system and its primary care physicians. Does this mean providing higher compensation to create more parity with other sought-after medical specialties? Absolutely.
One avenue for doing so would be to emphasize the importance of primary care and protect it within the Medicare Physician Fee Schedule, which in turn could bolster fee schedules used for Medicaid. Another option for making the field more attractive would be to expand loan forgiveness for physicians who practice primary care.
But increasing revenue opportunities alone will not be enough to incentivize a sustainable workforce shift. We also need to invest in primary care practices to ensure better staffing and task-sharing, so that everyone can practice to the top extent of their license and capabilities. Hiring nurse practitioners, physician assistants and medical assistants would provide support with patient care and help ease clerical burdens stemming from charting, coding and insurancerelated issues.
Taken together, these steps can enable more physicians to see primary care as a venue where they can focus on what drew them to medicine in the first place: helping patients. l
Best Hospitals for Maternity Care
U.S. News’ ratings identified 297 centers that excel
CHILDBIRTH is often a joyous event. And the hospital where a pregnant patient delivers can play a big role in making it a positive experience. When it comes to maternity care for uncomplicated pregnancies, the best hospitals achieve safe outcomes, offer sound care without performing unnecessary interventions and support patients who choose to breastfeed. The hospitals listed here excel in these respects. To identify them, we surveyed maternity centers across the nation and obtained detailed data from more than 600. As always, we recommend consulting with your doctor when deciding which hospital to use.
Reducing risks. While labor and delivery usually end well, complications can occur. Most have no lasting consequences, but no parent wants to see their newborn whisked away to a neonatal intensive care unit. We collected data on each hospital’s rate of newborn complications, both moderate and severe, and weighed it at 25%.
We also gathered data on cesarean section. C-section can be lifesaving, but as with all surgeries, it comes with risks, including potentially dangerous blood loss. It’s also costlier and has a longer recovery time than vaginal delivery. Furthermore, C-section is linked with long-term problems for the child, such as higher rates of asthma and allergies. There are long-term risks for the mother, too –and for any future children. Internal scarring from the operation can, in subsequent pregnancies, lead to placenta accreta, a dangerous condition. For these reasons, experts discourage unnecessary C-sections. Our methodology rewards hospitals for achieving low C-section rates; this measure counted for 30% of each hospital’s overall score.
Episiotomy is another procedure that ideally is avoided during delivery. Episiotomy rate accounted for 5% of each hospital’s score. Experts also advise against inducing labor or performing a C-section if a patient is more than a week away from her due date, unless there’s a compelling medical reason for initiating an early elective delivery. Our methodology checks whether a hospital has a reasonable early elective delivery rate of 5% or less. This measure counted for 5% of each hospital’s overall score.
Breastfeeding has benefits for a baby, including a stronger immune system. That’s why experts encourage new parents to feed breast milk if possible. But hospitals don’t always reinforce that message – or give patients the support they need to lactate and nurse. Each hospital’s success in encouraging and supporting breastfeeding counted for 20%.
America struggles with racial and ethnic disparities in maternal outcomes. Closing those gaps requires actionable data, so another 5% of each hospital’s score was determined by whether it tracked and reported data for individual races and ethnicities.
Another 5% of the methodology rewarded hospitals with higher rates of vaginal birth after cesarean. VBAC is desired by women who have had a previous C-section and want to avoid having another one.
Finally, 5% of the score was awarded to hospitals that met “birthing-friendly” criteria by using certain patient safety practices and collaborating with other hospitals to improve the quality of their maternity care.
The tables on these pages display these metrics along with a couple others that don’t factor into the methodology. For additional metrics, go to usnews.com/ bestmaternityhospitals. l
BEST HOSPITALS FOR MATERNITY CARE
Newborn complication rate (lower is
C-section rate (lower is
Episiotomy rate (lower is better) Early delivery rate (lower is better) Breastfeeding rate (higher is better)
VBAC* rate (higher is better)
Reported data by
Birthing-
BEST HOSPITALS FOR MATERNITY CARE
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
FLORIDA
ILLINOIS
Hospital
ILLINOIS
continued
KANSAS
MARYLAND
MASSACHUSETTS
MINNESOTA
Newborn complication rate (lower is better)
C-section rate (lower is better) Episiotomy rate (lower is better)
Early delivery rate (lower is better) Breastfeeding rate (higher is better)
*Vaginal birth after cesarean. **Neonatal intensive care unit. (-) indicates information is not available.
BEST HOSPITALS FOR MATERNITY CARE
NORTH CAROLINA
NORTH CAROLINA continued
BEST HOSPITALS FOR MATERNITY CARE
OREGON
PENNSYLVANIA
SOUTH CAROLINA
TEXAS
TEXAS
VIRGINIA
WYOMING
Confronting
the Maternal Health Crisis
Meet four experts leading the fight for better outcomes for our country’s mothers and their babies
SURVIVING PREGNANCY , childbirth and the first postpartum year is not a given in the United States, where the maternal mortality rate remains staggeringly high—triple that of other high income countries. And it’s not improving: A study published in JAMA in July 2023 found that the United States’ maternal mortality rate has more than doubled over the past two decades. And Black, American Indian and Alaska Native women are especially at risk, dying much more frequently than their white counterparts. Moreover, practitioners are alarmed that these inequities also impact infant mortality rates.
In May 2023, U.S. News hosted a webinar about the crisis of inequitable maternal and infant health outcomes. The event, which was developed with support from Texas Children’s Hospital, featured four prominent experts: Elizabeth Cherot, M.D., president and CEO of the March of Dimes; Christina Davidson, M.D., system chief health equity officer and chief quality officer of obstetrics and gynecology at Texas Children’s Hospital and associate professor in the division of maternal fetal medicine and vice chair of quality, patient safety and health equity in the department of obstetrics and gynecology at Baylor College of Medicine; Oluwatosin Goje, M.D., medical director of the Cleveland Clinic’s Center for Infant and Maternal Health; and Janelle Palacios, Ph.D., CNM, a nurse midwife, researcher and founder of Encoded 4 Story, a consulting firm aimed at improving maternal and child health outcomes.
Our panelists dove deep into the troubling maternal health problem and discussed potential solutions. Edited excerpts of the conversation follow.
Meet the Experts
Elizabeth Cherot, M.D., president and CEO of the March of Dimes
We know that the majority of these deaths and health complications are entirely preventable. What’s the crux of the problem?
Oluwatosin Goje: I think we have to set the stage and talk about structural racism and social determinants of health. For the past 20 years we’ve not significantly moved the needle when it comes to infant and maternal health care, especially in minority groups.
Health care and medical care is not enough to improve the health outcomes of our mothers and babies. In fact, 80% of a patient’s health outcome is actually due to social determinants of health: where they live, the job they have and access to care and transportation. So we can have excellent hospital care, but if my patient can’t access the care, it’s not worth anything to her. If she has food insecurity, she will want to survive first and look for food rather than come to the health care system.
What are some of the unique drivers of these glaring maternal and fetal disparities among Black women and babies?
Christina Davidson: So much of maternal morbidity and mortality is preventable. So while we cannot prevent every single death or adverse outcome, in some states, up to 90% of these cases are preventable, especially in the Black community.
Historically, these disparities in maternal morbidity and mortality were thought to be due to more medical problems in the Black community, like high blood pressure, diabetes and obesity. But now there are ways of looking at the data and determining if discrimination, racism or implicit bias played a role.
There’s a recognition that nothing is protective for Black women: income, level of education, socioeconomic status. That’s not to say that if you’re lower income and less educated, you should have a higher mortality rate. But even if you have the knowledge and excellent resources, that’s not going to protect you against things that happen in the hospital that may have to do with biased care, such as not listening to patients or dismissing
Christina Davidson, M.D., system chief health equity officer and chief quality officer of obstetrics and gynecology at Texas Children’s Hospital
their concerns. So now, as some of these cases are being reviewed, there’s an effort to identify whether implicit bias, racism or discrimination on the part of the healthcare team contributed to those outcomes.
But again, so much of this has to do with what’s happening outside of the hospital and access to care. More than 50% of maternal deaths happen up to one year after delivery, and a lot of those have to do with mental health disorders and chronic medical conditions, especially cardiac. We often talk about pregnancy as being a window into your health. But we need to ensure that we use this opportunity to transfer women into the services that they need beyond pregnancy, too.
How are these inequities experienced by American Indian and Alaska Native mothers and babies?
Janelle Palacios: I come from a reservation, and aside from racism being ever-present in a lot of our encounters, we often don’t even have the data, especially among American Indian and Alaska Native people. And when we are not counted, our needs are not even determined.
For example, the national statistic shows that Alaska Native women are two times more likely to die of pregnancy-related causes than white women, but there are regional differences that have yet to be uncovered. For example, South Dakota did a report and they found that the mortality rate for Native women there is nearly seven times the national mortality rate. That’s significant, so we need to understand that there are pockets in our country where data needs to be accessed, standardized and collected – and there have to be penalties when the data isn’t collected.
Elizabeth Cherot: Your race, wealth or where you live in this country shouldn’t matter, but what we’re seeing is that it does. The March of Dimes puts out their Maternity Care Deserts Report, and from 2020 to 2022, we had a 2% increase in maternity care deserts – the counties where there are no providers that do deliveries or birth centers. Access to care is so important. And while maternity care deserts aren’t just in rural
Oluwatosin Goje, M.D., medical director of the Cleveland Clinic’s Center for Infant and Maternal Health
areas, we do know that providers are not going to rural places, which creates a complex problem. The data shows that women who don’t get prenatal care are three to four times more likely to die.
In the interest of really understanding the data, Dr. Palacios, can you tell us how far women on rural reservations like yours are driving for pre- and postnatal care or birth?
JP: Depending on where you live on the reservation, it’s still quite common today to have to travel 120 miles round-trip, at minimum, to gain access to care and sometimes to deliver. And some of my colleagues in Alaska talk about how women and families who need services have to take a snowmobile, car or truck transportation and then maybe two airplane rides in order to get health care services for their pregnancy or their children.
This isn’t something you can do in 30 minutes on your lunch break. It’s going to take a lot of time. So in addition to the social determinants of health, I would add geographical and political aspects, too. Because in our country, Native American people were intentionally placed in isolated areas. And that’s why we often have reservations in geographically distant places.
So I’m trying to change the narrative, because for so long in our country, the system of practices and policies have looked at a birthing person’s outcomes as their fault. It is their own burden for having had asthma, diabetes, preeclampsia or a hemorrhage. And I’m here to say that it is not their fault. It didn’t start with them, right? There is a history of context for that person being in this world, and we need to understand that.
OG: I want to jump in to applaud what she said. It’s not race. It is racism. People tell Black women they have a high risk of diabetes, and slowly they internalize this and say, ‘maybe if I did something different.’ No. It’s not about you. It’s about the stage that was set up. It’s about the racism.
CD: There are so many things underlying what’s happening, and even talking about social determinants of health is a manifestation of structural racism that goes
Janelle Palacios, Ph.D., CNM, nurse midwife, researcher and founder of Encoded 4 Story
back to the legalization of segregated housing and health care. And we’re still seeing the impacts of that today, where hospitals and historically marginalized communities remain under-resourced and under-staffed.
There’s no biological reason why, as a Black woman, I should be more predisposed to complications from hemorrhage, or more likely to develop preeclampsia. It’s the impact of racism.
There is this concept of allostatic load, where when you are exposed to racism and discrimination on a regular basis your body perceives that as a stress and goes into fight or flight mode as a protective mechanism. But when it’s repeated and chronic, it can actually change some biological components that make you more likely to have cardiovascular disease, more likely to have hypertensive disorders, more likely to have a pre-term birth. And so it’s still racism, though, as the underlying root cause of that. It’s not a biologic basis.
I even remember having a patient who was an older Black woman in her 40s come in for an ultrasound, and when I went in to tell her everything was okay, she told me, ‘That’s good to hear. I’m really worried because since I am older and Black, I know I’m at higher risk for complications.’
And I said, ‘I want you to know that is true, but it’s not because of your age and your race. We’re realizing now it’s because of racism and implicit bias. So when you are at the hospital or your doctor’s visits, if you feel like you’re not being listened to, I want you to escalate that. I want you to ask to speak to somebody else.’ I wanted her to know it wasn’t just because she was a 40-year-old Black woman.
What work is being done to improve maternal health outcomes?
EC: The March of Dimes coordinates programs and pulls in practitioners and the financial support to help launch programs. And one of those programs that I like to speak about is our mobile units. We have three mobile units across the country — one in Ohio, one in Arizona, and one in Washington, DC, which people don’t think of as
a maternity care desert, but it is one. The next ones are launching in New York City, Texas and another unit in Arizona.
We have also been doing a lot of research, and
the most common causes of maternal morbidity and mortality, which are guides that help hospitals know what they need to do and have in place to improve outcomes for patients. There are over 220 birthing hospitals in Texas, and about 99% of them signed up to be a part of this initiative.
I work at two different hospitals, and they were both a part of this. And at Texas Children’s Hospital Pavilion for Women, one of the things we decided to do during that initiative was to overlay another one of AIM’s patient safety bundles, which was on the reduction of peripartum racial and ethnic disparities. So there was a bundle on hemorrhage and there was a bundle on reduction of disparities, and we combined the two and looked at the baseline data by race, ethnicity and language.
We recognized that we did have a huge disparity with our Black patients who were experiencing a hemorrhage having much higher complications than our white and Hispanic patients. And the same went for patients whose preferred language was something other than English. So then there was a lot of work done around how we were going to use some of the things we were implementing to target a real health equity lens, and at the end of it we were able to significantly reduce morbidity in our Black population and completely eliminate the Black/white disparity that existed beforehand.
DR. CHEROT AT THE MARCH OF DIMES HEADQUARTERS.
we do a ton of education like implicit bias training for providers and medical students. And we are doing advocacy for the extension of Medicaid postpartum coverage for a full year, which is where we really think every state should be at. One of our biggest goals is to get that passed, so we’re targeting certain states.
As we know, postpartum doesn’t end when you’ve finished your postpartum visit at six weeks. The complications can extend, and we know that moms need that help, whether it’s mental health, cardiovascular or follow up for their diabetes, so we are really looking at solutions around telemedicine and remote care. We’ve got a lot of work to do, but that’s the three-prong approach that the March of Dimes has been taking.
CD: In Texas we’ve been implementing patient safety bundles for the last few years. The Alliance for Innovation on Maternal Health (AIM) is a national organization that has patient safety bundles around
So now AIM has actually rewritten their bundles to have the health disparity components and health equity included in all bundles. And then they’ve added a fifth domain around respectful and equitable care. And that’s another thing we’re going to be embarking on at my hospital.
Dr. Goje, you head up the Cleveland Clinic’s newly launched Center for Infant and Maternal Health. Are there any differences to your approach?
OG: At the Cleveland Clinic, we have a community-based approach. The Cleveland Clinic is known to provide excellent care, so we already know that’s not enough—it’s not moving the needle.
Our community-based approach has three prongs: First, we invest in grassroots initiatives. Second, we collaborate with community partners that are already working in the maternal and health care space. And the third part of it, which is the Center for Infant and Maternal Health, is more of an integrated model of care.
So many countries do well with this integrated model of care, whereby you integrate the doulas, the OB-navigators and the community health workers along with your obstetric and medical team. It’s not about just offering this care, it’s about the patient trusting your care.
In addition to all of the resources that are available, our community health workers go on the journey with the patient throughout pregnancy and up to the first year of the infant’s life. They’re able to identify the needs of this patient in real time and call and say, ‘this patient is not feeling well.’ We all know that patients, depending on their race and ethnicity, complain about medical things in a different way, and we’re learning that there are nuances in how people complain about postpartum hypertension or even cardiovascular symptoms.
So these community health workers are there with them, they are building trust with them and learning the different ways they show up with complaints. And they support them throughout that first year.
We mentioned politics as a factor as well. Research suggests maternal and infant mortality rates are higher in states with restricted or banned abortion compared to those that have preserved access. How does this shifting climate impact the situation?
CD: I don’t know if we know yet. I think that we will get this information over time. But there are some medical conditions that we used to be able to provide medically indicated terminations for that are now under question in Texas, and we’re not providing them anymore because of the fear of what will happen next.
I think we are just beginning to go down the path of seeing what these restrictions are going to do. But if we look at global data, we are going to start seeing some really bad outcomes for patients who have to use alternate means to get abortion services.
Does this group have any advice for professionals or others who want to help improve the maternal and infant health situation in this country?
JP: As a nation we have to look at our history and come to terms with it. And I feel like we really haven’t done that on a national level to help people understand why we need to address needs of communities that have been historically marginalized, why we have certain programs in place, and why states should be a part of that conversation and help improve the lives of everyone in their state. So I’m very big on trying to help us, as a nation, to have empathy for our history and for what’s going on now.
focused in advocacy. There’s a lot for others to get involved in. So I would encourage people to go to the March of Dimes’ website and see if there’s something there that you might be aligned with that we can help, as a convenor, move you towards.
CD: I would encourage everyone to talk about this and share this information with the people that you are working with. Also, think about your interactions with patients and really listen to hear what they are saying. Deep, intentional listening to understand
Then I would say, you have to really build up trust with communities, partners and your patients. So that means spending time. And our current model of medicine does not allow for time to be spent on an individual level. So when we talk about group care or centering pregnancy, that is one solution of trying to help advocate for creating time to get to know a patient and to get to know a community.
EC: The complexity of the crisis is anchored in the fact that we don’t have one root cause and there’s no single solution. It’s a complex web of factors that includes where the person lives, both systemic and societal systems and racism.
So I would say that there’s a lot to do. At the March of Dimes, we’re focused in education, data evaluation and research. We’re also
DR. GOJE WITH A PATIENT AT THE CLEVELAND CLINIC.
the patient and what historical factors may be contributing to anything else that is happening with her.
I would also say to work with your hospital to implement best practices around the most common causes of maternal morbidity and mortality, with the AIM bundles being some of those. But as you look at your data, look at your data by race, ethnicity and language – at a minimum. You need to know where your disparities are, so that you can work to mitigate them. l
Trauma-informed care could help address the nation’s opioid crisis
by Raya Elfadel Kheirbek, M.D. and Aaron D. Greenblatt, M.D
LAST SPRING, a patient named Brittany was admitted to the University of Maryland Medical Center on the brink of death. Only 32 years old, she was suffering from kidney failure and a brain infection, the severe complications of intravenous drug use. Brittany, whose last name is being withheld for privacy, also needed a palliative care specialist to manage her pain and to help her mother deal with what could be the end of her daughter’s life.
A tragic cycle. As her mother explained, Brittany grew up in poverty in Baltimore, where drug deals openly took place in neighborhood schools and on sidewalks. She began using marijuana at age 13 and heroin by 20. That led to a series of overdoses, infections and a cycle of at least 34 emergency room visits and hospitalizations in a span of 10 years. Brittany had committed herself to addiction treatment many times but was never
able to break free of her substance use disorder. Sadly, her story is all too familiar: The opioid epidemic continues to worsen, accounting for more than 80,000 deaths in the U.S. in 2021. Baltimore has the highest opioid-related death rate of any city in the United States. When we take care of hospitalized patients like Brittany, we often face many hurdles. Getting them the treatment they need to get off drugs is the first step. Then, we need to help them become strong enough to return home to a life that’s hopefully better than the one they had before they were admitted to the hospital. It’s far from straightforward. Once the immediate health emergency is addressed, the battle is only halfway over. Many hospitalized patients with addictions need ongoing “post-acute” care before they can safely go home. Unfortunately,
2023 THE HEART OF QUALITY PATIENT CARE
ACC Accreditation Services™
s has been prove nt outcomes to care. All of the mprovement are rams.
For 25 years, ACC Accreditation Services has been helping hospitals and health systems improve cardiovascular care processes and patient outcomes to achieve the highest standard of cardiac care. All of the essential components of true process improvement are embedded in ACC’s accreditation programs.
NCDR® (National Cardiovascular Data Registry)
For more than 25 years, ACC’s suite of NCDR registries have been helping hospitals, health systems, centers and practices by providing data-driven insights, analysis and research to inform clinical and operational decisions, allowing the cardiovascular care team to perform at the highest level and to deliver optimal care to every patient, every time.
MedAxiom
MedAxiom, a member-driven network powered by data, is the premier source for cardiovascular organizational performance solutions.
As the global professional organization for the entire cardiovascular care team, the American College of Cardiology (ACC) is committed to supporting patients, caregivers and health care professionals by ensuring the highest quality care is delivered to every patient, every time. FOR CARDIOVASCULAR PROFESSIONALS, visit CVQuality.ACC.org to learn more. To learn more about MedAxiom, visit MedAxiom.com. FOR PATIENTS AND CAREGIVERS, to access heart health education and resources, please visit CardioSmart.org
The following pages list more than 2,000 hospitals, centers and health systems that rely on ACC’s NCDR and Accreditation Services. Patients and caregivers can trust hospitals and centers that participate in the NCDR, receive the ACC’s Accreditation seal of approval, and are recognized with the Chest Pain – MI Registry™ Performance Achievement Award and the HeartCARE Center™ Award for delivering the best cardiovascular patient care.
ACC ACCREDITATION SERVICES
CP
Cardiac Cath Lab Accreditation
CC Chest Pain Center Certification
HF Heart Failure Accreditation
Helps facilities implement all the pre-, peri- and post-procedures that are essential for safe care and efficient scheduling of patients through the cath lab.
Supports Critical Access Hospitals and FreeStanding EDs employ scientifically sound quality initiatives and best practices.
EP Electrophysiology Accreditation
Ensures that requisite protocols, processes and systems are established in the care of patients with heart failure.
TV Transcatheter Valve Certification
Chest Pain Center Accreditation
Focuses on efficient and effective emergency care of acute coronary syndrome (ACS) patients in the hospital setting.
Incorporates the most recently compiled guidelines and expert consensus statements to produce the best possible care of the EP patient.
NCDR
Helps hospitals meet standards for multidisciplinary teams, formalized and shared decision-making in performance of transcatheter valve replacement and repair procedures.
HONORS
AFib Ablation Registry™
IM IMPACT Registry®
Chest Pain — MI Registry™
Performance Achievement Award
(Catheter-based atrial fibrillation ablation procedures) Assesses the prevalence, demographics, acute management and outcomes of patients undergoing atrial fibrillation (AFib) catheter ablation procedures.
AFib (Cat abla prev man pati (AFi
Recognizes hospitals participating in Chest Pain – MI Registry that have demonstrated sustained, top level performance in quality of care and adherence to guideline recommendations.
Cath
CathPCI Registry®
(Pediatric and adult congenital treatment procedures) Assesses the prevalence, demographics, management and outcomes of pediatric and adult congenital heart disease patients who undergo diagnostic catheterizations and catheter-based interventions.
(Dia
(Diagnostic cardiac catheterization and percutaneous coronary intervention)
Assesses the characteristics, treatments and outcomes of cardiovascular disease patients who receive diagnostic catheterization and/or PCI procedures.
