Ratings, Overviews Help Parents Decide Which Hospital Best for Ailing Child by Carolyn Cosmos Your child is sick, very sick, and you want the best care. But what is ìbest?î Clinical excellence? Physicians you can trust? People who speak your language and understand your beliefs? Research reputation? The ability to put your child at ease? To save their life? How do you find out? To help parents answer some of these questions, the respected national publication Child magazine has, for three years now, rated childrenís hospitals in the United States, offering rankings and giving institutions detailed feedback. Some experts have said this open sharing of information of ìexcellenceî ratings may be helping all pediatric hospitals do a better job. Here is a closer look at some of the Child magazine ratings, along with some of the hospital rankings published by U.S. News & World Report last July. (The U.S. News pediatric rankings are based on hospital reputationsóthat is, the percentage of specialists who name a hospital as among the best.) In addition, The Washington Diplomat has added overviews of hospital services that are of particular interest to members of the international community. However, w hether a particular place is right for your child is more than a numbers game. A highly rated institution may not, in fact, be the best place for your child if he or she has a rare medical condition seldom seen thereóor if that hospital is located far away and your child needs attention over many months or years. Another facility may have more experience with that rare conditionóand more experts on boardóor it may be better at cross-cultural communication and interdisciplinary teamwork, resulting in fewer medical errors, new treatment ideas and better care. The idea is to find a ìgood fit.î Whoís Who in Pediatric Hospitals The Childrenís Hospital of Philadelphia was named the top-ranking pediatric hospital in the country by Child magazine in its 2005 ratings. The hospital was also named the best hospital for children in the United States by U.S. News & World Report in its July 2004 ìBest Hospitalsî issue. Child magazine credited the Philadelphia hospital with having the strongest pediatric research program in the country, praised its community service record, and noted its clinical excellence in several specialized areas. The magazine rated it first in pediatric cardiac care, first in orthopedic care, and first in intensive neonatal care, saying that the hospital serves ìthe sickest babies from around the country.î Philadelphia was also ranked first in pediatric cancer care for survival rates that are among the best in the nation. It was praised for its emergency care and its ìfirm policy not to divert patients to another hospital.î For its international pediatric services, the hospitalís programs include a Vaccine Education Center staffed with clinical and research experts who specialize in vaccines for world travelers. Philadelphia Childrenís Hospital also has an International Adoption Health Program that provides counseling and evaluation services, with ongoing medical care for internationally adopted children. The Childrenís Hospital of Philadelphia is located at 34th Street and Civic Center Boulevard, Philadelphia, PA 19104. For more information, please call (215) 590-1000 or visit www.chop.edu. The Childrenís Hospital of Boston was ranked number two in overall excellence by Child magazine, which cited it for excellence in treating heart abnormalities and for infant cardiac care. (Its physicians perform 2,500 heart procedures a year.) The hospital, which is affiliated with Harvard Medical School, was also cited for excellence in orthopedic care, particularly spinal and hip surgery. In addition, Child noted Bostonís Teen Advisory Committee and its excellent care of premature infants. Similarly, U.S. News & World Report ranked Boston Childrenís number two in pediatric excellence. Boston Childrenís has an extensive program of international health services, descriptions of which can be found on its Web site. The hospital serves families from more than 100 countries each year, and all services are coordinated through the International Center, which assists with international patient registration and provides cost estimates. In addition, the center will help families with visa matters, air travel and accommodation arrangements. The hospital provides interpreters in 35 languages and the International Center employees themselves speak, variously, English, Spanish, Arabic, French, Italian, Greek, Albanian and Serbo-Croatian. The Childrenís Hospital of Boston is located at 300 Longwood Ave., Boston, MA 02115. For more information, please call (617) 355-6000 or visit www.childrenshospital.org. Texas Childrenís Hospital in Houston describes itself as the largest pediatric hospital in the United States. It was ranked number four for overall excellence by Child magazine and rated the number one childrenís hospital in the South and Southwest. The hospital was also listed as fourth-best pediatric hospital in the country by U.S. News & World Report magazine last July. Child magazine pointed out that 100 percent of Texas Childrenís doctors are board certified in pediatrics or a pediatric specialty. (Board certification means that a doctor has met the training, practice and knowledge standards of an official medical specialty group.) Child magazine ranked the hospital fifth in neonatal excellence nationwide and pointed out that its Heart Center has a 97 percent success rate. It also cited its cancer and neonatal care as well as its cystic fibrosis program. And if the clinical credentials werenít enough, the hospital has, the magazine noted, an elaborate and child-fascinating display of model trains in its entrance lobby. For its international pediatric services, Texas Childrenís International Service Center provides culturally sensitive medical care to visitors from other