Methodology

In 1990, U.S. News & World Report published a number of short lists of hospitals in various specialties. The intent of America’s Best Hospitals, as the annual rankings were called, was to identify the best medical centers, by specialty, for the most difficult patients ? those whose illnesses pose unusual challenges because of underlying conditions, procedure difficulty or other medical issues that add significant risk. “America’s” was dropped from the name several years ago, but the annual rankings’ focus on identifying top sources of care for the most difficult patients is unchanged.

Pediatrics was among the specialties in which hospitals were first ranked, but until 2007 the pediatric rankings were based entirely on a reputational survey of physicians because of the absence of hard data. Pediatric-specific data are critical because young patients present special challenges. Their small size relative to adults complicates every facet of care, from intubation to drug dosages; they are more vulnerable to infection; they depend on adults to manage and administer their medications, and they are treated for congenital diseases such as spina bifida and cystic fibrosis.

In the absence of data bases for pediatrics comparable to the MedPAR files for Medicare recipients, U.S. News resolved to collect data directly from children’s hospitals. The first rankings incorporating such data were published in 2007 as the top 30 children’s centers in General Pediatrics.