CP Chest Pain — MI Registry™
(Acute myocardial infarction treatment) Is a risk-adjusted, outcomes-based quality improvement program for all patients with chest pain.
E EP Device Implant Registry™
(Implantable cardioverter defibrillator and pacemaker procedures)
Establishes a national standard for understanding patient characteristics, treatments, outcomes, device safety and the overall quality of care for ICD/ CRT-D and select novel pacemaker procedures.
L LAAO Registry™
(Left atrial appendage occlusion procedures) Captures data on left atrial appendage occlusion (LAAO) procedures to assess real-world procedural outcomes, short and long-term safety, and comparative effectiveness.
T STS/ACC TVT Registry™
(Transcatheter valve therapy procedures) Monitors patient safety and real-world outcomes related to transcatheter valve replacement and repair procedures – emerging treatments for valve disease patients.
HeartCARE Center™
Recognizes hospitals that have demonstrated a commitment to world-class cardiovascular care through comprehensive process improvement, disease and procedurespecific accreditation, professional excellence and community engagement.
Hospitals are listed by state and then by level of engagement with the ACC’s quality and process improvement programs.
University of Minnesota Health, Heart Care - Burnsville
MISSISSIPPI
Participants in ACC’s NCDR Registries, Accreditation Services and Awardees
2023 IMPROVING HEART FAILURE CARE TOGETHER
Coordinated care for post-discharge heart failure treatment is essential to your quality of life. That’s why we advocate the Partner in Care approach. Find health care facilities, outpatient clinics, and medical practices that are committed to the best patient outcomes and display these ACC Heart Failure Accreditation seals.
NORTHEAST
Jersey Shore University Medical Center Neptune City, NJ
Outpatient Services Partner: JSUMC Advanced Heart Failure Center Neptune City, NJ
SOUTH
Baptist Health Louisville Louisville, KY
Outpatient Services Partner: Baptist Health Louisville Heart Failure Clinic Louisville, KY
East Jefferson General Hospital Metairie, LA
Outpatient Services Partner: East Jefferson Heart Clinic Metairie, LA
King’s Daughters Medical Center Ashland, KY
Outpatient Services Partner: King’s Daughters Structural and Heart Failure Clinic Ashland, KY
Medical City Heart and Spine Hospitals Dallas, TX
Outpatient Services Partner:
Medical City Advanced Heart Failure Center Dallas, TX
Novant Health New Hanover Regional Center Wilmington, NC
Outpatient Services Partner: Novant Health Heart & Vascular Institute
– Wilmington Main Wilmington, NC
Spartanburg Medical Center
Spartanburg, SC
Outpatient Services Partners: Heart Failure Clinic Spartanburg Medical Center Spartanburg, SC
Heart Failure Clinic Pelham Medical Center Greer, SC
Heart Failure Clinic Cherokee Medical Center Gaffney, SC
Heart Failure Clinic Union Medical Center Union, SC
St. Luke’s Health Memorial Lufkin Lufkin, TX
Outpatient Services Partner: The Heart Institute of East Texas Lufkin, TX
MIDWEST
Lutheran Hospital of Indiana Fort Wayne, IN
Outpatient Services Partner: Lutheran Hospital Advanced Heart Failure Clinic Fort Wayne, IN
WEST
Eisenhower Medical Center Rancho Mirage, CA
Outpatient Services Partner: Glickman Cardiac Care Clinic Rancho Mirage, CA
Loma Linda University Medical Center Loma Linda, CA
Outpatient Services Partner: Loma Linda University Health International Heart Institute Loma Linda, CA
Ashley Regional Medical Center........................
THE HEART OF QUALITY PATIENT CARE
Columbia St. Mary’s
Medical
Grafton
Ascension Columbia St. Mary’s
Ozaukee
Aurora Medical Center Summit
SSM Health St. Mary’s Hospital
when they are referred for these services, these patients are commonly rejected by nursing facilities despite the federal law that protects them under the Americans with Disabilities Act. In a Massachusetts case, Athena Health Care Systems, operator of multiple skilled nursing facilities, paid a $10,000 penalty to the federal government after allegations surfaced that it had turned away patients who were being treated for opioid use disorder. That slap on the wrist provided little deterrent for others to stop discriminating.
After we managed to get Brittany out of the danger zone, we knew she needed a solid discharge plan to one of these nursing facilities to regain her strength and complete her course of medical therapy. She also desperately needed to reconnect with her addiction treatment program. Without it, her risk of relapse and hospital readmission was nearly 100%.
But Brittany was never accepted into one. Instead, she had to stay in the hospital, and when she was discharged, she returned home. While at the University of Maryland Medical Center, she worked hard in physical therapy and discussed the past trauma that had led to her drug use with us and the rest of her care team. She shared that she had been raped at age 14 by a drug dealer, that she had witnessed her father’s murder by random gun violence and that, by age 19, she had given her only son up for adoption. She then fell into a suicidal depression.
Failed by the system. Most of the patients we care for are marginalized. They are from the poorest neighborhoods in Baltimore and have dealt with abuse, violence and racism from institutions meant to protect them. They have taught us that unaddressed feelings of hurt get buried alive, waiting for a vulnerable moment to come roaring back, triggering pain and self-destruction.
Since being discharged from our hospital in August 2022, Brittany has utilized our outpatient addiction treatment programs. She also receives primary care services through a specialized Health and Recovery Practice (HARP), which offers comprehensive medical,
psychiatric and infectious disease care for people who use or have used drugs. The practice also focuses on trauma-informed care, recognizing that a vast number of people like Brittany started using drugs to cope with unbearable emotional pain. These patients need to feel heard. They must be treated with humanity by providers trained to care for people living with ongoing and past traumas in an environment designed to feel safe, welcoming and trustworthy.
We believe more patients should have access to this kind of care – and that a remodeling of our health system is warranted. Our nation’s poorest patients are most in need of trauma-informed care, and they are also the most likely to fall through the cracks with little or no insurance coverage.
More investment is crucial. Not in expensive medical tests and procedures, but in time, space and personnel. Health care practitioners need to schedule longer appointments and spend quality time with their patients in order to unearth the roots of people’s suffering and address the serious health consequences of addiction and trauma. Unfortunately, today’s healthcare climate rewards physicians for seeing the greatest number of patients as quickly as possible. We argue, however, that resource-intensive, trauma-informed care models like HARP’s will ultimately save the system money by decreasing the likelihood of relapse, repeat trips to the emergency room and prolonged hospitalizations.
Brittany kept up with her appointments, and on a recent one, she looked thin and pale but in good spirits. She was smiling and cradling a large folder full of applications for EMT and phlebotomy jobs. “I want to fix my life so when one day my son comes looking for me, he will be proud,” Brittany said.
“I am a good person. I am trying hard.” The future remains uncertain for Brittany as she lacks social support from her local community and lives in a neighborhood where drugs remain all too easy to obtain. She and many others like her are pushing us toward greater awareness of vulnerable people hiding in plain sight. They deserve more of our time, resources and attention. Let’s give it to them. l
Our poorest patients are the most likely to fall through the cracks.
CelebratingExcellenceinHealthcare
Shauna Raboteau, DOAmanda Krus-Johnston, DOLindsay Diemer, DO Ryan Smith, DO
Breanne Jaqua, DO Nicole Peña, DO
DeSimone, DOChandra Jennings, DOR. Sterling Haring, DO
7 Ways to Prevent Medical Errors
Take control of your medical care with these doctor-approved tips
AYBE YOU’VE heard horror stories about medical errors, such as a person who was left paralyzed on one side of their body after doctors failed to recognize signs of a stroke, or a patient who had the wrong leg removed during surgery. And while most medical errors — or preventable mistakes that cause patient harm — are much smaller in scale, errors of any size can cause problems. An estimated 10% of patients in high-income countries are harmed while receiving hospital care, according to the World Health Organization, but medical errors aren’t limited to hospitals. Medical harm can occur anywhere health care is delivered, says Dr. Jeff Brady, director of the Agency for Healthcare Research and Quality’s Center for Quality Improvement and Patient Safety (AHRQ) , part of the U.S. Department of Health and Human Services. That includes nursing homes, pharmacies and doctors’ offices.
Medical errors range from prescribing the wrong medication to misdiagnosing a health problem. “While not intentional, this can lead to delayed treatments,” says Dr. Ada Stewart, president of the American Academy of Family Physicians and a practicing family physician in Columbia, South Carolina. Sometimes, clerical errors are to blame, like a
PATIENT POWER
staff member mistakenly entering medical information into another patient’s account instead of yours. And if a hospitalized patient gets an infection that could have been avoided, that’s considered a medical error too.
Although you can’t avoid all potential medical errors, there are some moves you can make to lessen your chance of experiencing one. Follow these tips to help improve the quality of your care.
Come prepared
A doctor’s time is extremely limited, and you want to get to the main point of why you are there, says Dr. David Newman-Toker, director of the Johns Hopkins Armstrong Institute Center for Diagnostic Excellence at Johns Hopkins Medicine in Baltimore. Being thoughtful with your health information could help you get better care.
Newman-Toker recommends preparing a one-page executive summary, where you explain the highlights of your health concerns in advance. This gives you time to focus on details that will be helpful to the doctor, such as how your symptoms have changed over time. You’ll also want to disclose all information about your past medical history (the complete picture may make it easier to diagnose a problem) and share all of your potentially risky behaviors, such as smoking or drinking. “These are important factors that may influence care and treatment decisions,” Stewart says.
Not sure where to start? The Society to Improve Diagnosis in Medicine created a comprehensive handout, the Patient’s Toolkit for Diagnosis, that helps you gather key information in advance. You can include details of your medical history, medications, symptoms related to your current health problem, goals for the appointment and steps to follow after your appointment. To get the toolkit, go to improvediagnosis.org/patients-toolkit.
Prepare a medication list
Your health provider will want to know about the medications you’re taking (including over-
the-counter drugs and herbal supplements). They’ll use this information to determine if you’re using the right medications and to avoid prescribing a potentially unsafe combination of medications, since certain drugs can react with one another.
If you take several prescriptions, it can be easy to forget some, and you may not remember all the dosing information when you’re at the doctor’s office. The solution? Prepare a list of over-the-counter and prescription medications and supplements in advance. Include all relevant information, like the name of the medication, dosing instructions, why you’re taking that drug and the name of the prescriber.
If that sounds like too much work, know that there are also apps that allow you to snap photos of your pill bottles so you don’t have to remember complex drug names and dosages, says Brady.
Ask questions
“Asking questions – and making sure you understand the answers – is one of the most important things you can do to ensure that you get the safest care possible,” Brady says.
It may seem intimidating to question what the doctor is saying, but you want to have a provider who is willing to interact with you and share their thought process, Newman-Toker adds. One question that he encourages asking if you’re trying to get a new health problem diagnosed is: “What’s the worst thing that this may be and why?”
If the provider doesn’t think you have a worst-case problem, ask why. This gives you insight into how they’re thinking and their openness to working with you to help identify your health problem.
Seek a second opinion
Newman-Toker says he always encourages patients to get a second opinion from another physician if that makes them more comfortable or if they sense that their current doctor isn’t listening to them
properly. Not only do you want to work with someone who will take you and your health seriously, but seeking out a second opinion could improve your health outcome. A 2021 study found that getting a second opinion cuts the chance of a misdiagnosis in half (and a third opinion lowered the chance of an inaccurate diagnosis even further).
Bring a trusted friend or family member
There’s often a lot of information to absorb at a doctor’s appointment. If you bring a friend or family member to the appointment with you, they can listen and process information that you might miss or ask the doctor important questions that you may not have even thought of.
Plus, it will be easier to remember complex instructions for post-procedure at-home care if you have someone to take notes for you. Just make sure you don’t mind if the person coming with you hears your health information so that you can still be 100% honest with your physician, advises Dr. Stewart.
Stay vigilant
If you’re not getting better, you should absolutely say something to your doc tor. Let’s say that you’ve been prescribed an antibiotic for a suspected infection. If it’s not working, it’s perfectly reasonable to ask whether there are any other health problems to consider instead of the original diagnosis, explains Newman-Toker.
Talk to the provider if you suspect there’s a medical error.
Sometimes, what may seem like a medical error could just be a simple misunderstanding, and the provider may be able to help you understand the information more clearly. Returning to your provider for further explanation or to talk about what’s going on can often help clear things up. l
10 Common Medical Errors
Understanding the most frequent errors that occur in healthcare settings can help keep you informed and alert.
1
Misdiagnosis or Late Diagnosis
A failure to — or a delay in — identifying a patient’s ailment correctly.
2 Ignoring Patient Concerns
Not taking a patient’s complaints about pain or symptoms seriously.
3 Surgery Error
Operating on the wrong side of the body or the incorrect organ or limb or even performing the wrong procedure.
4
Lab-Related Mistakes
Ordering the wrong test, administering the test incorrectly or a failure to act on results.
5 Clerical Mishap
Pulling up the wrong patient file when adding in prescriptions or leaving critical messages on someone else’s voicemail.
6 Medication Mix-up
Prescribing the wrong medicine, giving an incorrect dosage or not considering a patient’s allergies.
7 Retained Objects
Accidentally leaving something inside the patient during surgery, for example absorbent pads, or in extreme cases, forceps.
8 Home Care Errors
Not giving accurate or detailed instructions for post-operative care, leading to worsening conditions or illness.
9 Early Discharge
Sending a patient home before they have properly healed or fully understood how to continue care for themselves at home.
10 Infections
Failure to properly sanitize or wear the appropriate masks or gloves, resulting in lifethreatening conditions.
12 steps to take before you walk into the operating room
WHEN YOU’RE ABOUT to go in for surgery, it’s normal to have a lot of questions and maybe some worries, too. One study in the journal
Patient Safety in Surgery found that 47% of patients have preoperative anxiety, with fear of death, complications and unexpected operation results topping their list of concerns. And considering that 15 million Americans have some sort of surgery each year, that’s a lot of people dealing with anxiety! But – deep breaths – you don’t need to be one of them.
Arming yourself with the knowledge of the best ways to prep for your operation could help calm your pre-surgery jitters. Not only that, but working closely with your healthcare providers before (and after!) surgery and surrounding yourself with the right support could even help you feel better faster. Read on for twelve easy
yet effective ways to improve your recovery, including how to prepare for surgery, how to minimize complications and what to do post-surgery.
1
Aim for a Healthy Pre-Surgery Weight
Being at a healthy weight at the time of your surgery helps improve your chance of avoiding postoperative complications. In a 2018 meta-analysis published in the Annals of Gastroenterological Surgery, researchers found that obesity prolongs operative time and, as a result, may be a risk factor for certain short term post-surgery outcomes, depending on the procedure.
“The risk of wound infection decreases and the ability to move around and speed up your recovery is so much better when the patient is closer to an ideal body weight,” says board-certified general and colorectal surgeon Dr. Tracey Childs, vice chair of surgery at Providence Saint John’s Health Center in Santa Monica, California.
Of course, losing weight is often easier said than done, and fad diets can do more harm than good. If you think you’d benefit from dropping a few pounds before your surgery, talk with your physician. They may be able to guide you to a dietitian or other specialist who can set you up with an achievable eating plan that takes your lifestyle and food preferences into account.
2
Focus on Nutrition
On the flip side, being underweight can also be a risk factor for surgical complications. For some patients, getting enough calories and maintaining a minimum healthy weight before their surgery is important.
“Many patients are coming for cancer surgery and have just completed chemotherapy or radiation that has left them underweight. It’s very difficult to heal from surgery and maintain healthy immune status when malnourished,” says Dr. Joyce A. Wahr, a professor of anesthesiology at the University of Minnesota. She recommends that patients consult a registered dietitian to help them develop a healthy eating plan that provides the nutrition and calories they need before their surgery.
Patients who need more nutrition should focus on eating calorie-dense foods before their procedure. Such patients can also consume nutrient- and calorie-dense beverages, such as breakfast drinks, two to three times a day, Wahr says. For example, peanut butter blended with an Ensure chocolate beverage is a delicious, high-calorie drink that’s also rich in nutrients.
3
Drink Clear Liquids
The American Society of Anesthesiologists recommends that all healthy patients drink clear liquids up until two hours before surgery. That includes water, black coffee or tea (no milk or creamer), fruit juice (without pulp) and clear electrolyte drinks (like Gatorade or Pedialyte). Doing so has been shown to reduce hunger, nausea and thirst, as well as ease anxiety.
PATIENT POWER
According to Wahr, “Thirst is an incredibly powerful drive. When we are thirsty and not permitted to drink, it can be really miserable.”
Other options include clear carbohydrate beverages, like Ensure Pre-Surgery, that have been formulated to help patients before and after surgery. This particular drink contains 50 grams of carbohydrates, which may improve surgical outcomes and help patients avoid dehydration that can occur during the preoperative fasting period.
4
Fuel Your Body with Protein
Eating enough protein prior to your operation helps support your immunity, promotes wound healing and assists in maintaining muscle mass. All of that can help you get back on your feet sooner, says Lauren Sullivan, clinical nutrition manager of inpatient nutrition therapy at Cleveland Clinic’s Center for Human Nutrition.
“Protein is a fuel source for the body,” says Sullivan. “It supports tissue, muscles, organs, your immune system, hair, skin, nails and more. Higher protein intake prior to surgery provides the body with the building blocks needed to heal and repair
itself during recovery.”
Excellent sources of protein include beans, dairy products like cottage cheese and Greek yogurt, eggs, fish, lean meat, skinless chicken, legumes and nuts.
5
Eat Plenty of Plant-Based Foods
Prior to surgery, you’ll also want to stock up and chow down on fruits, vegetables and other plant-based foods. In addition to providing dietary fiber, they contain lots of healthy nutrients, including compounds called phytochemicals that reduce the risk for inflammation, says Anne VanBeber, a professor of nutritional sciences at Texas Christian University in Fort Worth, Texas.
These anti-inflammatory compounds can help your body heal from surgery. For example, foods high in vitamin C – like bell peppers, broccoli, and strawberries – can help to rebuild collagen, which is the building block of our skin, VanBeber explains. Plant-based foods to add to your pre-surgery shopping list could include produce (leafy greens and berries are especially great picks), nuts and seeds, whole grains (like quinoa and rice) and legumes (like lentils and beans).
Make a point of walking at least 30 minutes every day prior to surgery.
Committed to the highest- quality surgical care.
Deciding where to get your surger y is critically impor tant The American College of Surgeons (AC S) is here to help you make that decision AC S Q uality Programs verif y that hospitals meet, and even exceed, clinical standards developed by the world ’s leading surgical exper ts , so you know that the care you receive at a hospital enrolled in these programs is of the highest quality AC S Quality Programs were built for patients - the future of patient care star ts here
6
Avoid Added Sugar
Excessive sugar intake may lead to insulin resistance or elevated blood glucose levels, which are associated with diabetes. For patients undergoing surgery, this can reduce healing and promote infection.
You should avoid treats with added sugar – such as cake, fruit pies, cookies, muffins and candy – before and after surgery. Instead, reach for fruits that contain natural sugars, like apples, blackberries, blueberries, and citrus fruits, as they provide plenty of nutrients, including fiber.
7 Stop Smoking and Vaping
If you haven’t quit yet, now’s the time to. That’s because smoking or vaping tobacco or cannabis right before a procedure could impair blood flow function. This can lead to complications such as death, heart attack, poor wound healing, shock and stroke.
Indeed, according to research published in 2020 by the World Health Organization, the University of Newcastle, Australia and the World Federation of Societies of Anesthesiologists, eliminating tobacco for more than four weeks prior to surgery was associated with better postsurgical outcomes – and each additional week of cutting out smoking improved outcomes even further. Moreover, a 2017 meta-analysis published in the journal Surgical Infections that evaluated 26 studies involving more than 67,000 patients found that smoking increases the risk of surgical site infection after surgery.
Childs suggests talking to your surgeon about ways to quit smoking or vaping as soon as your surgery is scheduled. For additional support, the American College of Surgeons has a program to help their surgery patients and physicians collaborate to achieve this health goal using various strategies, including nicotine cessation products and mindfulness techniques.
8 Increase Physical Activity
Getting enough exercise and staying active is always a smart choice for improving your health. But it’s especially important in the weeks and months before you’re scheduled to undergo surgery, since keeping your body in shape and accustomed to physical activity can help you bounce back after the operation.
“Sometimes people think they should become inactive because they are about to have surgery,” Wahr says. “We encourage patients who are active to continue to be active, and those who have a low level of physical activity to increase it.”
Make a point of walking at least 30 minutes every day, suggests Wahr. And if you have a favorite form of exercise, like swimming or playing tennis, try to continue your usual workout regimen. And aim to keep moving post-surgery too, since physical inactivity following an operation can make some patients vulnerable to potentially deadly blood clots.
9
Consider a Pain Management Plan.
Patients who undergo surgery may experience varying degrees of pain and a loss of functionality that comes with that discomfort. For example, someone who has surgery to reduce an enlarged prostate may feel little to no postoperative discomfort. However, someone who undergoes knee replacement surgery may experience significant pain and, in the short term, loss of functionality.
“Pain after surgery is something that a lot of patients fear. Knowing how to make good decisions about your options, especially non-opioid ones, will help you feel better and make the best progress,” says Sterling Elliott, clinical pharmacist lead at Northwestern Medicine and assistant professor of orthopedic surgery at Northwestern University Feinberg School of Medicine in Chicago.
Patients should ask their surgeon and pharmacist about the best options for managing their post-surgical pain and how to recognize when the discomfort is affecting their functionality. It’s also important to educate yourself on the dangers of using opioids such as oxycodone, which are associated with misuse, dependence and overdose. “There’s power in understanding how and when to use opioids,” Elliott says. “There’s power in knowing when another option is best. Ultimately, thoughtful decision-making will be best for your recovery.”
10
Get Enough Fiber
The combination of taking pain medications and getting less physical activity post-surgery can often lead to uncomfortable constipation. As a result, most hospitals no longer require patients to have a bowel movement before being discharged to go home, Childs says. And there is a way to stay more regular.
Consuming enough fiber and avoiding narcotic pain medications, which are associated with constipation, can help you maintain regularity following your surgery. Foods like beans, fruits, lentils, nuts, whole grains and vegetables are great options.
11
Continue Taking Your Prescribed Medications
It’s important that your care team is fully aware of all the medications you’re taking along with the dosages. And unless your surgeon or physician advises you otherwise, you should keep taking your prescribed medications as usual.
“Though it is becoming less common, some patients think they need to halt all medications in order to prepare for surgery, and it can have dire consequences,” says Dr. Neel Anand, professor of orthopaedics and director of the Spine Center at Cedars-Sinai Medical Center in Los Angeles. “This is one decision you shouldn’t make yourself. Leave it to the experts.”
Communicate with Your Surgeon
Typically, your surgeon will provide post-surgery recovery instructions before your procedure. These days, all of
this information tends to be provided through a digital portal, but you can ask for a printed copy if that’s more convenient for you, Childs says. You can go over the instructions with your surgeon or the physician’s staff and then reread them at home to make sure it’s all clear. Call your doctor’s office if you have any questions.