countries and an array of global outreach programs and collaborations. This second ìarmî includes treatment teams deployed to countries outside the United States, physician exchange programs, international symposia for healthcare professionals, participation in the Pan American Health Organization and telemedicine programs, i.e. long-distance electronic health care. Its international patient program evaluates potential patients and then works with families either in their own country or at the hospital. When an international patient comes to Houston, the hospital will provide an escort and translator at the airport if needed, as well as an escort and translator to help with doctor visits, admissions, medical and surgical events, and follow up. This unusual combination of in-house patient service and community outreach is also seen in Texas Childrenís Health Center for International Adoptions, which offers adoption evaluations, support and medical services to families, and also runs, with Baylor University, a Pediatric AIDS Initiative that serves HIV-positive children in the United States and other countries. Texas Childrenís Hospital International Patient Services Center is located at 6621 Fannin St., MC 1-4456 - net, Houston, Texas 77030-2399. For more information, please call (832) 824-1138 or (888) 240-8244 or visit www.texaschildrenshospital.org. Other highly rated hospitals in the Child survey included the Childrenís Hospital of Pittsburgh, ranked number nine. Child cited Pittsburgh for its pioneering procedures in pediatric organ transplants as well as its focus on minimally invasive surgery (less pain, faster recovery time). The magazine survey also praised the hospitalís support groups for the brothers and sisters of patients. Pittsburgh was ranked among the best pediatric hospitals in the country in cardiology, oncology, neonatology, emergency care and orthopedics. Child magazine medical kudos also went to the Rainbow Babies and Childrenís Hospital in Cleveland, which has an ethics center and a pediatric intensive care unit that lets parents sleep with a sick child in a private area. Elsewhere, Childrenís Healthcare of Atlanta offers numerous programs for families including 40 support groups for parents. Atlantaís kidney-transplant program has a 100 percent one-year survival rate. It also has highly rated pediatric cancer care. Another top-rated hospital, the Monroe Carell Jr. Childrenís Hospital at Vanderbilt in Nashville, Tenn., offers an International Adoption Clinic, a neonatal intensive care with private rooms and a highly rated epilepsy program. Also of note is the St. Louis Childrenís Hospital, which has, the magazine said, ìThe most comprehensive cerebral palsy center in the United States.î Hospitals Closer to Home The Childrenís National Medical Center (Childrenís Hospital) h ere in Washington, D.C., was named a national runner-up in the Child magazine pediatric ratings, and it was rated in the top 10 by U.S. News & World Report. In the previous yearís rankings, Child magazine labeled it seventh-best pediatric hospital overall and fourth in the nation in pediatric oncology. International pediatric services at Childrenís Hospital are available to the international community both here and abroad, explained Oussama El Baba, director of Childrenís National Medical Center International Programs. His programís Web site can be viewed three languages and features embassy links. ìWe serve people who come here from other countries for treatment and people living here for a short time, such as diplomats and those with the United Nations,î as well as long-time residents, he said. Clinical strengths include the treatment of cardiovascular conditions, the Center for Cancer and Blood Disorders and the Neurosciences Center. Service begins before a patient arrives, El Baba said. Information exchanges by e-mail, fax or telephone can include a free medical opinion. Childrenís international staff will make embassy contacts, assist with visa issues and write letters to officials to facilitate treatment and travel. ìIf they want to come straight here, we will send a complimentary limo to pick them up at the airport with a driver who speaks their language, or we can arrange for them to be taken to a hotel that offers reasonable rates,î he said. Childrenís Hospital will also provide interpreters and escorts to assist families throughout the medical treatment. Childrenís National Medical Center is located at 111 Michigan Ave., NW. For more information, please call (202) 884-3836 or visit www.dcchildrens.com. Georgetown University Hospital in Washington, D.C., was listed among the best hospitals in 2004 by U.S. News & World Report, with specialty recognition in orthopedics and psychiatry. Georgetown University Hospitalís International Services Department includes a special section devoted to international pediatric health, where patients and their families are offered support, complimentary interpreter services and assistance with accommodations. In addition, the hospitalís International Adoption Health Resource Center (IAHRC) offers pre-admissions counseling, medical evaluations and ongoing pediatric care. Its special strengths are in the area of genetics, genetic counseling and developmental disorders, and it works with families and children throughout the life span in some cases, from prenatal counseling through services for developmentally challenged adults. IAHRCís founder, Dr. Nina Scribanu, formerly a Fulbright scholar in genetics and developmental disabilities in Romania, is a member of the adoption section of the American Academy of Pediatrics. She is also head of Georgetownís division of pediatric genetics and the present director of the IAHRC. ìWe receive referrals from the State Department, handle overseas adoptions and see children from the diplomatic community,î said Scribanu, who explained that IAHRC specializes in medical teamwork and interdisciplinary evaluations and care. Additionally, ìWe are known for integrating the patientís whole family.