2010-2-11全美最好的医院排名

Best Hospitals 2010-11: The Honor Roll

The new U.S. News rankings showcase 14 hospitals with high scores in six or more specialties.

By Avery Comarow, U.S. News & World Report

It's no secret that all hospitals are not equal. The special quality shared by the 152 that made it into the new 2010-11 Best Hospitals rankings (out of nearly 5,000 that were considered), and even more so by the 14 in this year's Honor Roll, is their ability to take on and meet the most difficult challenges. Their operating rooms showcase delicate, demanding procedures—excising a cancerous portion of a pancreas without destroying the rest of the fragile organ, say, or restoring function to an arthritis-ravaged hand through a creative blend of fusing joints and splicing tendons. They are referral centers for ill patients with multiple risks—advanced age plus heart failure plus diabetes, perhaps.

Patients at these centers are not free from hospital-based infections or immune from getting the wrong drugs or becoming victims of other medical errors. No matter how skilled or deep their expertise, even "best hospitals" don't do everything right. But when the stakes are high, calling for unusual capabilities, they are hospitals that can save lives that might otherwise be lost or preserve quality of life that might otherwise be sacrificed. That is why U.S. News has published the Best Hospitals rankings for 21 years: to help guide patients who need high-stakes care because of the complexity or difficulty of their condition or procedure. For 2010-11 we analyzed 4,852 hospitals, virtually every one in the United States, in 16 specialties from cancer and heart disease to respiratory disorders and urology. Only 152 centers appear in even one of the 16 specialty rankings. Fourteen ultra-elite Honor Roll hospitals had very high scores in six or more specialties.

In 12 of the 16 specialties, the quality of hospital care can determine life or death. Therefore the largest part of each hospital's score in those 12 specialties came from death rates and other hard data on patient safety, volume, and various care-related factors such as nursing and patient services. The rest of the score was derived from a reputational survey of specialists. The 50 highest scorers were ranked. Scores and complete data for another 1,740 unranked hospitals are also available. In the four other specialties—ophthalmology, psychiatry, rehabilitation, and rheumatology—hospitals were ranked on reputation alone. The number of deaths in these specialties is so low that mortality data and certain other categories of data are not relevant factors.

A detailed description of the analysis in the 12 specialties is available. In brief, death rate, care-related factors, and patient safety added up to slightly more than two-thirds of each hospital's score. The reputation portion of the score used responses from nearly 10,000 physicians, who were surveyed in 2008, 2009, and 2010 and asked to name five hospitals they consider among the best in their specialty for difficult cases, ignoring cost or location.

The Honor Roll requirements were so stiff that 99.7 percent of all centers in the nation were excluded. A hospital had to be ranked in at least six specialties, but ranking alone was insufficient for inclusion. It also had to have an extremely high score (in statisticians' terms, at least 3 standard deviations above the mean). That earned 1 point per specialty. Reaching the top of the Honor Roll called for even higher scores (4 or more standard deviations above the mean), earning 2 points, in far more specialties. The highest-ranked hospitals on the Honor Roll, which is ordered by points, had high scores in 15 of the 16 specialty rankings. Johns Hopkins stands at No. 1—as it has for the last 20 years.

Rank	Hospital	Points	Specialties
1	Johns Hopkins Hospital, Baltimore	30	15
2	Mayo Clinic, Rochester, Minn.	28	15
3	Massachusetts General Hospital, Boston	27	15
4	Cleveland Clinic	26	13
5	Ronald Reagan UCLA Medical Center, Los Angeles	24	14
6	New York-Presbyterian University Hospital of Columbia and Cornell	21	11
7	University of California, San Francisco Medical Center	20	11
8	Barnes-Jewish Hospital/Washington University, St. Louis	17	10
9	Hospital of the University of Pennsylvania, Philadelphia	16	12
10	Duke University Medical Center, Durham, N.C.	16	10
11	Brigham and Women's Hospital, Boston	14	10
12	University of Washington Medical Center, Seattle	14	8
13	UPMC-University of Pittsburgh Medical Center	13	8
14	University of Michigan Hospitals and Health Centers, Ann Arbor	12	8

Courtesy of U.S. News & World Report

Genes Predict Who Will Live to Age 100

Technique may also help predict disease

Art Chimes | St. Louis, Missouri 

Photo: Photos.com

Genes, rather than lifestyle, impact who lives 100 years.

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Researchers at Boston University have identified a kind of genetic signature in people who are likely to live to age 100 or older. The technique may also help doctors predict whether you're likely to get a disease, decades before the symptoms show up.

Living a long, healthy life tends to run in families. If your grandparents and parents lived into their 90s and remained relatively healthy until the end, there's a pretty good chance you will, too.
So it's pretty clear genetics plays some role in longevity.
In this study, the research team developed a new statistical way of analyzing the genetic code of people who had reached age 100 as compared with people who had a more typical lifespan. Tom Perls, who heads the New England Centenarian Study, explains what they found.
"We discovered 150 or so genetic markers that can highly predict whether or not a person has the genetic propensity to live to extreme old age."
Using just that large number of genetic markers, the team was able to predict in almost four out of five cases whether a person would live to be 100.
Perls says the key to successfully predicting long life was the sophisticated statistical analysis of many different gene variations that each played some role.
"And that's what this method does - it captures the complexity of the puzzle and the interaction of all these genes together to produce exceptional longevity."
Perls and his colleagues publish their study in the online edition of the journal Science.

The Boston University researcher says this kind of analysis could play a role, not just in predicting who will live longest, but in actually helping people live longer and healthier lives.

In an interview via Skype, Tom Perls said the same technique used to predict long life may also be used to predict whether a person might eventually develop certain diseases. He gave the example of Alzheimer's Disease as one in which genetics plays a role.

"And we think that this methodology can very much be used to capture the bunch of genes that are playing an important role in one's susceptibility to that disease," he said. "And the same can be true, perhaps, for looking at adult-onset diabetes, or cardiovascular disease, or stroke. Again, where I think there is at least a moderate impact from genetic variation."

As the cost of the needed genetic tests continues to decline, he predicts doctors will be able to screen patients for diseases they may not develop until later in life, and recommend ways to avoid them.