Technology can also connect patients with their surgeons and other health care providers, allowing them to develop a plan for a successful post-operation recovery together. A patient engagement app, like Twistle, can come in handy for getting in touch with your care team and for sending reminders about upcoming appointments. After the surgery, the app sends patients checkin questions. Doctors can get in touch immediately to resolve any alarming issues, like pre-surgery anxiety or unexpected pain. “It keeps us connected and makes patients feel very cared for,” Childs says. l
Homeward Bound
Before you’re discharged from the hospital, take the time to set yourself up for a healthier future
YOU’VE RECEIVED THE GOOD NEWS: After a short stay at the hospital, your doctor has decided that you’re medically stable and ready to head home. As you start the discharge process, you’ll want to think ahead to your recovery and be proactive about asking certain questions before you leave the hospital. Not only will this set you up for a healthier future, but it could also lower your chances of readmission.
A 2021 report found an average of 14% of people were readmitted within 30 days of their initial hospital stay. You likely don’t want to head back to the hospital – and your doctors would prefer that you continue your care from home too. That’s because hospital readmission is associated with an increased risk of adverse health outcomes, including increased patient stress and higher mortality rates. Read on to learn more about the hospital discharge process – and 10 questions you should ask your doctor before heading home.
Go Time
Patients often wonder if they can ask to be discharged. The short answer is yes. You can leave the hospital anytime as long as you have the mental capacity to make that decision. (Making the decision to leave without a formal discharge is called AMA, which stands for “against medical advice.”)
The longer answer is that while you can do this, medical professionals do not always recommend it. Even if you feel great now, you still could become ill if you don’t fully understand your treatment plan going forward, says Dr. Renée Rulin, a Pawtucket, Rhode Island-based
family medicine physician.
You could also miss out on results that might determine other medical care you need. For instance, if you leave the hospital before your MRI results come back, you may not get important information on whether or not you need surgery.
Questions Are Encouraged
Yes, the hospital staff is busy, but don’t take that as a sign that they don’t want to help you get your questions answered. Doctors and nurses welcome your questions during the discharge process or any time during your stay, explains Dr. D. Ruby
Sahoo, a member of the Society of Hospital Medicine’s board of directors. They understand that not only will clearing up any confusion now make the rest of your hospital stay easier, but it will also set you up for success post-discharge.
“The more a patient understands, the better equipped they are for healing,” says Dr. Carl Cameron, chief medical officer with MVP Health Care in Schenectady, New York. Plus, when you know the care that you need, you can help prevent a return to the hospital.
Of course, being in the hospital doesn’t exactly put you in an ideal frame of mind to ask questions. You may feel confused or overwhelmed, and if you’re still recovering from surgery or an illness, you may not be mentally prepared to process a slew of new information.
Additionally, some people may simply not feel comfortable questioning their medical providers. It’s completely normal to feel a little shy about asking questions. But know that hospital professionals realize that patients feel this way, and they can work with you to address what you need to know for your discharge.
At most hospitals, the person to answer your health questions will be your attending physician, also known as a hospitalist or a doctor of hospital medicine. This is a primary care doctor who works for the hospital to coordinate care for patients. You can also lean on your nurses, social worker or registered dietitian depending on the type of question you have. The bottom line: If you have questions (like the ones on the next page), don’t hesitate to ask them! Your recovery could depend on it. l
TO ASK BEFORE LEAVING THE HOSPITAL
Work with a family member, trusted friend or caregiver to think of questions you want to have answered. If you’re not sure what to ask, start with these 10. Write down questions (on your phone or on a piece of paper) as you think of them, advises Dr. Sharon Santoso Clark, a director of patient experience in the division of hospital medicine at Ohio State University Wexner Medical Center in Columbus. And take note of the doctor’s responses. Tip: It may be helpful to have that same family member or friend present to jot down notes themselves so you can fully focus on the conversation with your physician.
1What medications do I need?
Getting a clear understanding of your medication use is a very important part of the discharge process, says Dr. Theodore Strange, chair of medicine at Staten Island University Hospital in Staten Island, New York. Hospital personnel will provide you with written information about your medications, but it’s important to have a verbal discussion about them
your to go ant to down ion, th l you k of the r in ave you
as well, says Dr. D. Ruby Sahoo. Ask your doctor if they can take a few minutes to go over your prescription plan. You’ll want to get information about the following: Dosage instructions Be sure to jot down when and how often to take the medication, how to take it (such as with water or with or without food), and how long you’ll need to take the prescription for.
The exact name of the Rx
Because medications often have a generic name and a brand name, you may not always recognize the name of a medication that you potentially already use. Getting clear on the medication names can help avoid duplicate medication use.
n you may no name of a m alrea the medication medic
Side effects B desirable effects doctor what y tice them. Certain you to stop th may have been t from the hos g medication? medicat as medic for your Kn
or pulmonologist (lung doctor). You’ll want to know if you need to continue to see these specialists going forward. You also may need physical, occupational or speech therapy. Your hospital health care team can let you know exactly what you need and help you identify where to find this care.
Be aware of possible undesirable effects of using a drug, and ask your doctor what you should do if you notice them. Certain side effects may require you to stop taking the medication entirely. How to get your Rx Some prescriptions may have already been called into a pharmacy, while others may need to be ordered after you’re discharged from the hospital.
6
When should I call a doctor or return to the hospital?
This helps you stay aware of more serious symptoms or medication side effects that require medical care, says Dr. Carl Cameron.
7 Do I need any follow-ups?
What’s the goal of my
recovery encourage you tion schedule post-discharge
Were
Taking your medication as prescribed – which is known as medication adherence – is important for your recovery. Knowing why you’re taking a particular medication and how it’s benefiting your recovery could encourage you to stick to your medication schedule post-discharge.
any other diagnoses made during my stay?
Were any other made d uring m
For instance, you may cause of a bad asthma a with blo additional diagn ger other to yo
If a CT scan found an abnormal growth in your lung, you may need a follow-up scan in a couple of months, Sahoo says. The follow-up scan may get ordered during your stay, or it may just be recommended. The latter means it’s left in your hands to schedule the follow-up, which is why this question is important to ask.
8
How long should I expect my recovery to take?
Some patients will just have a one- or twoday recovery while others may need weeks or months to regain their health. Keep in mind that recovery may take longer if you have other medical problems, such as heart or lung conditions.
For instance, you may go into the hospital because of a bad asthma attack, but doctors end up diagnosing you with high blood pressure or diabetes. Asking about additional diagnoses will potentially trigger other questions to help your at-home care.
9
When should I expect to hear from the home care agency?
Have you notified my primary care doctor about my admission to the hospital?
Have you notif care doctor a b ad m ission to t
You’ll want this person age condition once you’r Dr. Renée Rulin. And once yo should d your care and check on your re to have a care doctor one to two weeks a could be an in-person or virtu
If you’re having professional support come to your home to help care for you, knowing when you should expect to hear from them is useful. If you don’t hear from them by that date, you’ll need to follow up to ensure that your appointments are scheduled.
You’ll want this person in the loop to help manage your condition once you’re out of the hospital, says Dr. Renée Rulin. And once you leave the hospital, you should see your primary care doctor to help coordinate your care and check on your recovery. Generally speaking, expect to have a follow-up visit with your primary care doctor one to two weeks after your discharge. This could be an in-person or virtual visit
10
How much will my medication cost after discharge?
What other specialists should I see after my discharge?
Depending on your diagnosis, you may have seen other specialists, such as a cardiologist e Because m
What other s p I see af ter d on your d seen other specialists
Hospital personnel should be able to check on the cost of any medications before you leave the hospital, Santoso Clark says. If you have insurance, these costs are based on your insurance coverage. By finding out these costs in advance, you can make sure they are affordable for you. If they aren’t, your health care team can suggest alternatives or let you know about medication assistance programs. The same applies to covering the cost of equipment you may need, such as a walker or wheelchair. l
Is Ozempic the Answer?
It’s touted as a magic drug for weight loss, but doctors say that the medication still has its drawbacks
OVETED BY CELEBRITIES and labeled an obesity game-changer by doctors, it’s an understatement to say that Ozempic has changed the way we treat weight loss. Originally developed as a diabetes medication, Ozempic recently found itself in the spotlight after patients started noticing that the drug also helped them lose significant amounts of weight.
Essentially, Ozempic makes you eat less, though the exact mechanism isn’t clear, explains Dr. Heather Martin, a family medicine physician based in Tennessee. What we do know is that the medication keeps the stomach full for longer, which reduces appetite. It also affects gut bacteria, which can help with weight loss, says Dr. Neil Paulvin, a board-certified doctor in family practice and regenerative medicine in private practice in New York City.
But will the weight loss stay off – and is Ozempic safe? Here are some answers to top questions about the drug.
How Does Ozempic Work?
“Ozempic is a brand of semaglutide, a glucagon-like peptide-1 (known as GLP-1) receptor agonist,” explains Dr. Andres Acosta, an associate professor of medicine, director of the nutrition obesity research program at Mayo Clinic in Rochester, Minnesota and co-founder of Phenomix Sciences, a precision obesity biotechnology company that’s based in Excelsior, Minnesota.
Semaglutide and other GLP-1 medications mimic the function of a hormone called glucagon-like peptide 1. In
response to the rise in blood sugar you experience after eating a meal, GLP-1 receptor agonists trigger the pancreas to produce more insulin to keep those blood sugar levels from spiking.
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There are GLP-1 receptors in the brain which, when stimulated by GLP-1 agonists, lead to a decrease in food intake. Meanwhile, GLP-1 receptors in the gut cause a delay in gastric emptying when stimulated. This leads to weight loss in two main ways – reduced gastrointestinal motility (the movement of food through the gut) and decreased appetite. In fact, some patients say they lose interest in food entirely.
In fact, some e interest in food s delivered as a dminister into the skin h or arm. “That sound device it easy,” says Martin. y against and press ver in an instant with a little herself. “Since I started
The medication is delivered as a once-weekly injection that you administer yourself into the skin of the stomach, thigh or upper arm. “That may sound a little scary, but the device makes it easy,” says Martin. “You just put the tiny needle against your skin and press a button, and it’s over in an instant with just a little pinch.” Martin uses Ozempic herself. “Since I started taking it, it’s hard for me to finish all the food on my
plate, which is a new and welcome change for me.”
Ozempic is actually only FDA-approved for the treatment of Type 2 diabetes, but because weight loss is a secondary effect of Ozempic, doctors sometimes prescribe it offlabel for weight loss. And Ozempic isn’t the only medication option in this class of drugs. There’s a higher dose semaglutide called Wegovy that approved for the treatment of obesity.
Is Ozempic Effective for Weight Loss?
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The weight loss benefits of semaglutide are due to an overall decrease in one’s intake of calories from food and drink. The less calories you consume, the more weight you lose.
One study that looked at patients with overweight or obesity found that those taking semaglutide lost almost 6% of their body weight after three months and almost 11% of their body weight after six months.
cation’s e wears off, it to gain those
That’s in and doctors say that the used in w This means that some p their and hab some patients m benefits at all. “We know from the y e s is essential to tools to the best respo intervention.” To that end Acosta says that the Nation
It is important to know that Ozempic and other semaglutide medications work for many people, but your results may not be the same as someone else’s, notes Acosta. Additionally, weight loss generally plateaus around three to six months. And once the medication’s effect on weight loss wears off, it can be extremely easy to gain those pounds back.
That’s why in order to lose weight successfully and avoid weight regain, doctors say that the medication must be used in conjunction with diet and exercise. This means that some patients may need to adjust their lifestyle and habits.
Frustratingly, some patients may not see weight loss benefits at all. “We know from the years of work we have done at Mayo Clinic and the studies of each of these medications that not all patients respond to them,” says Acosta. “Thus, it is essential to develop tools to identify the best responders to each obesity intervention.” To that end, Acosta says that the National Institutes of Health is supporting ongoing work at Mayo Clinic to develop real-world evidence for for me is FDA-appr of weigh effect of doctors somet O c a semagluti is t
how to identify the best responders for obesity interventions.
What Are the Other Benefits of Ozempic?
Weight loss isn’t the only positive result that comes from taking Ozempic. Martin says that she’s seen patients’ health improve dramatically. Some have had improvements in blood pressure, cholesterol and energy levels, along with other benefits. “Obesity is correlated to a lot of serious chronic diseases,” says Martin, “and being able to treat and manage patients for these conditions in the primary care setting is important.”
In her own life, Martin says this new class of medications has been a game changer. “I have been overweight since medical school and have tried different diets and health programs, but even when I managed to lose weight, it always came back,” she explains. “My blood pressure and cholesterol were elevated, and I had sleep apnea, meaning my breathing would stop and start without notice while sleeping. It’s a potentially serious condition that can contribute to high blood pressure, fatigue and heart problems, among other negative health outcomes.”
To keep weight off, diet and exercise are key.
Because of the sleep apnea, Martin wore a sleep apnea mask every night and regularly felt exhausted. “I didn’t have a ton of energy to play with my kids, and I was starting to develop back and joint problems from the wear and tear of carrying more weight around than my 5’4” frame could easily support.”
But since she started taking semaglutide, Martin has lost 16% of her body weight and says she feels better than ever. “My BMI is no longer in the obese or overweight range. I’m eating a healthier amount and staying more active and I have an easier time playing with my kids. I also have stopped having to use my sleep apnea mask, which is a huge, welcome change to my quality of life.”
More research is needed to understand the full picture that Ozempic and other semaglutide have on a patient’s health, but doctors are starting to notice some other interesting side effects, such as a reduced interest in drinking alcohol, smoking and engaging in addictive behaviors like shopping and nail biting. However, as of press time, it’s too soon to say if Ozempic could be used as a potential cure for these behaviors.
What Are the Side Effects of Ozempic?
Before you start taking Ozempic or another semaglutide medication, it’s important to know what the possible drawbacks and health risks could be. Every medical intervention brings the potential for side effects, and Ozempic is no exception.
The most common side effects of semaglutide medications include nausea, abdominal pain, vomiting, diarrhea and constipation. Starting at a lower dose and slowly increasing the
dosage could help ward off some of these common side effects. “Sometimes we even decrease dosage if the side effects become unbearable,” Martin says.
Paulvin adds that people taking Ozempic should shift to eating two or three smaller meals a day rather than fasting. Opting for lower-carbohydrate, higherprotein meals can also support healthy, sustainable weight loss with Ozempic. ”Most people can use about two-thirds of the amount of food they normally would,” he says.
Less commonly, some patients who are taking other medications for diabetes may experience hypoglycemia, or very low blood sugar levels. If you have diabetes and start taking a semaglutide medication, be sure to check in with your doctor regularly so that they can monitor your progress.
Ozempic may also raise the risk of thyroid tumors, pancreatitis and gallbladder problems. That’s why it’s important to alert your doctor about any concerning symptoms including: a lump or swelling of the neck, difficulty swallowing or breathing, hoarseness, severe stomach pain or nausea, chills, fever, lightheadedness, indigestion and yellowing of the eyes or skin.
Paulvin adds that patients may see some muscle loss as part of their overall weight loss on Ozempic. To offset this, he instructs patients to consume adequate amounts of protein and to engage in weight-bearing exercise (such as walking, dancing, low-impact aerobics, stair climbing and gardening) on a regular basis in order to maintain as much muscle as possible.
And if you’ve heard about so-called “Ozempic face” – or a loss of fat in the face that can lead to a gaunt appearance, sagging skin and more obvious wrinkles – know that while this is not officially listed as a side effect of the medication, some users have reported looking older after taking Ozempic for a while. This is actually a natural consequence of losing fat, since the body sheds fat from all over, not just from specific places like the stomach or thighs, says Paulvin. “People who are using it more for cosmetic reasons need to understand the pluses and minuses there.”
What Is a U.S. News Best Hospital?
The best hospital for you or a loved one depends on the type of care you need. For a rare bone condition or a lung transplant, for instance, you may need to travel to a hospital that earned a top 50 national ranking for orthopedics or pulmonology, respectively. But for a common procedure or condition like a hip replacement or COPD, you are likely to find that a hospital close to home is highly rated by U.S. News.
WHY DOES U.S. NEWS RATE HOSPITALS?
The quality of health care provided by hospitals to patients across the nation varies widely. U.S. News delves into various quality measures to publish rankings and ratings of hospitals that assist millions of patients annually. These patients face the prospect of surgery or specialized hospital care that can pose a risk due to such factors as age, physical condition or the type of illness. The rankings and ratings are a tool to help consumers make important health care decisions, in conjunction with advice from medical practitioners.
HOW DID U.S. NEWS DETERMINE THE RANKINGS AND RATINGS?
U.S. News’s Best Hospitals project evaluates U.S. adult hospitals annually on how they provide 36 different types of care. The rankings of 15 medical specialties use a variety of quality measures to identify the hospitals that excel at handling the most complex and difficult cases. The ratings of 21 common procedures and conditions are based entirely on objective quality indicators, such as patient outcomes and nurse staffing levels. We also
For more information
publish an Honor Roll of the hospitals that excel in many types of care, as well as rankings of general hospitals by state and major metro area.
WHAT ARE BEST HOSPITALS BADGES AND EMBLEMS?
Hospitals that earn top 50 rankings in a specialty have a gold Best Hospitals award “badge” (logo) on their U.S. News profile page, with information about how many such rankings they won. General hospitals that excel in a large number of common procedures and conditions have a silver “Best Regional Hospitals” silver badge and may be ranked in their state and/or metro area. Hospitals that place in the top 10% for a specialty but not in the top 50, or that achieve the highest possible rating for a common procedure or condition, have a High Performing Hospitals emblem on their profile page.
Hospitals that earn a badge or emblem may obtain permission, for a fee, to display the badge or emblem via websites and other media from BrandConnex, U.S. News’s licensing agent. Current and future rankings, ratings and awards are not affected by such purchases or by any other promotional fees.
• The evaluation of hospitals in your area: https:bit.ly/USN-area
• For detailed information about a speci fic hospital: https://bit.ly/USN-search
• About U.S. News’s hospital evaluations, including Best Children’s Hospitals and Best Hospitals for Maternity Care as well as Best Hospitals: https://bit.ly/USN-FAQ
• Detailed methodology reports about the Best Hospitals specialty rankings https://bit.ly/USN-rank and the procedures and conditions ratings https://bit.ly/USN-ratings
• Hospitals that earn a badge or emblem may contact usnews@BrandConnex.com for information about using U.S. News Best Hospitals badges and emblems.
2023-2024
2023-2024
Who Should Use Ozempic?
“Like type 2 diabetes, obesity is a chronic condition, and should be treated as such,” Martin says. Because being overweight has been associated with a range of chronic conditions, including type 2 diabetes, hypertension and kidney disease, managing your weight in a safe and sustainable manner is an essential part of keeping you healthy for the long run, says Martin. “The new class of GLP-1 receptor agonists is a safe, effective way to do so.”
Martin adds that Ozempic is not for just anyone who wants to try to drop a few pounds for their wedding or high school reunion. In fact, she, like many practitioners, will only prescribe GLP-1 agonist medications to patients who really need them.
“Patients must have a BMI over 30, or a BMI over 27 with one associated condition like hypertension or type 2 diabetes, and have been unable to lose and keep off weight with lifestyle changes alone, like diet and exercise,” says Martin. “We also do a full intake, which includes blood tests, to ensure you’re a good fit.”
Lastly, patients with a personal or family history of medullary thyroid cancer or a rare condition called multiple endocrine neoplasia 2 should not take these medications, Acosta says. Those with a history of chronic pancreatitis should also give it a miss.
If Ozempic is deemed appropriate for your condition, you should know that the drug is intended for long-term
use, meaning that many patients may be prescribed it for the rest of their lives (though some experts argue that Ozempic shouldn’t be used long-term unless you have diabetes.) And patients who stop taking the drug will likely lose the feelings of fullness and see the scale creep up again.
Am I “Cheating” if I Use Ozempic?
Pharmacological interventions like Ozempic shouldn’t be viewed as a stand-alone solution. Instead, they’re just one piece of a larger get-healthy puzzle. “It’s important to know that this medication and other medications need to be part of a multidisciplinary lifestyle program that includes diet and physical activity,” explains Acosta.
Eating a lower-calorie diet may come naturally while on Ozempic, since the medication reduces appetite. That said, it’s still important to focus on nutritious foods, like fruits, vegetables, whole grains, lean protein and healthy fats. And not only can exercise help aid weight loss efforts, but it can also help prevent muscle loss.
But if you’re wondering if taking medication to aid with your weight loss is cheating, Martin (and other doctors) are quick to reassure you that’s not the case. “Obesity is a chronic condition and is associated with many other chronic conditions that could be incredibly detrimental to your health. We are lucky that medication now exists to help treat it.” l
5 More Weight Loss Solutions
Whether or not Ozempic is right for you, these strategies can help you work toward your get-healthy goals
Add Fiber
Research in the journal Annals of Internal Medicine found that eating 30 grams of fiber a day can help people lose weight (as well as lower blood pressure). High-fiber foods can increase feelings of fullness, which could help you eat less. Delicious high-fiber snacks include popcorn, raspberries, hummus and nuts.
Try Time-Restricted Eating
Shortening your eating window could help you lose weight. One new study found that those with obesity and type 2 diabetes who ate all of their meals between noon and 8 p.m. lost more weight than those who reduced their calorie intake.
If going that long without a bite seems too challenging, start with a longer eating window (such as eating all of your meals and snacks between 10 a.m. and 8 p.m.). Then, gradually shorten it.
Be More Mindful
time daily) could help you get more Zzzs. If you’re still having trouble falling asleep or staying asleep, talk with your doctor. They may recommend other strategies or see if sleep medications are right for you.
Set Yourself Up for Success
This seems obvious, but if you have foods in your fridge or pantry that you tend to consume too much of (whether chips or ice cream), you’ll likely overeat. But if you arrange your environment so that it supports your gethealthy goals (such as by replacing the ice cream with fruit or setting out workout clothes the night before to make it easier to get to the gym), you’ll be more inclined to make choices that benefit your well-being.
While you’re at it, make sure that you’re being realistic about your goals. For example, going to the gym daily or losing 20 pounds in a month is overly ambitious (not to mention unhealthy!). Instead, set a more achievable goal (like losing 4-6 pounds a month or exercising three times a week) and give yourself grace if you veer off course. You’re only human, after all! l
eople
Prioritize Your Sleep
Being more aware of your eating by engaging all of your senses could be beneficial for those looking to lose weight. Research has found that people who practice mindful eating are better able to recognize their fullness cues, and in turn tend to eat less. Not sure how to practice mindful eating? Start here: Turn off the TV, put down your phone and sit at the table so that you can truly savor the meal. Pay close attention to how it tastes and smells as well as other sensations, such as how the food feels in your mouth as you chew.
A lack of shut-eye is associated with a higher risk of weight gain and obesity, and one study in the Journal of the American Heart Association found that people who get poor sleep quality tend to eat more sugary foods. This could be because sleep affects a hormone called leptin, which influences appetite.