î Georgetown programs have ìvery good translation services,î she noted, and Scribanu herself speaks English, French, Russian, Romanian and Hebrew, with some German, Italian and Spanish. Georgetown University Hospital is located at 3800 Reservoir Road, NW. For more information on international pediatric health, please call (202) 444-2000 or visit www.georgetownuniversityhospital.org. Inova Fairfax Hospital for Children is a 157-bed childrenís hospital in Falls Church, Va., that is served by more than 400 board-certified pediatricians, family practice physicians and pediatric specialists. The hospital offers Northern Virginiaís only Pediatric Intensive Care Unit (PICU). Cardiology is one of the main specialties, and in 2003, the hospital performed more than 230 pediatric heart surgeries. There is also a pediatric craniofacial program that includes reconstructive surgery, and the Inova Kellar Center treats children and adolescents with mental health and substance abuse problems. The hospitalís patient population and staffing are extremely diverse, said Kathleen Thomas, media relations manager for Inova Health System, who noted that there are more than 100 different languages spoken by patients at the Inova hospitals in Virginia, according to one survey. In addition, many physicians speak several languages, and Inova supports this diversity by offering its professional caregivers and support staff cross-cultural training. Martine Charles, director of Inovaís cultural competency training, explained that the training does not focus on specific cultures, but offers physicians, nurses, receptionists and technicians and ìeverybody who works hereî tools to deal with diversity in a medical context. Charlesís workshops address caring for patients of other cultures and dealing with health beliefs, as well as approaches to managing illness, gender roles, and traditional and religious healing practices. Inova uses the CyraCom telephone interpreter servicesóinnovative telephones that provide real-time access to more than 150 different languages, 24 hours a day using a dual handset phone. Additionally, there are five Spanish-speaking interpreters on staff that are available on a 24-hour basis. Childrenís services also include the Inova International Adoption Center, which provides evaluations, developmental screenings and care for internationally adopted children. Inova Fairfax Hospital for Children is located at 3300 Gallows Road, Falls Church, VA 22042. For more information, please call (703) 204-6777 or visit www.inova.org. Carolyn Cosmos is a contributing writer for The Washington Diplomat Child Magazineís Top 10 Childrenís Hospitals for 2005 1. The Childrenís Hospital of Philadelphia 2. Childrenís Hospital Boston 3. Childrenís Hospital of Wisconsin, Milwaukee 4. Texas Childrenís Hospital, Houston 5. Rainbow Babies and Childrenís Hospital, Cleveland 6. Childrenís Healthcare of Atlanta 7. The Childrenís Hospital, Denver 8. Monroe Carell Jr. Childrenís Hospital at Vanderbilt, Nashville, Tenn. 9. Childrenís Hospital of Pittsburgh 10. (tie) Childrenís Hospital Los Angeles 10. (tie) St. Louis Childrenís Hospital Locally, a runner-up in the Child 2005 rankings included the Childrenís National Medical Center (Childrenís Hospital) of Washington, D.C., which ranked number 19. How did the ratings happen? The magazine screened members of the National Association of Childrenís Hospitals and Related Institutions and relied on the nonprofit agency that inspects all hospitals in the United States, the Joint Commission on Accreditation of Healthcare Organizations, whose standards were supplemented by a questionnaire that addressed survival rates, nurse-to-patient ratios, family services and whether or not a hospital had plans in place to make a childís experience less frightening. (Issues of international and cross-cultural care were not assessed.) óCarolyn Cosmos Health Insurance Availabl e for International Patients Although many foreigners who come to U.S. hospitals for their children or as patients themselves pay out of pocket for medical care, there is, in fact, health insurance available on a temporary basis when the costs become too high. For example, Liaison International Medical Insurance covers individuals and families traveling or living outside of their home countries for up to three years. Itís available from Insurance Services of America, an Arizona firm that specializes in international health and travel insurance for visitors to the United States. In addition to offering standard hospital and doctor benefits, Liaison International Medical coverage includes things such as emergency return to the home country for medical reasons, coverage for a family member to go along, help with emergency situations, return of minor children and, if needed, return of a personís remains to their home country. Similarly, a Baltimore, Md., insurance company, Riggs, Counselman, Michaels & Downs, Inc., offers a Visitor From Abroad Program that ìprovides basic medical coverage for people who are not citizens,î said the firmís Ginny Rison, regardless whether they are in the country for vacation, business or residence. The company not only provides basic health insurance in the United States, its coverage includes medical evacuation to the home country and repatriation of remains. There is also a ìreverse policyî that covers U.S. citizens traveling and working abroad. Rison said the Baltimore company, which dates back to the late 1800s, can tailor coverage and work with individuals to determine their best plan. For more information on Insurance Services of America, please call (800) 647-4589 or visit www.worldwidemedical.com. For more information on Riggs, Counselman, Michaels & Downes, Inc., please call Ginny Rison at (410) 339-7263 ext. 1416 or e-mail: rrison@rcmd.com. óCarolyn Cosmos