North Carolina's top children's hospitals are in the Triangle and less than 10 miles apart, a geographical factor that could prevent their scores from being higher in national rankings.
U.S. News & World Report said a total of four North Carolina children's hospitals rank among the top 50 pediatric hospitals nationwide in at least one specialty. Duke Children's Hospital and Health Center in Durham ranks in nine specialties, while N.C. Children's Hospital at UNC Chapel Hill makes the list in seven specialties; both admit at least 150 patients on a typical day.
The specialties include pediatric cancers, diabetes, neurology, heart surgery and orthopedics. The highest ranking for any North Carolina children's hospital is 12th best in the country for treatment of diabetes, and that ranking belongs to UNC. Duke's highest ranking is 17th in treatment pediatric neonatology, cancer and nephrology (kidney disorders).
Additionally, Levine Children's Hospital in Charlotte, owned by Atrium Health, has a top 50 ranking in six specialties. And Brenner Children's Hospital in Winston-Salem ranks nationally in one area: pediatric urology.
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"The rankings have become a tradition," said David Wescott, spokesman for UNC Children's. "We're talking about elite institutions here."
The U.S. News pediatric hospitals rankings, now in their 12th year, included 189 eligible hospitals and ranked 86 hospitals in the nation's top 50 in at least one specialty.
The rankings are based on mortality rates, nurse staffing, infection control and other measures, as well as on the reputations pediatric hospitals have among medical doctors. U.S. News has been ranking children's hospitals for more than a decade using metrics developed by and administered annually by RTI International, a nonprofit organization in Research Triangle Park.
Ira Cheifetz, the chief medical officer at Duke Children's, said the U.S. News rankings are used in marketing, advertising and faculty recruiting around the country, and as a result help institutions focus on improving their performance to raise their scores. Cheiftetz also noted that hospitals in the largest metro areas, such as Boston, Philadelphia, Chicago and Houston, tend to get the top rankings, in part because they are rewarded for high volumes of patients with complex conditions, which is why being so close together puts Duke and UNC at a disadvantage: they share patients in a mid-sized market.
Levine issued a statement saying it was founded 11 years ago and has been nationally ranked by U.S. News for the past nine years. Spokeswoman Claire Simmons said Levine narrowly missed getting ranked in the nation's top 50 in neonatology by a fraction of a point, even though its survival rates are well above the national average. She said a possible reason for missing inclusion in neonatology was because Levine doesn't have a fellowship program in that area.
The only children's hospital in Wake County, WakeMed Health & Hospitals, is not ranked because it doesn't submit the lengthy applications to U.S. News. To be evaluated hospitals must submit a clinical survey with more than a thousand items describing safety procedures, staffing levels and other details. WakeMed officials said it is considering applying next year.
Certain types of hospitals tend to do well in the rankings. Hospitals that train doctors and conduct advanced research tend to be best equipped to handle the sickest patients, said Ben Harder, chief of health analysis and managing editor at U.S. News.
About a third of a hospital's score is based on outcomes such as survival, infections and surgical complications. The hospital's reputation among doctors accounts for about 15 percent of the score. About half the score comes from procedures for patient safety, excellence initiatives such as fellowship programs, and "family centeredness," which includes the degree to which families are involved in their children's care.
Like all organizations that rank and score hospitals for safety and performance, U.S. News says its scores should not be the only criterion used by patients to select a hospital. Parents should also consider insurance coverage as well as the stress of traveling out of state for their child's care.
A hospital's ranking ultimately depends on outcomes, process and structure, U.S. News said. Outcomes refers to keeping children alive and preventing infections. Process refers to adopting industry "best practices," such as regular doctor conferences on patient deaths. And structure refers to nurse-to-patient ratios, specialized clinics and the availability of specialized surgeons.
The rankings can also vary from year to year. UNC was rated 12th nationwide in pediatric diabetes, up from 28th the previous year. But its pediatric gastroenterology ranking dropped from 27th in 2017 to 49th this year.
Duke Children's moved up in eight pediatric specialties, dropped two positions in pediatric neurology, and went from 44th nationwide to being unranked (below top 50) in pediatric urology.