Focussing on healthy sleep habits (such as turning off electronic devices an hour or two before bed, keeping your room dark, quiet and cool and going to bed and waking up at the same
ecognize their fullless. Not sure how here: Turn o sit at or w r d th a esit m peo at more se ich influits (such as hour or two rk, and up at the same
Best Diets of 2023
Your goal: to find the plan that will work for you
WHAT MAKES A DIET “BEST”? In the latest set of exclusive rankings from U.S. News weighing the merits and shortcomings of 24 eating plans, the Mediterranean diet beat out the competition to win the “Best Diets Overall” crown. Among the 13 commercial diet programs marketed to the public, WeightWatchers came out on top. We also ranked the diets on likelihood of weight loss, ability to prevent and control diabetes and heart disease, healthiness, how easy they are to follow and more.
Our analysis puts hard numbers on the commonsense belief that no diet is ideal for everybody.
Take the DASH diet, which tied with Flexitarian as the No. 2 Best Diet Overall. It wasn’t created as a way to drop extra pounds, but as a means of combating high blood pressure; the name stands for Dietary Approaches to Stop Hypertension. So if losing weight is your primary goal, a diet in our Best WeightLoss Diets rankings might be a better choice for you. Each diet in this category was scored by a panel of leading health experts, including nutritionists and doctors specializing in diabetes, heart health and weight loss, and rated for safe and effective weight loss.
At usnews.com/bestdiets, you’ll find a detailed profile of each diet that tells you how it works, what evidence supports (or refutes) its claims, do’s and don’ts for following each diet and, of course, a close look at the food you’d eat (including helpful sample food plans).
Once you’ve whittled down your eligible diets to a few, consider your personality and lifestyle. If you’re a foodie, you probably won’t be happy with a plan built around frozen dinners or just-add-water meals. And if cutting carbs makes you cranky, you’ll want to stay away from low-carb diets such as Atkins and South Beach.
Then, think about what did and didn’t work the last time you were on a diet. Was it too restrictive? (Luckily, lots of diets we reviewed don’t consider any food to be off-limits.) Did it provide enough structure? Some plans will tell you exactly what to eat and when. And ask yourself: How long can I stay on this? If you can’t stick with it in the long run, you’ll likely be back where you started after a couple months.
We’re not going to tell you what diet you should be on, but we can help lead you to a winner – the best diet for you. l
How We Rank Diets
U.S. News and a panel of experts rated 24 eating plans
AS MANY DIETERS have painfully learned, taking off weight can be a serious challenge. This is why U.S. News produces its Best Diets rankings, based on the views of nationally recognized experts (Page 100) who considered the effectiveness of some of the best-known eating plans. Our panelists reviewed the research, added their own fact-finding and rated the diets from 1 to 5 (the top score) in a number of areas including: weight loss; fast weight loss (the likelihood of losing weight in three months or less); diabetes preven-
tion; heart health (effectiveness at preventing cardiovascular disease and reducing risk for heart patients); ease of compliance; healthy eating (which combines nutritional completeness and safety ratings); bone and joint health (effectiveness at lowering risk factors for inflammation and improving bone and joint health); family-friendly adaptability; and plant-based emphasis. Which plan can help you achieve your goals? Check out the results in these pages. For more on the plans, visit usnews.com/bestdiets.
How the Plans Compare Overall
Twenty-four diets were rated from 1 to 5 on multiple measures. Rank is based on a score compiled from panelists’ average scores for each measure. The results:
Best Weight-Loss Diets
Diets are ranked by the average of the scores experts assigned them for producing long-term weight loss results.
Best Diets for the Heart
With these plans, you can take aim at cholesterol, blood pressure and triglycerides as well as weight.
The Expert Panel
Thirty-three panelists reviewed detailed assessments of the U.S. News list of diets and rated them on a number of key measures, described on Page 99.
Louis Aronne Professor of metabolic research, Weill Cornell Medical College
Katherine Beals Associate professor, nutrition and integrative physiology, University of Utah
Amy Campbell Clinical diabetes program manager
Lisa Coleman Director of healthy living, Giant Food
Mark Cucuzzella Family medicine practitioner, WVU Jefferson Medical Center
Best Diabetes Diets
These plans scored highest for both managing and preventing the condition.
Best Plant-Based Diets
These diets emphasize minimally processed foods from plants and are good bets for weight loss.
Easiest-to-Follow Diets
The ranking is based on ease of implementation and ability
Best FamilyFriendly Diets
Adaptability for the whole
is counted, along with the
Michael Dansinger Founding director, Diabetes Reversal Program, Tufts Medical Center
Michael Davidson Director, Lipid Clinic, University of Chicago Medicine
Katie Dodd Registered dietitian
Teresa Fung Professor of nutrition, Simmons College
Christopher Gardner Professor of medicine, Stanford University
Hollie Gelberg Dietitian at Plantful Living
Andrea Giancoli Registered dietitian
Michael Greger Physician and author
Jessica Isaacs Lead sports dietitian, LA Clippers
David Katz President, True Health Initiative
Penny Kris-Etherton Professor of nutritional sciences, Pennsylvania State University
Shana Minei Spence Registered dietitian, The Nutrition Tea
Yasmin MossavarRahmani Professor of epidemiology, Albert Einstein College of Medicine
Uma Naidoo Director of nutritional and lifestyle psychiatry, Massachusetts General Hospital
Lamia Nasrallah Registered dietitian
Sharon Palmer Plant-based dietitian
Elisabetta Politi Clinical dietitian, Duke Lifestyle and Weight Management Center
Lisa Sasson Clinical professor, nutrition and food studies, New York University
Jessianna Saville Registered dietitian
Toby Smithson Certified diabetes care and education specialist
WHAT DRIVES you to lace up and work out? Maybe you exercise to strengthen and tone. Or perhaps you get moving to help ward off health conditions, like heart disease and diabetes. Or maybe you simply want to have enough energy to keep up with your kids. There are many reasons to prioritize exercising, but here’s one you may not have considered: sweating to improve your mind.
“Exercise is the single best thing you can do for your brain in terms of mood, memory and learning,” says Dr. John Ratey, an associate clinical professor of psychiatry at Harvard Medical School and author of the book, Spark: The Revolutionary New Science of Exercise and the Brain “Even 10 minutes of activity changes your brain.”
So if you haven’t found your “why” for working out yet, keeping your brain in tip-top shape could inspire
you to get moving. Wondering just how you’ll benefit? Read on for eight amazing ways that exercise can boost brain health and makeover your mindset.
Keeps Dementia at Bay
Even mild activity, like a leisurely walk, can help keep your brain fit and active. Physical activity helps to fend off memory loss and keep skills like vocabulary retrieval strong, shows a study published in July 2020 in the journal BMC Geriatrics. And when it comes to dementia, regular exercise is a powerful tool for reducing your risk. In fact, physical inactivity, or being sedentary, is one of the key risk factors for developing dementia, according to a 2020 report from the Lancet Commission on dementia prevention, intervention and care. But physical activity can help lower that risk by 28%.
The Alzheimer’s Research Center touts exercise as one of the best weapons against Alzheimer’s disease – the most
Congratulations to the Platinum Recipients of the
2023 Performance Achievement Award
Providence Alaska Medical Center
Anchorage, AK
Baptist Health - Fort Smith Fort Smith, AR
CHI St. Vincent Hospital Hot Springs Hot Springs, AR
Mercy Health System of Northwestern Arkansas Rogers, AR
NEA Baptist Memorial Hospital
Jonesboro, AR
Adventist Health Bakersfield
Bakersfield, CA
California Pacific Medical Center
San Francisco, CA
Doctors Medical Center Modesto, CA
El Camino Health
Mountain View, CA
Memorial Medical Center Modesto Modesto, CA
Palomar Medical Center
Escondido, CA
Salinas Valley Memorial Healthcare System
Salinas, CA
Temecula Valley Hospital
Temecula, CA
Castle Rock Adventist
Castle Rock, CO
Littleton Adventist Hospital
Littleton, CO
Lutheran Medical Center
Wheat Ridge, CO
McKee Medical Center
Loveland, CO
Medical Center of the Rockies
Loveland, CO
National Jewish/
SCL Saint Joseph Hospital
Denver, CO
North Colorado Medical Center
Greeley, CO
Penrose Hospital
Colorado Springs, CO
Platte Valley Medical Center
Brighton, CO
Poudre Valley Hospital
Fort Collins, CO
SCL Health Good Samaritan Medical Center Lafayette, CO
St. Anthony Hospital
Lakewood, CO
St. Mary’s Hospital and Regional Medical Center
Grand Junction, CO
Swedish Medical Center
Englewood, CO
Hospitals receiving this award have demonstrated the highest standards of care for heart attack patients and are recognized by the Chest Pain – MI Registry for their sustained achievement and commitment to excellence with the Platinum Performance Achievement Award. View all award recipients in the “Heart of Quality Patient Care” insert in this issue of U.S. News & World Report. Look for the hospitals that have the triangle; Platinum, Gold, and Silver.
i have the t
Scan this QR code to find the full listing of Performance Achievement Award recipients.
The Medical Center of Aurora Aurora, CO
UCH - Memorial Hospital
Colorado Springs, CO
Valley View Hospital
Glenwood Springs, CO
ChristianaCare Newark, DE
George Washington University Hospital
Washington, DC
Manatee Memorial Hospital
Bradenton, FL
UF Health Jacksonville Jacksonville, FL
Wellington Regional Medical Center
Wellington, FL
Piedmont Fayette Hospital
Fayetteville, GA
Piedmont Henry Hospital
Stockbridge, GA
Piedmont Newnan Hospital Newnan, GA
South Georgia Medical Center Valdosta, GA
St. Joseph’s Hospital Savannah, GA
St. Alphonsus Medical Center - Nampa Nampa, ID
St. Alphonsus Regional Medical Center Boise, ID
Carle BroMenn Medical Center Normal, IL
Good Samaritan Hospital
Mt.Vernon, IL
Loyola University Medical Center Maywood, IL
Memorial Hospital Carbondale Carbondale, IL
Memorial Hospital Shiloh
Shiloh, IL
Northwestern Lake Forest Hospital
Lake Forest, IL
Northwestern Medicine
Huntley Hospital
Huntley, IL
Northwestern Medicine
McHenry Hospital
McHenry, IL
OSF HealthCare St. Francis Medical Center
Peoria, IL
OSF Saint Anthony Medical Center
Rockford, IL
OSF Saint Joseph Medical Center
Bloomington, IL
Protestant Memorial Medical Center Belleville, IL
Rush - Copley Hospital Aurora, IL
Trinity Medical Center - Rock Island Rock Island, IL
Columbus Regional Hospital Columbus, IN
Deaconess Gateway Heart Hospital Newburgh, IN
Deaconess Hospital Evansville, IN
Goshen Hospital Goshen, IN
Indiana University Health Arnett Hospital Lafayette, IN
Indiana University Health Ball
Memorial Hospital Muncie, IN
Indiana University Health Bloomington Bloomington, IN
Indiana University Health
Methodist Hospital Indianapolis, IN
Indiana University Health North Hospital Carmel, IN
Indiana University Health Saxony Hospital Fishers, IN
Indiana University Health West Hospital Avon, IN
Northwest Health La Porte La Porte, IN
Allen Memorial Hospital Waterloo, IA
Mercy Iowa City Iowa City, IA
MercyOne Siouxland Medical Center
Sioux City, IA
St. Luke’s Hospital Cedar Rapids, IA
Trinity Medical Center - Bettendorf Bettendorf, IA
Trinity Regional Medical Center Ft. Dodge, IA
Advent Health Shawnee Mission Shawnee Mission, KS
Hays Medical Center
Hays, KS
Olathe Medical Center Olathe, KS
Stormont Vail Health Topeka, KS
The University of Kansas Health System
Kansas City, KS
Baptist Health Corbin Corbin, KY
Baptist Health Lexington Lexington, KY
Baptist Health Louisville Louisville, KY
Baptist Health Paducah Paducah, KY
Ephraim McDowell
Regional Medical Center
Danville, KY
Jewish Hospital Louisville, KY
Pikeville Medical Center Pikeville, KY
St. Elizabeth Healthcare Edgewood Edgewood, KY
St. Francis Medical Center Monroe, LA
St. Tammany Health System
Covington, LA
UPMC Western Maryland Cumberland, MD
Corewell Health Grand Rapids, MI
MidMichigan Medical Center - Midland Midland, MI
CentraCare Heart & Vascular Center Saint Cloud, MN
Essentia Health - St. Mary’s Medical Center Duluth, MN
Anderson Regional Medical Center Meridian, MS
Baptist Memorial Hospital - Desoto Southaven, MS
Baptist Memorial HospitalGolden Triangle Columbus, MS
Baptist Memorial Hospital North Mississippi Oxford, MS
Forrest Health Hattiesburg, MS
Magnolia Regional Health Center Corinth, MS
Merit Health Wesley Medical Center Hattiesburg, MS
Mississippi Baptist Medical Center Jackson, MS
North Mississippi Medical Center Tupelo, MS
Ocean Springs Hospital
Ocean Springs, MS
Pascagoula Hospital
Pascagoula, MS
University of Mississippi
Medical Center
Jackson, MS
Barnes Jewish Hospital/ Washington University
Saint Louis, MO
Centerpoint Medical Center
Independence, MO
Christian Hospital BJC Healthcare
St. Louis, MO
Citizens Memorial Hospital
Bolivar, MO
Cox Medical Center Branson Branson, MO
Freeman Health System
Joplin, MO
Heartland Regional Medical Center
St. Joseph, MO
Liberty Hospital
Liberty, MO
Mercy Hospital Springfield Springfield, MO
Mercy Hospital St. Louis
St. Louis, MO
North Kansas City Hospital
North Kansas City, MO
Poplar Bluff Regional Medical Center
Poplar Bluff, MO
Research Medical Center
Kansas City, MO
Southeast Hospital
Cape Girardeau, MO
St. Joseph Medical Center
Kansas City, MO
St. Mary’s Medical Center
Blue Springs, MO
Billings Clinic
Billings, MT
Bozeman Health
Bozeman, MT
Logan Health
Kalispell, MT
St. James Health Care
Butte, MT
St. Vincent Healthcare
Billings, MT
Faith Regional Health Services
Norfolk, NE
Nebraska Medicine Omaha, NE
Renown Regional Medical Center Reno, NV
St. Mary’s Regional Medical Center Reno, NV
Bayshore Community Hospital
Holmdel, NJ
Englewood Health
Englewood, NJ
Jersey Shore University Medical Center
Neptune, NJ
JFK University Medical Center Edison, NJ
Ocean Medical Center
Brick, NJ
Riverview Medical Center
Red Bank, NJ
Presbyterian Healthcare Services Albuquerque, NM
Bronx Care Health System
Bronx, NY
Jamaica Hospital Medical Center
Jamaica, NY
New York Presbyterian/Queens Flushing, NY
Richmond University Medical Center
Staten Island, NY
The Mount Sinai Medical Center
New York, NY
UR Medicine Strong
Memorial Hospital Rochester, NY
Alamance Regional Medical Center
Burlington, NC
Atrium Health Cabarrus
Concord, NC
Atrium Health Pineville Charlotte, NC
Atrium Health Wake Forest
Baptist High Point
High Point, NC
Atrium Health Wake Forest Baptist
Medical Center
Winston-Salem, NC
Atrium Health’s Carolinas Medical Center
Charlotte, NC
CarolinaEast Medical Center
New Bern, NC
Duke Regional Hospital
Durham, NC
Duke University Hospital
Durham, NC
Frye Regional Medical Center
Hickory, NC
Moses H. Cone Memorial Hospital
Greensboro, NC
Nash UNC Healthcare
Rocky Mount, NC
Novant Health New Hanover Regional Medical Center Wilmington, NC
Rex Hospital
Raleigh, NC
UNC Medical Center
Chapel Hill, NC
WakeMed Cary Hospital Cary, NC
WakeMed Raleigh Campus Raleigh, NC
Wayne UNC Healthcare
Goldsboro, NC
Altru Health System
Grand Forks, ND
Essentia Health - Fargo Fargo, ND
Sanford Medical Center Bismarck
Bismarck, ND
Sanford Medical Center Fargo Fargo, ND
Aultman Hospital
Canton, OH
Firelands Regional Medical Center
Sandusky, OH
ProMedica Toledo Hospital Toledo, OH
Southwest General Health Center
Middleburg Heights, OH
The MetroHealth System Cleveland, OH
Asante
Medford, OR
Butler Memorial Hospital Butler, PA
Doylestown Hospital
Doylestown, PA
Sharon Regional Medical Center
Sharon, PA
UPMC Hanover
Hanover, PA
UPMC Harrisburg
Harrisburg, PA
UPMC Memorial York, PA
UPMC West Shore Mechanicsburg, PA
AnMed Health Anderson, SC
Beaufort Memorial Hospital
Beaufort, SC
Bon Secours St. Francis Health System Greenville, SC
Lexington Medical Center
West Columbia, SC
McLeod Regional Medical Center Florence, SC
Prisma Health Richland Columbia, SC
Self Regional Healthcare Greenwood, SC
Spartanburg Regional Healthcare System
Spartanburg, SC
Avera Heart Hospital of South Dakota
Sioux Falls, SD
Monument Health
Rapid City, SD
Prairie Lakes Healthcare
Watertown, SD
Sanford USD Medical Center
Sioux Falls, SD
Baptist Memorial Hospital Memphis Memphis, TN
Blount Memorial Hospital Maryville, TN
Bristol Regional Medical Center Bristol, TN
Holston Valley Medical Center Kingsport, TN
Jackson Madison County General Hospital Jackson, TN
Methodist Hospital University Memphis, TN
Ascension Providence Waco, TX
Baylor Scott & White
All Saints Medical Center Fort Worth, TX
Baylor Scott & White Health Temple, TX
Baylor Scott & White
Heart and Vascular - Dallas Dallas, TX
Baylor Scott & White Medical Center - Irving Irving, TX
Baylor Scott & White
Medical Center - Round Rock Round Rock, TX
CHI Baylor St. Luke’s Medical Center Houston, TX
CHRISTUS Good Shepherd Medical Center Longview, TX
CHRISTUS Mother Frances Hospital Tyler, TX
Citizens Medical Center Victoria, TX
DeTar Healthcare System Victoria, TX
Harris Health System Houston, TX
Houston Methodist Hospital Houston, TX
Memorial Hermann Memorial City Hospital Houston, TX
Memorial Hermann Sugar Land Sugar Land, TX
Methodist Stone Oak Hospital San Antonio, TX
North Central Baptist Hospital San Antonio, TX
Northeast Baptist Hospital San Antonio, TX
Resolute Health Hospital New Braunfels, TX
Shannon Medical Center San Angelo, TX
Texas Health Harris Methodist Bedford, TX
Texas Health Harris
Methodist Fort Worth Fort Worth, TX
Texas Health Harris
Methodist Hospital Alliance Ft. Worth, TX
Texas Health Harris
Methodist Hospital Southwest Fort Worth, TX
Texas Health Heart and Vascular Hospital Arlington, TX
Texas Health Presbyterian Denton Denton, TX
Texas Health Presbyterian Hospital of Dallas Dallas, TX
Texas Health Presbyterian Hospital Plano Plano, TX
The Hospitals of Providence
Sierra Campus
El Paso, TX
University Health
San Antonio, TX
University of Texas
Southwestern Medical Center Dallas, TX
UT Health Tyler Tyler, TX
University of Utah Health
Salt Lake City, UT
Augusta Health Fishersville, VA
Carilion Roanoke Memorial Hospital Roanoke, VA
Chesapeake Regional Medical Center Chesapeake, VA
Inova Alexandria Hospital Alexandria, VA
Inova Fairfax Medical Campus/IHVI Falls Church, VA
Inova Loudoun Hospital Leesburg, VA
Reston Hospital Center Reston, VA
Sentara Careplex Hospital Hampton, VA
Sentara Leigh Hospital Norfolk, VA
Sentara Martha Jefferson Hospital Charlottesville, VA
Sentara Norfolk General Hospital Norfolk, VA
Sentara Northern Virginia Medical Center
Woodbridge, VA
Sentara Rockingham Memorial Hospital Harrisonburg, VA
Sentara Virginia Beach
General Hospital Virginia Beach, VA
Sentara Williamsburg
Regional Medical Center
Williamsburg, VA
Winchester Medical Center, Inc. Winchester, VA
Deaconess Hospital MultiCare Health System Spokane, WA
MultiCare Auburn Medical Center Auburn, WA
MultiCare Good Samaritan Hospital Puyallup, WA
MultiCare Tacoma General Hospital Tacoma, WA
St. Mary’s Medical Center Huntington, WV
Ascension Columbia St. Mary’s Hospital Milwaukee Milwaukee, WI
Aurora Medical Center Grafton Grafton, WI
Aurora Medical Center Summit Summit, WI
Aurora St. Luke’s Medical Center Milwaukee, WI
Gundersen Lutheran Health System
La Crosse, WI
Marshfield Medical Center
Marshfield, WI
Marshfield Medical Center - Weston Weston, WI
UW Health Madison, WI
Campbell County Health Gillette, WY
common dementia type, and research shows working out can reduce the chance of Alzheimer’s by 45%. So what’s going on when you work up a sweat? Exercise appears to protect the hippocampus, which governs memory and spatial navigation and is one of the first brain regions to succumb to Alzheimer’s-related damage.
Helps Lift Depression and Anxiety
Meghan Kennihan, a certified personal trainer and running coach based in LaGrange, Illinois, says that some of her clients came to her feeling depressed or anxious. But after adopting a workout schedule, they started to feel better. That could be because exercise combats gloomy feelings by boosting endorphins, or feel-good chemicals in the brain.
Indeed, a 2021 randomized trial in the Annals of Family Medicine that compared physical activity with antidepressant drugs in those ages 65 and older found that improvement in depression was similar in both the exercise group and the medication group after one month. The results did favor antidepressant meds over the long term, but study participants still found exercise to be helpful.
Recharges Your Spirit
Feeling burnt out and in need of a vacation? If a trip to a tropical destination isn’t in the cards, try working up a sweat instead. “Exercise can refresh and recharge our mindset,” says Angie Fifer, a sport and exercise psychologist and owner of Breakthrough Performance Consulting, a Pittsburgh-based performance coaching service.
Fifer, who works with athletes as well as businesses and other organizations, says that a regular workout routine can be particularly effective for helping to relieve everyday stress. “One of the things we talk about is making sure to create some personal time for whatever it is you need for stress relief. Exercise is such a great one because it provides both the physical and the mental and emotional benefits.”
Improves Learning
It may have been quite some time since you were in the classroom, but that doesn’t mean your days of learning are over – and physical activity could be helpful for keeping your brain sharp. That’s because exercise increases the level of brain chemicals that make new brain cells and establish fresh connections between brain cells.
Interestingly, complicated activities, like playing tennis or taking a dance class, may provide the biggest brain boost. “You challenge your brain even more when you have to think about coordination,” Ratey explains. “Like muscles, you have to stress your brain cells to maintain their health.”
Complex activities also improve our capacity to
learn by enhancing attention and concentration skills. In one study, German researchers found that students ages 13 to 16 scored better on high-attention tasks after doing 10 minutes of a complicated fitness routine compared with 10 minutes of regular activity.
Fosters Confidence
Putting yourself – and your fitness goals – toward the top of your to-do list could help improve how you view yourself. “The weight loss and muscle gain that come with working out improves a lot of my clients’ self-esteem and self-confidence,” Kennihan says. Even without losing weight, learning a new physical skill or seeing progress through weight sessions often boosts confidence, she adds.
Research backs this up. One 2016 study in the journal Neuropsychiatric Disease and Treatment found that physical activity is associated with higher selfesteem in adults. Plus, the researchers explain that developing strength and muscle tone and improving flexibility, coordination and balance can help people feel more physically competent, which can in turn improve body image. We can all agree that’s a win-win!
Clears Your Head Space
Most of us have dozens – if not more! – of thoughts careening through our minds at once. In fact, research shows that the average adult makes 35,000 conscious decisions each day. This can become overwhelming, but working out may help, since exercise can channel your energy and focus elsewhere. “When we get the body moving and the blood pumping, it frees our mind up,” Fifer says. “And we’re not focused so hard on thinking about a work deadline or solving a personal problem – we’re just moving.”
This zen state is thanks to the fact that the body releases hormones such as energizing endorphins and calming serotonin, while also reducing stressrelated cortisol levels, says Fifer. “And that’s on top of creating that mental space for us to be open in the present moment, and just kind of ‘be,’ instead of questioning: ‘What’s next?’ or ‘What do I have to solve?’”
you enjoy doing. The best workout is the one
Delays the Aging Process
Want to not only feel younger but also be physically younger? Exercise could help make this fountain-of-youth dream a reality. That’s because it can help reverse the toll stress has on the aging process. Being highly active may reduce aging at the cellular level by up to nine years, according to a 2017 Brigham Young University study.
After looking at nearly 6,000 U.S. adults, researchers at Brigham Young found that highly active participants had the least signs of chromosomal aging (to be considered highly active, women had to jog at least 30 minutes daily and men had to jog at least 40 minutes daily, five days a week). In comparison, both moderately active participants and those with sedentary lifestyles had significantly shorter telomeres – the DNA bookends on each chromosome that are associated with cellular aging.
Boosts the Fun Factor
Don’t love the gym? Not everyone likes to work out indoors with machinery, and that’s fine! Physical activity doesn’t need to be limited to treadmills and weights, and if that’s not what you’re into, it’s okay to sit the gym out.
Experts say it’s best to find an activity you enjoy, since it could help you stick with your workout program. So think about what sort of movement you actually have fun doing. “The best exercise is the one we like to do,” says Camila Buonani da Silva, head of the sports research group in the department of physical education at Sao Paulo State University in Brazil. And these fun workouts can have big pay-offs. Dancing, for example, has been shown to sharpen balance and agility, lessen dementia risk and improve cardiovascular and bone health. “In addition, it’s a fun practice that promotes socialization and it can easily be included in people’s routines,” says Buonani da Silva.
If dancing isn’t your thing, maybe you’d prefer hiking, playing beach volleyball or taking a rejuvenating yoga class. The goal is to find a form of movement that you find fun and can see yourself doing for years to come. l
In surgery at Mayo Clinic
BRETT ZIEGLER FOR USN&WR
Best Hospitals
HONOR ROLL
Hospitals recognized on the Honor Roll excel in treating patients with complex diagnoses as well as those with relatively routine needs.
2023-24
Selection for the Honor Roll is based on points, which hospitals received for strong rankings and ratings. Hospitals that earned at least 273 out of 531 possible points made this year’s list. Each hospital on the 2023-2024 Best Hospitals Honor Roll, listed below in alphabetical order, is nationally ranked in nine or more of the 15 Best Hospitals specialties and is rated “high performing” in most of 21 common procedures and conditions (see Page 184 and usnews.com/best-hospitals). This year, due to ties, the following 22 highest scoring medical centers qualified for the Honor Roll.
Barnes-Jewish Hospital, St. Louis
Brigham and Women’s Hospital, Boston
Cedars-Sinai Medical Center, Los Angeles
Cleveland Clinic
Hospitals of the University of Pennsylvania-Penn Presbyterian, Philadelphia
Houston Methodist Hospital
Johns Hopkins Hospital, Baltimore
Massachusetts General Hospital, Boston
Mayo Clinic, Rochester, Minnesota
Mount Sinai Hospital, New York
New York-Presbyterian Hospital-Columbia and Cornell
North Shore University Hospital at Northwell Health, Manhasset, New York
Northwestern Medicine-Northwestern Memorial Hospital, Chicago
NYU Langone Hospitals, New York
Rush University Medical Center, Chicago
Stanford Health Care-Stanford Hospital, Stanford, California
UC San Diego Health-La Jolla and Hillcrest Hospitals, San Diego
UCLA Medical Center, Los Angeles
UCSF Health-UCSF Medical Center, San Francisco, California
University of Michigan Health-Ann Arbor
UT Southwestern Medical Center, Dallas
Vanderbilt University Medical Center, Nashville, Tennessee
A Guide to the Rankings
How we identified 164 outstanding hospitals in 15 specialties
OR MORE THAN three decades, the mission of the U.S. News & World Report Best Hospitals rankings has been to help guide patients, in consultation with their doctors, to the appropriate place when they need a high level of specialty care. These are patients whose surgery or condition is complex, or whose advanced age, physical infirmity or existing medical condition limits their options.
FSuch people account for a small fraction of hospital patients, but they add up to millions of individuals – and many hospitals may not be able to meet their needs. A hospital ranked by U.S. News in cancer, say, is likely to have the expertise and capability to enroll an elderly patient with a metastatic tumor into a clinical trial for an unproven but innovative treatment.
Some community hospitals can also provide access to such experimental therapies. But not all.
The following pages offer hospital rankings in 15 different specialties, from cancer to urology. Of more than 4,500 hospitals evaluated by U.S. News this year, only 164 performed well enough to be ranked in any specialty.
In 12 of these 15 specialties, analysis of objective data from the federal government and other sources generated the main factors determining whether a hospital was ranked. To capture medical experts’ opinions, we also factored in results from annual surveys of specialist physicians who were asked to name hospitals they consider best in their specialty at handling difficult cases.
Hospitals in the other three specialties (ophthalmology, psychiatry and rheumatology) were ranked solely on the basis
No hospital is best for every patient.
of the annual physician surveys, because reliable objective data aren’t available for those areas of care.
Based on input from experts and medical studies, we have revised the ranking methodologies over time to make the rankings even more useful to consumers. This year, for example, objective factors such as patient outcomes received more weight than ever.
Beyond the specialty rankings, a set of hospital ratings gives patients information about which hospitals excel in specific procedures or in caring for patients with certain conditions, including leukemia, lymphoma and myeloma, which were rated for the first time this year. Hospital performance in these procedures and conditions
can be found in the Best Regional Hospitals rankings (Page 184), which are designed to help consumers identify hospitals with expertise in numerous areas of care. If you want to learn more, additional detail is available at usnews.com/best-hospitals.
To be considered for ranking in most specialties, a hospital had to meet any of four criteria. It had to either: be a teaching hospital; be affiliated with a medical school; have at least 200 beds; or have at least 100 beds and offer at least four out of eight advanced medical technologies.
The hospitals next had to meet a volume requirement in each specialty – a minimum number of Medicare inpatients from 2019 to 2021 who received certain procedures and treatment for specific conditions. A hospital that fell short was still eligible if nominated in the specialty by at least 1% of physicians responding to the expert opinion survey.
At the end of the process, 2,320 hospitals remained candidates for ranking in at least one specialty. Each received a U.S. News score of 0 to 100 based on the four elements, described below. Then, the top 50 hospitals in each specialty were ranked. Scores and data for the rest are at usnews.com. The four elements and their weights in most specialties are:
Patient outcomes (45%): Success at keeping patients alive and getting them home was judged by the proportion of Medicare inpatients with certain conditions in 2019, 2020 and 2021 who died within 30 days of hospital admission or were discharged to another health care facility. Both of these rates were adjusted to account for the severity of patients’ illnesses and the complexity of their care as well as risk-elevating factors such as advanced age, obesity, high blood pressure and poverty (as reflected by whether they received Medicaid).
A widely used approach to so-called risk adjustment was employed to adjust each patient’s risk in calculating odds of a good outcome. To avoid penalizing institutions receiving the sickest patients, we excluded patients transferred in from another hospital from our analysis. A score of 5 indicates the best chance of survival or discharge to home (and 1 the worst) relative to other hospitals.
In two specialties where same-day (a.k.a. outpatient) surgery is common, a third outcome – potentially preventable complications following outpatient surgery – also factored in the rankings.
Patient experience (5%): Most hospitals are required to assess patients’ satisfaction with their experience using a survey known as the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS. The score reflects how many patients had a positive overall experience during hospitalization.
Other care-related indicators (35%): The balance of patients per nurse and the hospital’s number of patients – an indicator of its degree of experience in a specialty – are examples of these factors.
Expert opinion (12 - 15%): Specialists were asked to name up to five hospitals that they consider best in their area of expertise for patients with the most difficult medical problems. In the 2023 survey alone, responses were tallied from more than 31,000 physicians.
The figures shown in the tables under “% of specialists recommending hospital” are the average percentages of specialists in 2021, 2022 and 2023 who recommended a hospital. In rehabilitation, expert opinion carried a weight of 30%. In the three specialties based entirely on expert opinion, a hospital had to be cited by at least 5% of responding physicians in the last three years of U.S. News surveys in order to be ranked.
Transparency (3%): In four specialties, hospitals are rewarded for participating in nationwide programs that measure their performance and opting to transparently share results with the public.
If you’ve consulted past editions of this U.S. News Best Hospitals guidebook, you may notice that a particular hospital you’re considering has risen or fallen in the rankings. A decline shouldn’t automatically be interpreted as a decline in performance; rather, it may be because of changes to the methodology or because other hospitals improved.
The bottom line is that no hospital – no matter how excellent – is best for every single patient. You’ll want to add your own fact-gathering to ours and consult with your doctor or other health professional as you weigh your options for where to go to get your care. l
A Glossary of Terms
CARF: accredited by the Commission on Accreditation of Rehabilitation Facilities International as of April 30, 2022. Completion of care rate: how often a hospital avoids needing to transfer patients to an acute-care hospital during their rehabilitation.
Discharge to home score: reflects proportion of patients who, at discharge, went home rather than to a nursing home or other facility.
FACT accreditation level: hospital meets Foundation for the Accreditation of Cellular Therapy standards as of Jan. 27, 2023 for harvesting and transplanting stem cells from a patient’s own bone marrow and tissue (level 1) and from a donor (level 2) to treat cancer.
Flu vaccination rate: percentage of hospital’s staff who received a seasonal flu vaccine.
NAEC epilepsy center: designated by the National Association of Epilepsy Centers as of March 1, 2022 as a regional or national referral facility (level 4) for staffing, technology and training in epilepsy care.
NCI cancer center: designated by the National Cancer Institute as of Feb. 2, 2023 as a clinical or comprehensive cancer hospital.
NIA Alzheimer’s center: designated by the National Institute on Aging as of Jan. 12, 2023 as an Alzheimer’s Disease Center, indicating high quality of research and clinical care.
Number of patients: except in rehabilitation, estimated number of Medicare patients in 2019, 2020 and 2021 who received certain high-level care as defined by U.S. News. Based on an adjustment to the number of such patients with traditional Medicare insurance. In obstetrics and gynecology and ear, nose and throat, inpatients and outpatients were included; in other specialties, only inpatients. In geriatrics, only patients ages 75 and older were included. In rehabilitation, only patients treated in 2021 were included.
A Nurse Magnet hospital: recognized by the American Nurses Credentialing Center as of Dec. 31, 2022 for nursing excellence.
Nurse staffing score: relative balance of nonsupervisory registered nurses (inpatient and outpatient) to average daily number of all patients. Inpatient staffing receives greater weight. Agency and temporary nurses are not counted. Outpatient outcome score: reflects proportion of patients who experienced a potentially preventable complication
following outpatient surgery.
Patient experience: percentage of patients who responded positively to a survey about the overall quality of their stay.
Patient services score: number of services offered out of the number considered important to quality (such as genetic testing in cancer and an Alzheimer’s center in geriatrics).
% of specialists recommending hospital: percentage of physicians responding to U.S. News surveys in 2021, 2022 and 2023 who named the hospital as among the best in their specialty for especially challenging cases and procedures, setting aside location and cost.
Transparency score: indicates whether hospital publicly reports its performance through the American College of Cardiology, the American Heart Association and the Society of Thoracic Surgeons (in cardiology and heart surgery), the American Heart Association (in neurology and neurosurgery) or the Society of Thoracic Surgeons (in pulmonology and lung surgery), and whether hospital completed a U.S. News survey about maternity care (in obstetrics & gynecology).
Rank: based on U.S. News score except in ophthalmology, psychiatry and rheumatology, where specialist recommendations determined rank.
Readmission prevention rate: how often a hospital keeps patients from being readmitted to an acute-care hospital within the 30 days following discharge. Successful discharge rate: how often patients go directly home from this hospital and remain at home, rather than requiring further institutional care.
Survival score: reflects patient survival rate in the specialty within 30 days of admission.
Technology score: reflects availability of technologies considered important to a high quality of care, such as PET/CT scanner in pulmonology and diagnostic radioisotope services in urology.
Trauma center: indicates Level 1 or 2 trauma center certification. Such a center can care properly for the most severe injuries
U.S. News score: summary of quality of hospital inpatient care. In most specialties, survival is worth 36%, discharge to home 9%, operational quality data such as nurse staffing and patient volume 35%, specialists’ recommendations 15% and patient experience 5%.
the prize is our future, every day is the match of our lives.
In all my years of playing around the world, I have never seen a brighter soul than Chiara’s. You would never know what it took for her to be here. Together with her world class team, Chiara triumphed over a rare cancer that nearly stole her future as a dancer.” – Pilo Gomez
When we unite around one goal, that is when we win. Play on.
See Chiara’s story at cancer.montefioreeinstein.org/Chiara
Cardiology, Heart & Vascular Surgery
“I don’t know that I ever would’ve survived if I wasn’t at Montefiore Einstein.” — James Bradley
When former White Plains Deputy Police Commissioner James Bradley suffered two massive back-to-back heart attacks, the specialists at Montefiore Einstein saved his life by implanting a mechanical support system called an LVAD. What happened next was a heart failure reversal for the record books. His team did what a few have the expertise to do, they removed the LVAD, and James’ heart continued to function well without needing a transplant.
See James’ heart failure reversal story at montefiore.org/James
PROVENQUALITY PROGRAMS AMERICANCOLLEGE of CARDIOLOGY
The American College of Cardiology (ACC) recognizes these Health Systems for their commitment to drive preeminent hospital care for heart patients. Participating in the ACC’s proven quality care delivery and outcomes programs demonstrates their commitment to better lives for healthier tomorrows.
Cardiovascular Institute
Cardiology, Heart & Vascular Surgery
30 Advocate Christ Medical Center, Oak Lawn, Ill.65.2
31 Montefiore Medical Center, Bronx, N.Y.64.6 5584%312,6692.0No
32 UCSF Health-UCSF Medical Center, San Francisco, Calif.64.3
33 Mayo Clinic-Phoenix63.9 5595%33,7442.3Yes
33 MedStar Heart & Vascular Inst. at MedStar Washington Hosp. Ctr., D.C. 63.9
35 Barnes-Jewish Hospital, St. Louis63.7 5589%37,4972.0Yes
36 Ohio State University Wexner Medical Center, Columbus63.6 5588%38,1412.1Yes
U.
44 Morristown Medical Center, Morristown, N.J.61.5
46 Virginia Mason Medical Center, Seattle59.9 5590%33,1892.8No
47 Saint Luke’s Mid America Heart Institute, Kansas City, Mo.59.5 5592%35,9931.7Yes
48
Diabetes & Endocrinology
Ear, Nose & Throat
1
5
8
Gastroenterology & GI Surgery
1
5
36
39 Cleveland Clinic Weston, Fla.70.6
Geriatrics
4
5
8
12
12
15
16 North Shore University Hosp. at Northwell Health, Manhasset, N.Y.79.8
38
39 Scripps La Jolla Hospitals, La Jolla, Calif.65.1
40 Vanderbilt University Medical Center, Nashville, Tenn.64.7
41 Emory University
50
Neurology & Neurosurgery
1
3
4
5
36
38
39
Obstetrics & Gynecology
1
4
5
6
7
8
9
13 New York-Presbyterian Hospital-Columbia and Cornell73.0
16
20 Hosps. of the U. of Pennsylvania-Penn Presby., Philadelphia69.6
21 Barnes-Jewish Hospital, St. Louis68.3
22 Vanderbilt University Medical Center, Nashville, Tenn.67.3
23 Aurora St. Luke’s Medical Center, Milwaukee67.2
24 John Muir Health-Walnut Creek Med. Ctr., Walnut Creek, Calif.66.4 4489%5522.51580.0%
25
27 Duke University Hospital, Durham, N.C.65.8
28 Beaumont Hospital-Royal Oak, Mich.65.2
28 University of Chicago Medical Center65.2 4389%6962.41591.0%
30 West Penn Hospital,
33 Advocate Christ Medical Center, Oak Lawn, Ill.63.9
33 Rush University Medical Center, Chicago63.9
35 Scripps La Jolla Hospitals, La Jolla, Calif.63.7 3492%7382.71590.6%
36 Morristown Medical Center, Morristown, N.J.63.1
37 Ohio State University Wexner Medical Center, Columbus62.4
38 UMass Memorial Medical Center, Worcester62.2
39 UF Health Shands Hospital, Gainesville, Fla.61.0 3390%7072.01591.0%
40 University of Kentucky Albert B. Chandler Hospital, Lexington60.9
41 West Virginia University Hospitals, Morgantown, W.Va.60.6
42 MemorialCare Long Beach Medical Center, Long Beach, Calif.60.5
47
50
Hospital Data Insights is an analytics platform from U.S. News & World Report based on the data underpinning the Best Hospitals rankings.
Why Hospital Data Insights?
Transform Insights Into Action
•Explore elements to help improve patient care
•Promote brand awareness
•Inform resource allocation
•Discover performance drivers
For more information or to request a free customized demo of your data, get in touch.
3,300+ hospitals
31+ million data points
3,200+ metrics
23 years of data
hdi.usnews.com
hdi@usnews.com (202) 955-2171
Orthopedics
CEDARS-SINAI MEDICAL CENTER, NO. 2
CHOOSE BETTER. MOVE BETTER.
U.S. #1
IN ORTHOPEDICS
14 YEARS
IN A ROW
HSS is proud to be officially named the nation's best orthopedic hospital for 14 straight years, according to U.S. News & World Report. Our specialized doctors, dedicated staff and state-of-the-art facilities will get you moving and living better, with the lowest readmission rates for orthopedics in the nation, and among the lowest rates for infections and complications.
Orthopedics
25
28
29
32
34
34 St. Francis Hospital and Heart Center, Roslyn, N.Y.63.2
37 Barnes-Jewish Hospital, St. Louis62.4
38 Providence Saint John’s Health Center, Santa Monica, Calif.62.1
39 MemorialCare Long Beach Medical Center, Long Beach, Calif.62.0
40 NorthShore University Health System-Metro Chicago61.9 51589%4,4251.3270.2%
43 University of Kansas Hospital, Kansas City61.3 55292%2,2962.1270.3%
45 Memorial Hermann-Texas Medical Center, Houston61.0 45488%3,5892.4270.6%
46 Advocate Good Samaritan Hospital, Downers Grove, Ill.60.9 51489%1,6122.0270.0%
46 Montefiore Medical Center, Bronx, N.Y.60.9 52284%1,9612.0270.6%
48 MedStar Union Memorial Hospital, Baltimore60.5 55487%2,1152.2270.4%
49 Advocate Good Shepherd Hospital, Barrington, Ill.60.1 54489%1,1022.0270.0%
50 Penn State Health Milton S. Hershey Medical Center, Hershey, Pa. 59.5 55290%2,0142.1270.7%
50 UW Health University Hospital, Madison, Wis.59.5 53491%2,5942.2270.8%
THE BEST HOSPITALS AND PRACTICES OWN THE BONE
The American Orthopaedic Association applauds the following institutions for their achievements and participation in the Own the Bone® quality improvement program:
STAR PERFORMERS
AdventHealth Orthopedic Institute,
Central Florida Division - Orlando, FL
Advocate Christ Medical Center - Oak Lawn, IL
Allegheny Health Network (AHN)Jefferson Hospital - Jefferson Hills, PA
Anne Arundel Medical Group Orthopedics/ Luminis Health - Annapolis, MD
AtlantiCare Regional Medical Center - Pomona, NJ
Atrium Health MSKI Fracture Prevention Program - Charlotte, NC
Atrium Health Wake Forest Baptist Medical Center - Winston Salem, NC
Baptist Orthopedic Hospital at Mission TrailSan Antonio, TX
Berkshire Medical Center - Pittsfield, MA
Bryan Medical Center - Lincoln, NE
Cedars-Sinai Medical Center - Los Angeles, CA
Central Carolina Orthopaedic AssociatesSanford, NC
CHRISTUS Mother Frances Hospital - TylerTyler, TX
Cleveland Clinic Akron General Osteoporosis and Bone Health Center - Akron, OH
Coastal Orthopedic & Spine InstituteCamarillo, CA
Concord Hospital Orthopaedic InstituteConcord, NH
Cooper Health System - Camden, NJ
Crystal Clinic Orthopaedic Center - Akron, OH
Firelands Physician Group - Sandusky Orthopedics and Pain ManagementSandusky, OH
Froedtert & the Medical College of WisconsinMilwaukee, WI
Hartford HealthCare Bone and Joint InstituteHartford, CT
Henry Ford Hospital - Detroit, MI
Hoag Orthopedic Institute - Irvine, CA
Huntington Hospital - Northwell HealthHuntington, NY
JPS Health Network - Fort Worth, TX
Lahey Hospital and Medical CenterBurlington, MA
Lexington Medical Center - West Columbia, SC
Institutions are recognized for at least 75% compliance on at least 5 of the 10 recommended secondary fracture prevention measures over the last year.
MaineGeneral Orthopaedics - Augusta, ME
Marshfield Clinic Health System - Marshfield, WI
Medical University of South CarolinaCharleston, SC
Memorial Regional Hospital - Hollywood, FL
Mendelson Kornblum Orthopedic & Spine Specialists - Warren, MI
Michigan Medicine, University of MichiganAnn Arbor, MI
Michigan Neurosurgical Institute, PCGrand Blanc, MI
Mount Sinai South Nassau - Oceanside, NY
NMC Health - Newton, KS
North Central Baptist Hospital - San Antonio, TX
Northern Light Eastern Maine Medical CenterBangor, ME
Norton Women's and Children's HospitalLouisville, KY
NYU Langone Orthopedic Hospital - New York, NY
NYU Winthrop Hospital - Mineola, NY
OhioHealth Orthopedic & Sports Medicine
Physicians - Mansfield Hospital - Mansfield, OH
OHSU Department of Orthopaedics & Rehabilitation - Portland, OR
Orthopaedic Associates of MichiganGrand Rapids, MI
^Orthopedic Associates of SW Ohio - Dayton, OH
Overlake Medical Center & ClinicsBellevue, WA
^Park Nicollet Methodist Hospital/TRIA
Orthopaedic Center - Minneapolis, MN
^Prisma Health-Upstate - Greenville, SC
ProMedica Toledo Hospital - Toledo, OH
Regions Hospital - St. Paul, MN
Resolute Baptist Hospital - New Braunfels, TX
^Sanford Medical Center - Fargo - Fargo, ND
Sonoran Orthopedics - Scottsdale, AZ
Southern Illinois Healthcare Herrin HospitalHerrin, IL
South Texas Fracture Prevention ClinicSan Antonio, TX
SSM Health Dean Medical Group OrthopedicsMadison, WI
St. Luke's Health System Osteoporosis and Bone Health Program - Boise, ID
St. Peter's Health - Helena, MT
Tahoe Forest Health System - Truckee, CA
Tallahassee Memorial HealthCareTallahassee, FL
The Bone and Joint Center at AdventHealth Zephyrhills - Zephyrhills, FL
The Bone and Joint Center- Capital Region Orthopaedic Associates - Albany, NY
The Centers for Advanced Orthopaedics, Orthopaedic Associates of Central Maryland Division (CAO/OACM) - Catonsville, MD
The Centers for Advanced Orthopaedics, Mid-Maryland Musculoskeletal Institute (MMI) - Frederick, MD
The Ohio State University Wexner Medical Center - Columbus, OH
^The Queen's Medical Center - Honolulu, HI
The University of Texas at AustinUT Health Austin - Austin, TX
TSAOG Orthopaedics and SpineSan Antonio, TX
Carle Health Endocrinology Clinic - PeoriaPeoria, IL
University Hospital - San Antonio, TX
University of Cincinnati - Cincinnati, OH
University of Connecticut - Farmington, CT
University of Iowa Hospitals & ClinicsIowa City, IA
^UT Southwestern Medical Center- Dallas, TX
University of Wisconsin Hospitals and ClinicsMadison, WI
UT Health East Texas Orthopedic and Sports Medicine Institute - Tyler, TX
VCU Health - Richmond, VA
Wooster Community Hospital Health SystemWooster, OH
^WVU Medicine Department of OrthopaedicsMorgantown, WV
^Yale New Haven Hospital Fragility Hip Fracture Program - New Haven, CT
NEWLY ENROLLED INSTITUTIONS
Bristol Regional Medical CenterBristol, TN
Greeneville Community HospitalGreeneville, TN
Holston Valley Medical CenterKingsport, TN
Johnson City Medical CenterJohnson City, TN
Johnston Memorial HospitalAbingdon, VA
Loyola Medicine - Maywood, IL
Memorial Hospital - Oconomowoc, WI
Mount Carmel Health SystemColumbus, OH
Myrtue Medical Center - Harlan, IA
ProHealth Care Oconomowoc
ProHealth Care Waukesha Memorial Hospital - Waukesha, WI
Roane General Medical ClinicSpencer, WV
Smyth County Community HospitalMarion, VA
Sycamore Shoals HospitalElizabethton, TN
Trinity Health Ann Arbor - Ypsilanti, MI
Own the Bone®, a national quality improvement program, provides education and resources to support orthopaedic surgeons and their departments to improve the bone health care provided to fragility fracture patients and prevent future fractures. www.ownthebone.org
Pulmonology & Lung Surgery
1 Mayo Clinic, Rochester, Minn.100.0
3 NYU Langone Hospitals, New York98.7
4 UCLA Medical Center, Los Angeles97.9
5 Hosps. of the U. of Pennsylvania-Penn Presby., Philadelphia96.2
6
7 Stanford Health Care-Stanford Hospital, Stanford, Calif.91.4
8 UCSF Health-UCSF Medical Center, San Francisco, Calif.91.1 5591%3,9012.4Yes
9 UC San Diego Health-La Jolla and Hillcrest Hospitals, San Diego91.0
10 North Shore University Hosp. at Northwell Health, Manhasset, N.Y.90.7 5587%10,9262.9Yes
16 UT Southwestern Medical Center, Dallas87.0 5594%4,9732.4Yes
17 Massachusetts General Hospital, Boston86.4 5593%7,9582.6Yes
18
20 Rush University Medical Center, Chicago83.6
22 Lenox Hill Hospital at Northwell Health, New York82.3 5586%5,2463.7Yes
30
32 Vanderbilt University Medical Center, Nashville, Tenn.77.5
33
34 Mayo Clinic-Jacksonville, Fla.77.2
35
36 Keck Medical Center of USC, Los Angeles76.4
37 Ohio State University Wexner Medical Center, Columbus76.2
38 Huntington Hospital at Northwell Health, Huntington, N.Y.75.9
39 Advocate Christ Medical Center, Oak Lawn, Ill.75.6
40 T. Jefferson U. Hosps.-Jane & L. Korman Resp. Inst., Philadelphia75.1 5588%5,6342.1Yes
41 Brigham
50
At National Jewish Health, the nation’s leading respiratory hospital, we bring doctors, scientists and caregivers together to find answers, develop treatments and solve medical challenges. Providing care for adults and children with complicated lung, heart, immune and related diseases — our experts work within our communities and across the nation. Our research breakthroughs improve lives around the world, while our innovative care leads to extraordinary outcomes.
Ranked a top 10 hospital in Pulmonology on the U.S. News & World Report Best Hospitals list for 27 years.
To learn more or make an appointment, call 800.621.0505 or visit njhealth.org.
Rehabilitation
33
35
36
1
4 Mayo Clinic, Rochester, Minn.89.7
5
6
8 University of Texas MD Anderson Cancer Center, Houston85.3
9 Hosps. of the U. of Pennsylvania-Penn Presby., Philadelphia84.8
10 UCLA Medical Center, Los Angeles83.2
11 Northwestern Medicine-Northwestern Memorial Hospital, Chicago 83.1
13 Fox Chase Cancer Center, Philadelphia81.9
14 Stanford Health Care-Stanford Hospital, Stanford, Calif.80.8
15 Vanderbilt University Medical Center, Nashville, Tenn.80.5
16 Houston Methodist Hospital79.5
19 University of Michigan Health-Ann Arbor77.9
20 Brigham and Women’s Hospital, Boston76.6
21 Keck Medical Center of USC, Los
These
hospitals are among the best in their specialty for particularly challenging patients, in the view of at least 5% of medical specialists surveyed by U.S. News over the past three years.
Ophthalmology
1 Bascom Palmer Eye Institute-U. of Miami Hosp. and Clinics, Miami
2 Wills Eye Hospital, Thomas Jefferson U. Hospitals, Philadelphia 30.9%
3 Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore 22.3%
4 Mass Eye and Ear, Massachusetts General Hospital, Boston
5 Stein and Doheny Eye Institutes, UCLA Med. Ctr., Los Angeles
8 University of Michigan Health Kellogg Eye Center, Ann Arbor
9 UCSF Health-UCSF Medical Center, San Francisco, Calif. 5.8%
10 John A. Moran Eye Ctr., U. of Utah Hosps. & Clinics, Salt Lake City 5.5%
Psychiatry
Rheumatology
Mayo Clinic, Rochester, Minn.
5 Brigham and Women’s Hospital, Boston
6 Massachusetts General Hospital, Boston
7 UCSF Health-UCSF Medical Center, San Francisco, Calif.
8 NYU Langone Hospitals, New York
9 UCLA Medical Center, Los Angeles
10 University of Alabama at Birmingham Hospital
11 University of Michigan Health-Ann Arbor
Carl D. Regillo, MD, FACS Chief, Retina Service
Top-Ranked Children’s Hospital in N. California
For the eighth year in a row, we’re honored to be ranked in all 10 specialties in the 2023–24 U.S. News & World Report Best Children’s Hospitals survey. Stanford Medicine Children’s Health is also ranked as the No. 3 children’s hospital in the Pacific region and top-ranked in Northern California. This distinction demonstrates the enduring pursuit of excellence and exceptional quality that our faculty, physicians, and staff commit to patients and families. With our network of 65+ Bay Area locations, our patients can access this same great care close to home.
Learn more at stanfordchildrens.org.
Kids’ Food Allergies: A Racial Divide
The consequences can be devastating for children and their parents
THOMAS SILVERA and his exwife had always been vigilant about managing their children’s multiple food allergies. But Silvera acknowledges that there was an added level of caution when it came to his son Elijah, who, in addition to having food allergies, also had asthma. “Asthma and food allergies are a ticking time bomb with each other,” says Silvera.
Concern over Elijah’s condition made it a priority for the New York City family to search for a preschool with staff that understood how to manage children who have multiple food allergies. They ended up finding a school in Harlem that seemed promising. “With this child care center, when they gave us the approval that they do understand the signs and symptoms of allergic reactions, it gave us peace of mind,” says Silvera.
But in November 2017, despite it being documented that he was allergic to dairy, Elijah was fed a grilled cheese sandwich at the preschool. The 3-year-old suffered a severe allergic reaction. The school called Elijah’s mother, who took him to a local hospital where he went into anaphylactic shock and, tragically, died.
“It’s so disheartening for us as parents to deal with such a situation because the negligence falls on the educators for not abiding by their policies,” says Silvera. “Now we’re faced with grief and trying to figure out life after that.”
An Uneven Toll
The tragedy of Elijah Silvera highlights a growing concern regarding the problem of food allergies in children, particularly among young people of color in the U.S., where evidence points to an increasing public health risk among Black children. While the prevalence of food allergies in children is increasing overall (an estimated 1 in 20 children, or 5.8%, were diagnosed with a food allergy in the U.S. in 2021, according to a recent analysis), the largest percentage was found among Black children, of whom 7.6% had a food allergy.
While the exact reasons for the racial disparities in food allergies are multiple and complex, experts link the causes to many of the same social factors and problems with health care access that contribute to an array of worse health outcomes for African Americans. They also say that, in addition to having a higher incidence of asthma and food allergies, Black people have an increased likelihood of having more severe versions of those conditions after they are diagnosed.
Dr. Purvi Parikh, a pediatric allergist and immunologist who is the national spokesperson for the Allergy & Asthma Network, a patient advocacy organization, says food allergies are often environmental and that some of the same factors that can lead to higher rates of asthma – including exposure to air pollution, tobacco smoke, dust mites and mold – can also increase a person’s risk for fatal anaphylaxis from food allergies.
“There are disproportionate numbers of Black individuals living in urban settings with these increased allergen exposures,” says Parikh. “Furthermore, there is the hygiene hypothesis that suggests that processed foods and unhealthy foods contribute to the development of food allergies due to disruption of gut microbiome,” she says, noting that Black people are more likely to live in areas where there is less access to affordable healthy food options.
Indeed, a 2021 study published in the Journal of Allergy and Clinical Immunology: In Practice found that Black children had a significantly higher likelihood for having an allergy to shellfish and finfish and an increased chance of having a wheat allergy compared to white children, which may be linked to increased exposure to cockroaches among children living in poorer urban communities. That same study found that Black children with food allergies also had higher rates of having asthma, a condition that is estimated to be a factor in about 70 to 75% of food-related anaphylaxis fatalities.
Moreover, there is some evidence that the higher rates at which Black women deliver children by cesarean section could contribute to increased rates of food allergies among Black children.
Dr. Corinna Bowser, an allergist and founder of Suburban Allergy Consultants, a clinic primarily serving suburban Philadelphia, says cesarean births may deprive the infant of exposure to beneficial germs within the birth canal. “It’s like good bacteria that the baby is exposed to on the way out,” Bowser says. More research is needed, however, since the results of a 2022 Australian study argue against those claims, finding no relationship between babies delivered by C-section and a higher likelihood of developing food allergies.
Addressing Racial Disparities
Many of the causes for the disparity in food allergies between Black and white children are rooted in systemic racism, explains Melanie Carver, chief mission officer for the Asthma and Allergy Foundation of America (AAFA). Discriminatory policies and segregation
have led many predominantly racial and ethnic minority communities to be located in areas that both lack adequate green space and have higher levels of air pollution compared to predominantly white neighborhoods.
“Systemic racism influences social determinants of health such as socioeconomic status, education, neighborhood and physical environment, employment, social support networks and access to health care,” explains Carver. “When young children are exposed to higher levels of stress, it can contribute to changes in the immune system and lead to allergic disease.”
levels of stress can
Being exposed to higher lead to allergic disease.
Like with other health inequities, Carver says that we already know enough about the root causes of the racial disparities surrounding food allergies to put effective strategies in place to address the problem. Yet, she says, insufficient funding and a lack of political support continues to hinder progress.
Addressing such disparities was the key focus behind the development of AAFA’s Health Equity Advancement and Leadership program, or HEAL, which was launched in May 2022 to fund local projects throughout the United States that work to reduce asthma and food allergy hospitalizations and deaths in high-risk communities. During the first year of the program, HEAL funded pilot projects in Chicago, St. Louis, Detroit and Los Angeles that focus on adults and teenagers with asthma. The projects collect metrics in the hopes of establishing a set of best practices that can serve as a model for other communities.
“We have an opportunity to focus efforts on the intersection of injustice in the environment, education, wealth and income, race and ethnicity – and how these factors determine health outcomes,” Carver says.
Other efforts have focused on outreach to patients. Helen Margellos-Anast, president of the Sinai Urban Health Institute at Sinai Health System in Chicago, says a large part of the institute’s effort to reduce the adverse health impact of asthma has involved work on the grassroots level by their team of community health
workers, who go out into communities and provide counseling support to patients as well as help residents identify possible risk factors. She says similar efforts can focus on reducing issues related to food allergies within those communities.
“Health care providers need to be at the table listening to find out what the barriers to care are,” Margellos-Anast says.
“There are barriers that we are not always aware of.”
Carver says more immediate actions to reduce food allergies from developing in children should focus on early interventions, which include increasing access to specialists who can determine a child’s level of risk for food allergies and devise a prevention strategy and treatment. One key risk factor for a possible food allergy is the sight of eczema on their skin, which previous research found occurred in 16% of children ages 17 years and younger with a food allergy, and in 23% of kids between the ages of 0 and 2 years. A 2017 University of Pennsylvania study found that Black children were 30% less likely to visit a doctor to treat eczema compared to white children, despite being more likely than other racial and ethnic groups to develop the condition.
Taking Action
Thomas Silvera and his ex-wife quickly turned their grief into action in the weeks following their tragedy. They created the Elijah-Alavi Foundation, a nonprofit for food allergy and asthma education and advocacy. They also lobbied for changes to New York state law that would require preschool and child care centers to have a plan in place to identify kids with allergies and emergency protocols for allergic reactions.
The result was the passage of what is commonly known as “Elijah’s law” in 2019. Since then, Illinois passed a version of the law in 2021, followed by Virginia in 2022, with a similar bill under consideration in Pennsylvania.
Silvera says despite some progress, laws on the management of food allergies by child care providers vary by state, which leaves gaps within the country. He hopes the passage of legislation like Elijah’s law can help address these gaps, whether through passage on a state-by-state basis or through regulatory changes on the federal level. “If we all come to consensus, we can work toward a more equitable future for those affected by food allergies,” Silvera says. l
Fighting for Better Youth Mental Health Support
When it comes to the mental health crisis facing our youth, it truly takes a village
THE KIDS ARE NOT ALL RIGHT —especially when it comes to our nation’s teenagers. Earlier this year, the Centers for Disease Control and Prevention released data from the Youth Risk Behavior Survey that observed health behaviors and experiences among U.S. teens from 2011 to 2021. The results were alarming, to say the least.
After connecting with thousands of teens, the survey found that nearly all signs of poor mental health and suicidal thoughts have increased since 2011, with certain demographics more at risk than others. For example, in 2021, teen girls
reported higher rates of sadness and more frequent thoughts of suicide than teen boys. Meanwhile, compared to their peers in other racial and ethnic groups, Black teens were more likely to attempt suicide.
In addition to the concerning trends surrounding mental well-being, even everyday behaviors within our children –such as their relationship with social media and internet use – have changed in troubling ways over the years and call for immediate action from caring adults, including community allies, from coaches and teachers to barbers and parents.
Timely Work. In February 2020, I led the launch of the Morgan Stanley Alliance for Children’s Mental Health, which
works to address and raise awareness of the mental health crisis facing our youth. We could not have predicted how crucial our work would be going into lockdown the following month.
The Alliance supports kids and young adults by working with other industry leaders, conducting new research and providing relevant resources to educate both urban and rural communities about mental health. We have clearly seen that prevention and intervention are two vital components of the solution to this crisis. Connecting more kids with mental health professionals such as therapists and psychiatrists might seem like a clear solution, but it has its own obstacles. For example, the U.S. is facing a mental health professional shortage.
So, what can we do about it? While government and health care leaders work hard to address this mental health emergency and professional gap, we need to get creative and find new ways to ensure the safety of the children of today and tomorrow. That’s why we’re working closely with community leaders who are teaching adults who regularly interact with our youth how to act as the first line of defense in protecting them. These new intermediaries can be critical players.
intervention for students in K-12 public schools through a free online mental health check-in tool. The platform detects concerns early and connects students with virtual or in-person help almost immediately. Since its founding in California, Closegap has grown to all 50 states.
The Confess Project and Closegap are two members of the second cohort of the Morgan Stanley Alliance for Children’s Mental Health Innovation Awards, which provides grants to nonprofits working on mental health solutions for our youth. To date, we have awarded a total of $1 million to 10 nonprofits across the country – and we just opened applications for our third cohort.
Anyone can be a mental health advocate.
Leading the Way. One such pioneer is Lorenzo P. Lewis, founder of The Confess Project. Growing up, Lewis was able to work through his own mental health struggles while spending time at his aunt’s beauty salon. This inspired Lewis to create The Confess Project in 2016, which trains barbers and stylists to become mental health advocates and ensures that Black youth can receive the same care and support that he did as a child. To date, the organization has trained nearly 3,000 barbers and stylists, reaching more than 3.6 million people per year in 30 states across 50 cities. Another innovator in the space is Rachel Miller, founder of Closegap. Like Lewis, Miller struggled with mental health issues as a child, which significantly impacted her performance at school. She always wondered what would have happened had she received the support she needed from her teachers.
In 2019, Miller launched Closegap, a nonprofit focused on providing real-time mental health support and early
Other organizations recognized this year are the Society for the Prevention of Teen Suicide, which trains non-psychiatric nurses to identify and assist adolescents at risk of suicide; Strategies for Youth, which offers game-based trauma and distress coping strategies for LGBTQ+ youth; and Up2Us Sports, which trains coaches to address mental health and other challenges facing youth in underserved communities. These nonprofits are creating stopgaps for youth in need, helping them interact with caring adults in their everyday lives to address any concerns.
Get Involved. Anyone can be a mental health advocate. It begins with educating yourself about the signs of mental health challenges in teens, including changes in sleep patterns, weight or eating habits, a loss of interest in activities they used to enjoy or canceling plans, struggles in school, frequent worrying, acting withdrawn around friends and family and signs of self-harm or drug or alcohol use.
Additionally, parents can talk to their children about ways to express themselves and build safe spaces for sharing, while health care professionals can seek to understand how mental health struggles might be physically manifesting in patients. Even employers can get involved by providing mental health resources in the workplace. If we all do our part – whether big or small – we can help to normalize conversations about mental health and create a path to a mentally resilient future for everyone. l
You’d go to great lengths for your child’s health. Good thing you don’t have to go far.
We are nationally ranked in pediatric orthopedics at The Bristol-Myers Squibb Children’s Hospital at Robert Wood Johnson University Hospital and in pediatric urology at The Bristol-Myers Squibb Children’s Hospital, Children’s Hospital of New Jersey at Newark Beth Israel Medical Center, McMullen Children’s Center at Cooperman Barnabas Medical Center, and Unterberg Children’s Hospital at Monmouth Medical Center. And we’re also New Jersey’s largest provider of children’s healthcare.
From primary care to specialized treatments and therapies and in partnership with Rutgers Health, our Children’s Health network provides advanced research, teaching, social impact and outstanding care to improve the health and well-being of every child in every community. Learn more at rwjbh.org/ChildrensHealth.
CHILDREN’S
The Great Multivitamin Debate
Do kids need them — or should their nutritional goals be met through the food on their plates?
multivitamin industry markets its products so extensively and effectively that you’d be forgiven for thinking that everyone needs to take a multivitamin. But that’s not the case – especially for kids.
“The vast majority of children don’t need to take a multivitamin,” says Dr. Eric Ball, a pediatrician at the Children’s Hospital of Orange County (CHOC) in Orange County, California. “Children should obtain all of the vitamins and minerals they need from their food.”
Supplementing unnecessarily can actually be problematic, says Hanane Dahoui, a pediatrician and medical director of the Orlando Health Primary Care Pediatric Clinic at Orlando Health Arnold Palmer Hospital for Children in Florida. “While it may seem harmless to give your child vitamins as an ‘insurance policy,’ receiving large amounts of certain vitamins such as vitamin A, C or D can cause nausea, rashes, headaches and sometimes even more severe adverse effects.”
But that’s not to say that supplements are off the table completely. Use this guide to learn about the specific vitamins and minerals your child needs – and when you may want to consider adding in a multivitamin.
Nutrition for Growing Kids
The amount of food your child needs to eat in order to get enough vitamins is probably much smaller than you think, says Dahoui. “Many common foods such as
breakfast cereal, pasta, milk, granola bars and bread are fortified with important nutrients, including calcium, vitamin D, vitamin B and iron.”
Getting these vitamins and minerals is important for kids’ growing bodies, and selecting a few foods from each of the basic food groups can help your child meet their nutritional needs each day. Here’s how each vitamin and mineral plays a role in your child’s health.
Vitamin A is a fat-soluble vitamin that supports healthy eyesight, growth and tissue repair. It’s found in a variety of vegetables and fruits and dairy products.
B vitamins fulfill many functions in the body, including helping with red blood cell development and supporting a healthy metabolism. These vitamins can be found in meat, fish, poultry, eggs and enriched foods such as whole grains or enriched grains and cereals.
Vitamin C supports a healthy immune system and skin and helps kids grow strong muscles. It’s found in a wide variety of fruits and vegetables including citrus fruits, broccoli, spinach and tomatoes.
Vitamin D is a very important vitamin for kids as it helps the body build and maintain strong teeth and bones. Many dairy products are fortified with it, and the skin makes vitamin D when exposed to sunlight. Vitamin D also helps the body absorb calcium from the diet.
Calcium aids the development of strong bones and teeth. It can be found in dairy products, dark leafy greens, tofu and fortified juices.
Iron is an important nutrient for kids as it helps growing bodies and blood cell production. Iron can be found
CHILDREN’S HEALTH
in beans, fish, turkey, beef and whole grain foods as well as fortified cereals.
Special Cases
While getting vitamins and minerals from food tends to be the best option for kids, there are some circumstances where multivitamins may make sense, Ball says. “One such exception is for children who have food allergies or other medical conditions that limit the types of food they can eat. They sometimes need to take a supplement to make up for the vitamins that they can’t eat.”
(along with some fortified foods, like breakfast cereals).
You’ll also want to speak with your pediatrician about supplements if your child has a chronic medical condition such as celiac disease, inflammatory bowel disease or cystic fibrosis. They may not be able to properly absorb fat-soluble vitamins such as vitamins A, D, E and K, and supplementation may be appropriate.
Lastly, breastfed infants and babies who drink less than one liter of baby formula are at risk of vitamin D deficiency and should receive 400 international units of vitamin D each day, says Dahoui. “Vitamin D is important for bone growth and helps prevent a bone condition known as rickets, where deformities in the legs can develop.”
For example, if your child is lactose intolerant or doesn’t drink milk or calcium-fortified non-dairy alternatives, they may not be getting enough calcium or vitamin D in their diet.
Supplementation Safety
If your child has a food allergy or other medical condition that prevents them from getting enough nutrients, work with your pediatrician to discuss the risks and benefits and determine whether a multivitamin supplement is a good choice.
If you do go the supplementation route, choose a vitamin that’s designed for your child’s age group. (If your child isn’t able to swallow pills yet, look for a chewable option.) Ball notes that when choosing a product, less may be more.
“It’s not healthy for a child to take a supplement that has high doses of vitamins. You should look for one that provides the recommended daily al-
Vitamins may taste good, but kids should know that they are medicine, not candy.
lowance of vitamins and not much more.”
“School-aged children generally need three to four servings per day of calcium and vitamin D-rich foods to help build healthy bones,” Ball explains. “Children who don’t obtain enough in their diet sometimes need to take a supplement.”
Children with extremely limited diets and kids with sensory food issues or food aversions (for example, those who eat mostly white carb-based foods) may also need multivitamin supplementation to avoid nutrient deficiencies. The same goes for children on limited diets such as a vegetarian or vegan diet. Your health care provider may recommend a B12 vitamin supplement because this vitamin is only found in animal-based food
Store the bottle out of your child’s reach to avoid accidental overdoses and when giving them a supplement, be sure to only provide the recommended dose. “Overdoing it on supplements can be dangerous,” says Dahoui. She also stresses that you shouldn’t treat the vitamins like a treat. “Children’s vitamins and supplements may come in fun colors and taste good, but make sure you tell your child that vitamins are a kind of medicine – not candy. You don’t want your toddler begging for more.”
Food-Based Is Best
Even if your child is taking a vitamin to address a specific health need, you still need to pay attention to offering them a balanced, healthy diet. “The USDA recommends that parents use MyPlate as a guideline for how much of certain foods kids and adolescents need for a healthy diet,” says Dahoui. MyPlate.gov, published by
the USDA and based on the Dietary Guidelines for Americans, was developed with the appropriate levels of vitamins and minerals that kids need in mind.
MyPlate is divided into five food group categories, which emphasize nutritional intake of:
Whole grains. Foods that are made from wheat, rice, oats, cornmeal, barley or another cereal grain count as whole grains. Kid-friendly examples include whole-wheat bread, brown rice, oatmeal and popcorn.
Because it’s not always easy to know what type of grain is in a product, you should make a point to check labels. Whole-grain products will include a whole grain at the beginning of the ingredient list, such as whole wheat or whole bran. If you just see “wheat” or “bran,” that’s a sign that the product is not whole-grain.
Vegetables. Choose a variety of colorful produce, including dark green, red and orange vegetables, legumes (including peas and beans) and starchy vegetables. Tomato soup or carrot sticks with ranch dressing make for tasty food choices for tots.
Fruits. Fruits may be fresh, canned, frozen or dried and can be served whole, cut up or pureed. Fruit juice can sometimes count toward this serving, though it’s important to check the label and make sure it contains real fruit content and isn’t made from concentrates or full of sweeteners. Fruit smoothies also count, and are a great way to encourage kids to get more fruit in their diet.
Dairy. Milk products and many foods made from milk are considered to be part of this food group. “Focus on fat-free or low-fat products, as well as those that are high in calcium,” says Dahoui. A cup of Greek yogurt or a natural cheese stick makes for a yummy snack.
Protein. “Go lean on protein,” Dahoui says. She recommends opting for low-fat or lean meats and poultry or fish. For vegetarian protein choices, look toward nuts, beans and peas. Specifically, edamame, nut butters and dry roasted chickpeas may be palatable for children.
Ball says that the best way to ensure your child is getting proper nutrition is to make sure that healthy foods are available in the house and offered to them at each meal. He also notes that until your kids have money of their own and can drive, you, the parent, are in control of the vast majority of the food that your children are offered. “It’s critical to feed them healthy foods, including fruits and vegetables, and to not offer them other options if they refuse the foods that are presented.”
Of course, this is sometimes easier said than done. To avoid fights at the kitchen table, Ball says that it can be helpful to offer your child a few acceptable options and let them make the call.
“If children are offered apples or crackers for a snack, most will choose the crackers. And if they’re offered apples or pears, they’ll be more likely to eat fruit,” explains Ball. But whichever they choose, you’ll be happy that your child is on their way to getting the daily vitamins and minerals that they need for their growth and good health. l
ACPC QUALITY NETWORK IMPACT REGISTRY® 2023
The ACC's comprehensive offerings of adult and pediatric congenital heart disease (CHD) programs drive quality improvement and help advance optimal patient care for children and adults with heart disease. Choose one of these top hospitals and clinics that deliver the best heart-focused care and are dedicated to treating patients of all ages.
is a national network of CHD clinics dedicated to developing best practices and advancing standards for patient care. The physician champion and site manager are listed with the clinics
Boston Children's Hospital
Susan F. Saleeb, MD, FACC & Elizabeth Casto, MPH
Cardiology Care for Children
Devyani Chowdhury, MD, FACC & Katie Roth, PA-C
Child Cardiology Associates
Sarah Chambers Gurson, MD, FACC
Children's Healthcare of Atlanta
Andrew Porter, MD, FACC
Children's Hearts
Luke Bruns, MD, FACC
Children's Hospital Colorado
Jessica Stansauk, MD, FACC
Children's Hospital Medical Center of Akron
Kathryn Weller, MSN, APRN-CNP
Children's Hospital of New Orleans
Thomas Kimball, MD, FACC & Scott Macicek, MD, FACC
Children's Hospital of Orange County
Wyman Lai, MD, FACC & Elizabeth Miller, MSN, CPNP
Children's Hospital of Philadelphia
Andrea Kennedy, BS
Children's Mercy Kansas Ciy
Sanket Shah, MD, MHS, FACC & David Coultier, MSc, MBA
Children's National Medical Center
Ashraf Harahsheh, MD, FACC & Lisa Hom, RN, Esq.
Cincinnati Children's Hospital Medical Center
Allison Divanovic, MD, FACC & Christopher Statile, MD, FACC
Eastern Maine Medical Center
Daniel Gruenstein, MD, FACC & Jaime Randall, CMA PSR III
Intermountain Primary Children's Hospital
Antonio Cabrera, MD, FACC & Jennifer Marietta, BSN
The IMPACT Registry® assesses key information of CHD patients undergoing diagnostic catheterizations and catheter-based care. The physician champion and site manager are listed with the hospitals
Adventhealth Orlando
Matthew Zussman, MD & Karla Gennette, RN, BSN
Advocate Children’s Hospital Oak Lawn
Alexander Javois, MD & Linda Rassman, RN
Arkansas Children’s Hospital
Michael Angtuaco, MD & Greg Outlaw, RN, BSN
Ascension St. Vincent Hospital
Sanjay Parikh, MD & Sherrie Streckley, RN, BSN
Atrium Health Wake Forest Baptist Medical Center
Derek Williams, DO & Amanda Kiger, RT-R CI
Atrium Health’s Carolinas Medical Center
Joseph Paolillo, MD, FACC & Stacie Hauswirth-Houghton, BS Boston Children’s Hospital
Brian Quinn, MD & Mirjam Keochakian, MS Cedars - Sinai Health Systems
Evan Zahn, MD & Stanley Conte, RN, MSN, PHN, RCIS Children’s Healthcare of Atlanta
Dennis Kim, MD, PhD & Christine Cunningham, RN, BSN Children’s Hospital and Medical Center
Abby Kirsch, RN, BSN, CPN & Christopher Curzon, DO Children’s Hospital Colorado
This elite list showcases hospitals with unusual breadth of excellence in pediatric specialty care. For each specialty, each hospital that ranked among the top 50 earned points toward the Honor Roll: 25 points for ranking No. 1, 24 points for No. 2 and so on; hospitals ranked 21-50 received 5 points. The 10 hospitals with the most points define the Honor Roll.
2023-24
2
3
4
Cincinnati Children’s Hospital Medical Center
Cincinnati, Ohio
235 points
Boston Children’s Hospital
Boston, Massachusetts
230 points
Texas Children’s Hospital
Houston, Texas
222 points
Children’s Hospital of Philadelphia Philadelphia, Pennsylvania
205 points
5 Children’s National Hospital Washington, D.C.
180 points
6 Nationwide Children’s Hospital Columbus, Ohio
178 points
7 Children's Hospital Los Angeles Los Angeles, California
171 points
8
UPMC Children’s Hospital of Pittsburgh Pittsburgh, Pennsylvania
146 points
9
Rady Children’s Hospital
San Diego, California
142 points
10
Johns Hopkins Children’s Center
Baltimore, Maryland
136 points
FROM LEFT: UPMC CHILDREN'S HOSPITAL OF PITTSBURGH; CINCINNATI CHILDREN'S
CINCINNATI CHILDREN’S HOSPITAL MEDICAL CENTER HERE, NURSE LASHONDA MCADAMS IS ON THE HOSPITAL'S MAIN CAMPUS.
UPMC CHILDREN’S HOSPITAL OF PITTSBURGH HAD OVER 14,200 INPATIENT STAYS AND MORE THAN 1.7 MILLION OUTPATIENT VISITS IN 2022.
AN EXTRAORDINARY CHILD DESERVES ...
EXTRAORDINARY CARE.
At Children’s Hospital of Philadelphia, our nurses, physicians and researchers work side by side every day to deliver life-changing solutions for children. Their passion and relentless dedication bring hope to families facing the most challenging diagnoses.
Because we know every child is extraordinary.
Because we know Abbie.
Proud to be selected for the U.S. News & World Report Honor Roll for 15 straight years.
At age 7, Abbie was treated for a rare cancer at CHOP. She is now cancer free.
What Matters in Pediatrics
How we identified 88 outstanding children’s hospitals
HERE SHOULD anxious parents take a newborn with a life-threatening heart defect, or find ongoing care for a child with failing kidneys or lung-clogging cystic fibrosis? A local hospital’s pediatric department might be perfectly capable of managing ear infections, allergies, flu and other common childhood ailments. But it may not have the expertise to treat severely ill kids. That’s where children’s hospitals come in. There are approximately 200 hospitals in the country that either exclusively treat pediatric patients or possess a pediatric department that functions like a self-contained
children’s hospital. Even within that group, some centers are better than others. U.S. News created the Best Children’s Hospitals rankings to help parents, in consultation with their doctors, find those best suited to their child.
The 2023-24 rankings highlight top children’s centers in 10 specialties: cancer, cardiology and heart surgery, diabetes and endocrinology, gastroenterology and gastrointestinal surgery, neonatology, nephrology, neurology and neurosurgery, orthopedics, pulmonology and lung surgery and urology. This year, 88 hospitals ranked in at least one specialty, and 10 were named to the Honor Roll for scoring near the top in most or all specialties. Regional rankings for each of seven multi-state regions
tures data on dozens of additional children’s hospitals.
Almost all of the medical data used in these rankings were obtained by asking hospitals to complete a lengthy online data-collection process. This year, 119 hospitals surveyed by U.S. News provided enough data to be evaluated.
RTI International, a North Carolina-based research firm, oversaw data collection and produced the rankings. Collaborating with RTI staff, 170 pediatric experts serving in working groups helped design the data-collection survey.
Whether and how high an institution was ranked depended on three elements: its clinical outcomes (such as survival and surgical complications), its delivery of care (such as adhering to safe and effective practices) and its resources (such as staffing and technology). Each element contributed one-third of a hospital’s overall score in most specialties. A detailed FAQ about the rankings is available at usnews.com/aboutchildrens. Here are the basics:
(Page 202) list hospitals according to the number of specialties in which they were among the best. Rich data. Judging the excellence of children’s hospitals is challenging, and no single metric or ranking should be viewed as a definitive guide. U.S. News gathered more than 1,000 data points on each hospital to determine its strengths and weaknesses. Many summary measures appear in the ranking tables that follow; more can be found at usnews.com/childrenshospitals, which also fea-
Clinical outcomes. These reveal a hospital’s success at keeping kids alive after their treatment, protecting them from infections and complications and improving their quality of life. While tough to measure, outcomes tend to matter most to both families and doctors. Delivery of care. How well a hospital handles day-to-day care was determined in part by compliance with accepted “best practices,” such as performing neuropsychological evaluation of patients with certain cancers. Another factor: a hospital’s demonstrated commitment to diversity, equity and inclusion by, say, screening patients for social determinants of health like food insecurity. U.S. News also surveyed pediatric specialists, asking them to identify up to 10 hospitals they consider best in their area of expertise for kids with complex medical problems.
Resources. Surgical volume, nursepatient ratio, clinics and programs for conditions such as asthma, and dozens of other measures were considered.
A Word on the Terms
USED IN MORE THAN ONE SPECIALTY
A Nurse Magnet hospital: hospital recognized by American Nurses Credentialing Center as meeting standards for nursing excellence.
Infection prevention score, ICU: ability to prevent central-line bloodstream infections in intensive care units.
Infection prevention score, overall: ability to prevent infections through measures such as hand hygiene and vaccination. No. of best practices: how well hospital adheres to recommended ways of diagnosing and treating patients, such as documenting blood sugar levels for a high percentage of outpatients (diabetes & endocrinology) and conducting hip exams with ultrasound specialists (orthopedics).
Nurse-patient ratio: balance of full-time registered nurses to inpatients.
Patient volume score:
relative number of patients in past year with specified disorders.
% of specialists recommending hospital: percentage of physician specialists surveyed in 2021, 2022 and 2023 who named hospital among best for very challenging patients.
Procedure volume score:
relative number of tests and nonsurgical procedures in past one, two or three years, such as implanting radioactive seeds in a cancerous thyroid (diabetes & endocrinology) and using an endoscope for diagnosis (gastroenterology). Surgical procedures are included in orthopedics.
Surgery volume score: relative number of patients who had specified surgical procedures in past year.
Surgical complications prevention score: ability to prevent surgery-related complications and readmissions within 30 days (neurology & neurosurgery, orthopedics, urology).
U.S. News score:
0 to 100 summary of overall performance in specialty.
NA: not applicable; service not provided by hospital.
NR: data not reported or unavailable.
USED IN ONE SPECIALTY
CANCER
Bone marrow transplant survival score: survival of stem cell recipients at 100 days. Five-year survival score: survival five years after treatment for acute lymphoblastic leukemia, acute myeloid leukemia and neuroblastoma.
Palliative care score: how well program meets specified training and staffing standards for children with terminal or life-limiting conditions, and number of cancer patients referred to program.
CARDIOLOGY & HEART SURGERY
Catheter procedure volume score: relative number of specified catheter-based procedures in past year, such as inserting stents and treating heart rhythm problems. Length of stay after surgery score: success in minimizing how long certain congenital heart patients spend in the hospital for care related to their heart condition.
Norwood/hybrid surgery survival score: survival at one year after the first in a series of reconstructive surgeries, evaluated over past four years.
Risk-adjusted surgical survival score: survival in the hospital and 30 days from discharge after congenital heart surgery, adjusted for operative and patient risk, evaluated over past four years.
DIABETES & ENDOCRINOLOGY
Diabetes management score: ability to prevent serious problems in children with Type 1 diabetes and to keep blood sugar levels in check.
Hypothyroid management score: relative proportions of children treated for underactive thyroid who test normal and of infants who begin treatment by 3 weeks of age.
GASTROENTEROLOGY & GI SURGERY
Liver transplant survival score: one- and three-year survival after liver transplant. Nonsurgical procedure volume score: relative number of tests and noninvasive procedures. Selected treatments success score: shown, for example, by high remission rates for inflammatory bowel disease and few complications from endoscopic procedures.
NEONATOLOGY
Infection prevention score, NICU: ability to prevent central-line bloodstream infections in neonatal ICU. Keeping breathing tube in place score: ability to minimize inappropriate breathingtube removal in intubated infants. Leaves NICU on breast milk score: relative percentage of infants discharged from NICU receiving some nutrition from breast milk.
NICU temperature management score: success in managing NICU patients’ temperature at the time of admission and postoperatively.
NEPHROLOGY
Biopsy complications prevention score: ability to minimize complications after kidney biopsy.
Dialysis management score: relative proportion of dialysis patients in past two years who tested normal. Infection prevention score, dialysis: ability to minimize dialysis-related infection. Kidney transplant survival score: based on patient survival and functioning kidney at one and three years.
NEUROLOGY & NEUROSURGERY
Epilepsy management score: ability to treat children with epilepsy. Surgical survival score: survival at 30 days after complex surgery and procedures, such as those involving brain tumors, epilepsy and head trauma.
ORTHOPEDICS
Fracture repair score: ability to treat complex leg and forearm fractures efficiently.
PULMONOLOGY & LUNG SURGERY
Asthma inpatient care score: ability to minimize asthmatic children’s asthma-related deaths, length of stay and readmissions. Cystic fibrosis management score: ability to improve lung function and nutritional status.
Lung transplant survival score: reflects number of transplants in past two years, one-year survival and recognition by United Network for Organ Sharing.
UROLOGY
Minimally invasive volume score: relative number of patients in past year who had specified nonsurgical procedures. Testicular torsion care score: promptness of emergency surgery to correct twisted spermatic cord.
4
RANKED AMONG THE BEST. YEAR AFTER YEAR.
Children’s Medical Center Dallas, part of the Children’s HealthSM system, has been ranked in all 10 pediatric specialties by U.S. News & World Report for the sixth year in a row. Our breakthrough research and innovative medical technology allow us to achieve the best possible outcomes for kids. Together with UT Southwestern, we’re pushing the boundaries of incredible care.
Learn more at childrens.com/excellence
Cardiology & Heart Surgery
4
Hospital Data Insights is an analytics platform from U.S. News & World Report based on the data underpinning the Best Hospitals rankings.
Why Hospital Data Insights?
Transform Insights Into Action
•Explore elements to help improve patient care
•Promote brand awareness
•Inform resource allocation
•Discover performance drivers Your
For more information or to request a free customized demo of your data, get in touch.
hospitals 3+ million data points
metrics
custom visualizations
Diabetes & Endocrinology
Gastroenterology & GI Surgery
Neonatology
Nephrology
50
“I had acute liver failure from fatty liver disease. To know that I was the first child to be put on the MARS machine in the Northeast is pretty neat.” -Diego Catalan Diego marches on.
See Diego’s miraculous story at montefiore.org/DiegoCatalan
*MARS: Molecular Absorbent Recirculating System
Neurology & Neurosurgery
Orthopedics
Pulmonology & Lung Surgery
Shortness of breath
Pain that travels down one or both arms t h do b Chest pressure, squeezing, aching, or burning Nausea or vomiting
Use CardioSmart® patient tools, including Early Heart Attack Care™ (EHAC®), to learn the signs and symptoms so you can recognize and respond.
Discomfort in back, neck, shoulder, or jaw
Excessive fatigue or weakness
if you think you are having a heart attack. DON’T DELAY CALL 911
The American College of Cardiology works with Accredited and Certified Chest Pain Centers across the U.S. to improve the diagnosis and care of patients with heart attack symptoms.
The ACC is proud to be a part of the NFL’s Smart Heart Sports Coalition and working to ensure young athletes and others are protected from heart-related emergencies, such as sudden cardiac death. Awareness drives action, as does access to AEDs and CPR training. Remember, for any heart-related emergency, DON’T DELAY, CALL 911.
Learn more about this public awareness campaign and access the tools at CardioSmart.org/EHAC
Best Regional Hospitals
184 Great Care Near Home: Read about how U.S. News identified and ranked top hospitals in each state.
186 The Rankings: See how district hospitals performed in areas of specialty care and in common procedures and conditions.
202 Best Regional Children’s Hospitals: Explore a region-by-region ranking based on performance in 10 specialties.
Great Care Near Home
How we identified and ranked the top hospitals state by state
IF YOU’RE LIKE MOST people facing hospitalization, you’d likely prefer to stay close to home. Not only is going to a local hospital more convenient, but it could help you avoid a hefty bill for out-of-network care. Additionally, friends and family may be able to visit you if you go to a nearby hospital, and that support can be incredibly important during your recovery. And getting follow-up care from the same medical team will be more practical if you don’t need to travel a great distance.
The U.S. News & World Report Best Regional Hospitals listings showcase nearly 500 hospitals in the country that offer high-quality care across a range of clinical services. These services include both complex, highly specialized care for the sickest patients – the focus of the Best Hospitals specialty rankings (see Page 110) – and safe, effective treatment for those whose medical needs are more commonplace, such as patients seeking hip or knee replacement surgery for age-related arthritis. The 2023-2024 Best Regional Hospitals rankings, found in their entirety at usnews.com/bestregionalhospitals, offer readers in most parts of the country a number of high-quality choices near home.
These evaluations include ratings of how well hospitals handle 21 relatively common procedures and conditions in addition to their assessments in 11 specialties.* These 21 areas of care are: colon cancer surgery; lung cancer surgery; ovarian cancer surgery; prostate cancer surgery; uterine cancer surgery; leukemia, lymphoma and myeloma; heart attack; heart failure; heart bypass surgery; heart valve surgery; transcatheter aortic valve replacement; abdominal aortic aneurysm repair; stroke; back surgery; hip replacement; knee
*Cancer; cardiology, heart and vascular surgery; diabetes and endocrinology; ear, nose and throat; gastroenterology and GI surgery; geriatrics; obstetrics and gynecology; neurology and neurosurgery; orthopedics; pulmonology and lung surgery; urology
replacement; hip fracture; diabetes; kidney failure; pneumonia; and chronic obstructive pulmonary disease.
Hospitals are assigned a rating of “high performing,” “average” or “below average” in each area in which they treated enough patients to be evaluated.
Recognition as a Best Regional Hospital means a hospital was nationally ranked in at least one of 11 specialties, or that it earned at least seven “high performing” ratings across the procedures and conditions. Each such hospital also had to meet certain other criteria. To learn more, check out the FAQ at usnews.com/best-hospitals.
The Best Regional Hospitals appear ranked by state on the following pages. Hospitals are numerically ordered according to the following rules:
1. Hospitals on the Honor Roll (see Page 109) were ranked No. 1 in their state. In states with more than one Honor Roll hospital, all were tied at No. 1.
2. All other hospitals received two points for each of the 11 specialties in which they were ranked among the top 50 and one point
for each of those specialties and each procedure or condition in which it was rated high performing. Certain pairs of related procedures were treated as one procedure for scoring purposes.
3. A hospital lost one point for each procedure or condition in which it was rated below average. Again, certain pairs of procedures were scored together.
Based on the same rules, hospitals in major metropolitan areas also were ranked against other top hospitals in the metropolis. Our website displays these rankings for 92 metro areas with approximately 500,000 or more residents.
To help consumers outside the biggest urban centers who are searching for high-
quality care, the website also lists top hospitals in more than 100 U.S. News-defined regions, such as Kentucky’s Bluegrass Region, the Ozarks in Arkansas and the Florida Panhandle.
Our goal with the state and metro area rankings is to identify general medical-surgical hospitals that provide both breadth and quality, so only hospitals that deliver a wide range of clinical services for adults were considered for the Best Regional Hospitals rankings.
Maternal and pediatric care did not factor into these rankings. Hospitals are separately evaluated in maternity care (Page 42), and children’s hospitals are separately ranked by region (Page 202) based on their performance across the 10 children’s specialties (Page 165).
How a hospital performed in ophthalmology, psychiatry, rehabilitation and rheumatology did not factor into the Best Regional Hospitals rankings, either. While these four specialties are undeniably important, many hospitals treat few, if any, inpatients in these specialty areas.
Additionally, specialty hospitals such as dedicated cancer centers, surgical hospitals and rehabilitation facilities were not considered for the regional rankings.
Of course, a local hospital doesn’t make sense for every patient. Where you live, the type of care you need, your insurance coverage and other factors will all play a role in determining which type of hospital is preferable for your treatment. That’s why when choosing a hospital, it’s important to consult with your physician or other health professional and talk with family and friends about the hospitals that you’re comparing. Then you can combine your own research with ours to find the best possible care. l
MAINE MEDICAL CENTER IN PORTLAND
Best Regional Hospitals
To help patients identify top hospitals near home, the table below compares hospitals across 15 areas of complex specialty care that comprise the Best Hospitals rankings (Page 110) plus 21 procedures and conditions.
1
2
1
1
l High performing
l Average
l Below average – Service rarely or never provided COMMON PROCEDURES & CONDITIONS
A footnote indicates that another hospital’s results are included,
COMMON PROCEDURES & CONDITIONS
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BEST REGIONAL HOSPITALS
COMPLEX SPECIALTY CARE
9
l High performing
l Average
l Below average
– Service rarely or never provided COMMON PROCEDURES & CONDITIONS
INDICATES NUMBER OF SPECIALTIES IN WHICH HOSPITAL IS NATIONALLY RANKED
COMMON PROCEDURES & CONDITIONS
NATIONALLYRANKEDLEUKEMIA& LYMPHOMA* COLONCANCER SURGERY LUNGCANCER SURGERY OVARIANCANCER SURGERYUTERINECANCER SURGERYPROSTATECANCER SURGERY HEARTATTACKHEARTFAILUREHEARTBYPASS SURGERY HEARTVALVE SURGERY TAVR†ABDOMINALAORTIC ANEURYSM STROKEBACKSURGERYHIPREPLACEMENTKNEEREPLACEMENT
18 John Muir Health-Concord Medical Center, Concord
18 Loma Linda University Medical Center, Loma Linda
18 Sharp Memorial Hospital, San Diego5
21 Kaiser Permanente Anaheim and Irvine Med. Centers, Anaheim
22 MemorialCare Orange Coast Medical Center, Fountain Valley
22 Sharp Chula Vista Medical Center, Chula Vista
24 Providence St. Joseph Hospital-Orange
24 Providence St. Joseph Medical Center-Burbank
26 Kaiser Permanente San Diego Zion and San Diego Med. Ctr.
27 PIH Health Hospital-Whittier
28 Adventist Health Glendale
28 Mercy General Hospital, Sacramento
28 Providence Holy Cross Medical Center, Mission Hills
28 Providence Little Company of Mary Medical Center Torrance
28 Providence St. Jude Medical Center, Fullerton
33 Mercy San Juan Medical Center, Carmichael
33 Providence Tarzana Medical Center, Tarzana
33 Santa Barbara Cottage Hospital, Santa Barbara
36 Community Hospital of the Monterey Peninsula, Monterey
36 Community Memorial Hospital-Ventura
36 El Camino Health-Mountain View
36 Kaiser Permanente Oakland & Richmond Med. Centers, Oakland
36 MemorialCare Saddleback Medical Center, Laguna Hills
36 Sharp Grossmont Hospital, La Mesa
36 Sutter Medical Center, Sacramento
43 Kaiser Permanente Fontana and Ontario Med. Centers, Fontana
43 Kaiser Permanente Los Angeles Medical Center
43 Kaiser Permanente Santa Clara Medical Center, Santa Clara
43 Scripps Mercy Hospital, San Diego
43 St. Agnes Medical Center, Fresno
43 St. Joseph’s Medical Center-Stockton
43 Washington Hospital-Fremont
50 Kaiser Permanente Downey Medical Center, Downey
50 Kaiser Permanente Roseville Medical Center, Roseville
50 Kaiser Permanente San Francisco Medical Center
50 Kaiser Permanente South Sacramento Medical Ctr., Sacramento
**MedStar Washington Hospital Center is ranked No. 2, MedStar Georgetown University Hospital is ranked No. 3, George Washington University Hospital is ranked No. 5 and Johns Hopkins Medicine-Sibley Memorial Hospital is ranked No. 7 in the Washington, D.C., metro area rankings, which include hospitals in and around the District of Columbia. These four hospitals in D.C. are presented here alphabetically.
A footnote indicates that another hospital’s results are included, that the hospital has a different name in one or more areas of care, or both. 6University of Colorado Cancer Center-UCHealth University of Colorado Hospital, National Jewish Health 7Smilow Cancer Hospital at Yale New Haven 8MedStar Heart & Vascular Institute at MedStar Washington Hospital Center 9Florida Orthopaedic Institute at Tampa General Hospital State Rank Hospital
5
5
l
CONDITIONS
l Average
l
–
1
GEORGIA
4
6
7 WellStar Kennestone Hospital, Marietta
9 Northside Hospital Cherokee, Canton
COMPLEX
includes
COMMON PROCEDURES & CONDITIONS
l
l
l
IDAHO
1
2
ILLINOIS
1
3
4
5
8
9
*Also includes myeloma. †TAVR: Transcatheter aortic valve replacement. ‡COPD: Chronic obstructive pulmonary disease. A footnote indicates that another hospital’s results are included, that the hospital has a different name in one or more areas of care, or both. 14Midwest Orthopaedics at Rush
COMPLEX SPECIALTY CARE INDICATES NUMBER OF SPECIALTIES IN WHICH HOSPITAL IS NATIONALLY RANKED
l High performing
l Average
l Below average
– Service rarely or never provided COMMON PROCEDURES & CONDITIONS
State Rank Hospital
1
2
3
4
5
1
1
2
3 University of Maryland St. Joseph Medical Center, Towson
9 Luminis Health Anne Arundel Medical Center, Annapolis
MASSACHUSETTS
1
3
4
5 Tufts Medical Center, Boston
6 Lahey Hospital and Medical Center, Burlington
7 Baystate Medical Center, Springfield
8 Brigham and Women’s Faulkner Hospital, Boston
8 Newton-Wellesley Hospital, Newton Lower Falls
10 Salem Hospital, Salem
10 Winchester Hospital, Winchester
MICHIGAN
1 University of Michigan Health-Ann Arbor20
2 Beaumont Hospital-Royal Oak
3 Beaumont Hospital-Troy
4 Trinity Health Ann Arbor Hospital, Ypsilanti
5 Henry Ford Hospital, Detroit
5 Spectrum Health-Butterworth and Blodgett, Grand Rapids
7 Munson Medical Center, Traverse City
8 Beaumont Hospital-Grosse Pointe
9 Bronson Methodist Hospital, Kalamazoo
10 Ascension Genesys Hospital, Grand Blanc
COMMON PROCEDURES & CONDITIONS
NATIONALLYRANKEDLEUKEMIA& LYMPHOMA* COLONCANCER SURGERY LUNGCANCER SURGERY OVARIANCANCER SURGERYUTERINECANCER SURGERYPROSTATECANCER SURGERY HEARTATTACKHEARTFAILUREHEARTBYPASS SURGERY HEARTVALVE SURGERY TAVR†ABDOMINALAORTIC ANEURYSM STROKEBACKSURGERYHIPREPLACEMENTKNEEREPLACEMENTHIPFRACTUREDIABETESKIDNEYFAILUREPNEUMONIACOPD‡
A footnote indicates that another hospital’s results are included, that the hospital has a different name in one or more areas of care, or both.
18Dana-Farber/Brigham and Women’s Cancer Center 19Mass Eye and Ear 20University of Michigan Health Rogel Cancer Center, University of Michigan Health Von Voigtlander Women’s Hospital, University of Michigan Health Frankel Cardiovascular Center
l High performing
l Average
l Below average
COMPLEX SPECIALTY CARE INDICATES NUMBER OF SPECIALTIES IN WHICH HOSPITAL IS NATIONALLY RANKED
– Service rarely or never provided COMMON PROCEDURES & CONDITIONS NATIONALLYRANKEDLEUKEMIA& LYMPHOMA* COLONCANCER SURGERY LUNGCANCER SURGERY OVARIANCANCER SURGERYUTERINECANCER SURGERYPROSTATECANCER SURGERY HEARTATTACKHEARTFAILUREHEARTBYPASS SURGERY HEARTVALVE SURGERY
COMMON PROCEDURES & CONDITIONS
1
*Also includes myeloma. †TAVR: Transcatheter aortic valve replacement. ‡COPD: Chronic obstructive pulmonary disease. A footnote indicates that another hospital’s results are included, that the hospital has a different name in one or more areas of care, or both. 21Minneapolis Heart Institute at Abbott Northwestern Hospital, Courage Kenney Rehabilitation Institute at Abbott Northwestern Hospital 22Courage Kenney Rehabilitation Institute at United Hospital 23Siteman Cancer Center at Barnes-Jewish Hospital, Barnes-Jewish Hospital 24Saint Luke’s Cancer Institute, Saint Luke’s Mid America Heart Institute, Saint Luke’s Marion Bloch Neuroscience Institute 25Fred & Pamela Buffett Cancer Center
BEST REGIONAL HOSPITALS
COMPLEX SPECIALTY CARE INDICATES NUMBER OF SPECIALTIES IN WHICH HOSPITAL IS NATIONALLY RANKED
l High performing
l Average
l Below average
– Service rarely or never provided COMMON PROCEDURES & CONDITIONS
continued
3 Bryan Medical Center, Lincoln
3 Creighton University Medical Center-Bergan Mercy, Omaha
1 Renown Regional Medical Center, Reno
1 Dartmouth Hitchcock Medical Center, Lebanon
2 Catholic Medical Center, Manchester
NEW JERSEY
1 Hackensack U. Med. Ctr. at Hackensack Meridian, Hackensack
2 Morristown Medical Center, Morristown
3 Valley Hospital, Ridgewood
4 Overlook Medical Center, Summit
5 Robert Wood Johnson University Hospital, New Brunswick26
6 Jersey Shore U. Med. Ctr. at Hackensack Meridian, Neptune
7 Cooper University Health Care-Camden
8 AtlantiCare Regional Medical Center, Atlantic City
8 Jefferson Health-Stratford
10 St. Joseph’s University Medical Center, Paterson
NEW MEXICO
1 Presbyterian Hospital, Albuquerque
2 Lovelace Medical Center, Albuquerque
3 University of New Mexico Hospitals, Albuquerque
NEW YORK
1 Mount Sinai Hospital, New York
1 NYU Langone Hospitals, New York27
1 New York-Presbyterian Hospital-Columbia and Cornell
1 North Shore U. Hospital at Northwell Health, Manhasset
5 Lenox Hill Hospital at Northwell Health, New York28
6 Long Island Jewish Medical Ctr. at Northwell, New Hyde Park
6 St. Francis Hospital and Heart Center, Roslyn
8 Montefiore Medical Center, Bronx
9 Mount Sinai Morningside & Mount Sinai West Hosps., New York
COMMON PROCEDURES & CONDITIONS
NATIONALLYRANKEDLEUKEMIA& LYMPHOMA* COLONCANCER SURGERY LUNGCANCER SURGERY OVARIANCANCER SURGERYUTERINECANCER SURGERYPROSTATECANCER SURGERY HEARTATTACKHEARTFAILUREHEARTBYPASS SURGERY HEARTVALVE SURGERY TAVR†ABDOMINALAORTIC ANEURYSM STROKEBACKSURGERYHIPREPLACEMENTKNEEREPLACEMENT
A footnote indicates that another hospital’s results are included, that the hospital has a different name in one or more areas of care, or both.
26Rutgers Cancer Institute of New Jersey/Robert Wood Johnson University Hospital 27Perlmutter Cancer Center at NYU Langone Hospitals, NYU Langone Orthopedic Hospital, Rusk Rehabilitation at NYU Langone Hospitals 28Manhattan Eye, Ear & Throat Hospital 29Wilmot Cancer Institute
TWO TOP 10 HOSPITALS IN NEW JERSEY INCLUDING THE # 1 ADULT AND CHILDREN’S HOSPITALS.
HACKENSACK UNIVERSITY
MEDICAL CENTER
JOSEPH M. SANZARI & K. HOVNANIAN
CHILDREN’S HOSPITALS
JERSEY SHORE UNIVERSITY
MEDICAL CENTER
JFK JOHNSON REHABILITATION INSTITUTE
At Hackensack Meridian Health, we’re proud to have two hospitals ranked in New Jersey’s top 10, according to U.S. News & World Report. Hackensack University Medical Center is the #1 adult and children’s hospitals in New Jersey, with premier cancer care at John Theurer Cancer Center, a nationally ranked Orthopedics program, the state’s best programs in Cardiology, Heart & Vascular Surgery, Geriatrics, Pulmonology and Lung Surgery, and the only nationally ranked programs in the state for Neurology & Neurosurgery, and Urology. Jersey Shore University Medical Center has received national recognition in its Orthopedics and Pulmonary & Lung Surgery programs. And JFK Johnson Rehabilitation Institute has once again been ranked among the nation’s best rehabilitation hospitals. It’s proof that here, no matter what, or when, we’re ready to care for you.
To learn more, visit HackensackMeridianHealth.org/Rankings.
BEST REGIONAL HOSPITALS
l
l
l
NORTH CAROLINA
1
2
3 Atrium Health Carolinas Medical Center, Charlotte30
4 UNC Rex Hospital, Raleigh
5
5
7
7
*Also includes myeloma. †TAVR: Transcatheter aortic valve replacement. ‡COPD:
1
COMMON PROCEDURES & CONDITIONS
l High performing
l Average
l Below average
– Service rarely or never provided
COMPLEX SPECIALTY CARE
INDICATES NUMBER OF SPECIALTIES IN WHICH HOSPITAL IS NATIONALLY RANKED
COMMON PROCEDURES & CONDITIONS
NATIONALLYRANKEDLEUKEMIA& LYMPHOMA* COLONCANCER SURGERY LUNGCANCER SURGERY OVARIANCANCER SURGERYUTERINECANCER SURGERYPROSTATECANCER SURGERY HEARTATTACKHEARTFAILUREHEARTBYPASS SURGERY HEARTVALVE SURGERY TAVR†ABDOMINALAORTIC ANEURYSM STROKEBACKSURGERYHIPREPLACEMENTKNEEREPLACEMENTHIPFRACTUREDIABETESKIDNEYFAILUREPNEUMONIACOPD‡
1
4
4 St. Charles Medical Center, Bend
6 Kaiser Permanente Sunnyside Medical Center, Clackamas
6 PeaceHealth Sacred Heart Med. Ctr. RiverBend, Springfield
8 Asante Rogue Regional Medical Center, Medford
PENNSYLVANIA
1 Hosps. of U. of Pennsylvania-Penn Presbyterian, Philadelphia
2 UPMC Presbyterian Shadyside, Pittsburgh
3 Jefferson Health-Thomas Jefferson U. Hosps., Philadelphia34
4 Lancaster General Hospital, Lancaster
5 Penn State Health Milton S. Hershey Medical Center, Hershey
6 Lehigh Valley Hospital-Cedar Crest, Allentown
7 Main Line Health Lankenau Medical Center, Wynnewood
A footnote indicates that another hospital’s results are included, that the hospital has a different name in one or more areas of care, or both.
33OHSU Hospital-Knight Cancer Institute, OHSU Hospital-Harold Schnitzer Diabetes Health Center, OHSU Hospital-Knight Cardiovascular Institute 34Thomas Jefferson University Hospitals-Sidney Kimmel Cancer Center, Thomas Jefferson University Hospitals-Vickie and Jack Farber Institute for Neuroscience, Rothman Orthopaedics at Thomas Jefferson University Hospitals, Thomas Jefferson University Hospitals-Jane and Leonard Korman Respiratory Institute
BEST REGIONAL HOSPITALS
l
l
l
23
RHODE ISLAND
1
SOUTH CAROLINA
1
2
3
3
3 Roper Hospital, Charleston
3 Spartanburg Medical Center, Spartanburg
7 Prisma Health Greenville Memorial Hospital, Greenville
8 McLeod Regional Medical Center, Florence
SOUTH DAKOTA
1 Sanford USD Medical Center, Sioux Falls
2 Avera McKennan Hospital and U. Health Center, Sioux
1
2
3
4 Baptist Memorial Hospital-Memphis
1
l
l
l
1
1
l High performing
l Average
l Below average
– Service rarely or never provided COMMON PROCEDURES & CONDITIONS NATIONALLYRANKED
WASHINGTON
1
2
3
5
VIRGINIA
1
COMMON PROCEDURES & CONDITIONS
1
2
3 Froedtert Hosp. & the Med. College of Wisconsin, Milwaukee
A footnote indicates that another hospital’s results are included, that the hospital has a different name in one or more areas of care, or both.
40Fred Hutchinson Cancer Center/University of Washington Medical Center 41WVU Cancer Institute, WVU Heart & Vascular Institute, WVU Rockefeller Neuroscience Institute
For good reasons, parents of kids who need specialty care tend to seek a hospital close to home, usually within the state where they live or in a neighboring state. Designed to help families identify top pediatric centers near home, the region-by-region rankings below compare children’s hospitals on overall performance across ten pediatric specialties.
NATIONALLY RANKED
Hospital
1 Boston Children’s Hospital1
2 Yale New Haven Children’s Hospital, New Haven, Conn.
3 MassGeneral Hospital for Children, Boston
of Columbia
1 Children’s Hospital of Philadelphia
2 Children’s National Hospital, Washington, D.C.
3 UPMC Children’s Hospital of Pittsburgh2
4 Johns Hopkins Children’s Center, Baltimore3
5 New York-Presbyterian Children’s Hospital-Columbia and Cornell, New York
6 University of Virginia Children’s Hospital, Charlottesville4
7 Children’s Hospital of Richmond at VCU, Va.
7 Cohen Children’s Medical Center, New Hyde Park, N.Y.
9 Nemours Children’s Hospital-Delaware, Wilmington, Del.
10 Hackensack Meridian Health JM Sanzari and K Hovnanian Children’s Hosps., Hackensack, N.J.
Mount Sinai Kravis Children’s Hospital, New York
Children’s Hospital at Montefiore, New York
12 Hassenfeld Children’s Hospital at NYU Langone, New York
12 University of Rochester-Golisano Children’s Hospital, N.Y.
15 West Virginia University Children’s Hospital, Morgantown
( - ) indicates hospital is not nationally ranked.
A footnote indicates that another hospital’s results are included, that the hospital has a different name in one or more areas of care, or both.
1Dana-Farber/Boston Children’s Cancer and Blood Disorders Center 2UPMC Children’s Hospital of Pittsburgh-Shriners Hospitals for Children Erie
3Johns Hopkins Children’s Center-Kennedy Krieger Institute 4Virginia Congenital Cardiac Collaborative 5Rutgers Cancer Institute of New Jersey
1
4
5
5
( - ) indicates hospital is not nationally ranked. A footnote indicates that another hospital’s results are included, that the hospital has a different name in one or more areas of care, or both. 6MUSC Children’s Heart Network of South Carolina 7Wolfson Children’s Terry Heart Institute 8Cincinnati Children’s and Kentucky Children’s Hospital Joint Heart Program 9University of Michigan Health C.S. Mott Children’s Hospital 10Ann and Robert H. Lurie Children’s Hospital-Prentice Women’s Hospital 11Mayo Clinic Children’s Minnesota Cardiovascular Collaborative 12St. Louis Children’s Hospital-Washington University/Shriners Hospital 13Kentucky Children’s Hospital-Shriners Hospitals for Children 14M Health Fairview Masonic Children’s Hospital-Children’s Minnesota 15Advocate Children’s Heart Institute
BEST REGIONAL HOSPITALS
l NATIONALLY RANKED
1 Children’s Hospital Colorado, Aurora
2 Intermountain Primary Children’s Hospital-University of Utah, Salt Lake City16
1 Texas Children’s Hospital, Houston
2 Children’s Medical Center Dallas17
3 Phoenix Children’s Hospital
4 Cook Children’s Medical Center, Fort Worth
5 Children’s Memorial Hermann Hospital, Houston
6 Dell Children’s Medical Center, Austin
6 Oklahoma Children’s Hospital OU Health, Oklahoma City18
3 UCSF Benioff Children’s Hospitals, San Francisco and Oakland
6 UCLA Mattel Children’s Hospital, Los Angeles
7 CHOC Children’s Hospital, Orange, Calif.
8 Valley Children’s Healthcare and Hospital, Madera, Calif.
9 Doernbecher Children’s Hospital at Oregon Health and Science University, Portland, Ore.19
10 Loma Linda University Children’s Hospital, Loma Linda, Calif.
10 UC Davis Children’s Hospital, Sacramento, Calif.20
12 MemorialCare Miller Children’s and Women’s Hospital Long Beach, Calif.
( - ) indicates hospital is not nationally ranked.
A footnote indicates that another hospital’s results are included, that the hospital has a different name in one or more areas of care, or both.
16Intermountain Primary Children’s Hospital-Shriners Hospitals for Children-University of Utah 17Children’s Medical Center Dallas-Scottish Rite for Children
18Jimmy Everest Center for Cancer and Blood Disorders in Children 19OHSU Doernbecher Children’s Hospital/Shriners Hospitals for Children Portland
20UC Davis Children’s Hospital/Shriners Children’s Northern California
