This NC hospital is ranked nation’s second-most ‘socially responsible.’ Here’s why.

In a new set of hospital rankings released last month, Duke Regional Hospital in Durham was named the nation’s second-most “socially responsible” hospital, while other Triangle- and North Carolina-based hospitals also received high marks.

The rankings, released annually since 2020 by nonprofit think tank the Lown Institute, are the first “to define clear, measurable standards for hospital social responsibility, providing “benchmarks for hospitals to measure how well they serve their patients and communities.”

While other hospital rankings — including the Leapfrog Group’s Hospital Safety Grades, which The News & Observer has previously written about — rate hospitals solely on safety and patient outcomes, the Lown Institute’s rankings rate hospitals in patient outcomes, plus two other categories: value of care and health equity.

The rankings include more than 3,600 hospitals across the country, including 94 in North Carolina.

Duke Regional Hospital, No. 2 overall in the rankings, was one of just 66 hospitals, or less than 2%, that earned straight A rankings in all three of the Lown Institute’s key categories. Duke Regional Hospital was formerly known as Durham Regional Hospital until it rebranded in 2013. It’s ranked and graded separately from Duke University Hospital, also in Durham.

Three other North Carolina hospitals, including WakeMed in Raleigh, also scored straight A rankings across the categories. WakeMed ranked 52nd in the nation and 3rd in North Carolina.

Learn more about how Duke Regional and other North Carolina hospitals ranked in the Lown Institute’s Hospitals Index for Social Responsibility, how the rankings are calculated and more.

How Lown Institute calculates hospital social responsibility rankings

The Lown Institute’s Hospitals Index for Social Responsibility uses three categories to calculate a hospital’s overall social responsibility score: patient outcomes, value of care and health equity. The main categories are weighted at 40%, 30% and 30%, respectively, to calculate a hospital’s overall score.

Each category has subcategories. Each hospital received letter grades for the subcategory that contributed to the overall letter grade for the three main categories. Each subcategory is calculated using several metrics, measured on a scale of five stars, with the overall hospital rankings representing a composite of 53 metrics.

Note: Because each metric and subcategory is weighted differently within the main three categories, a hospital could receive a rating lower than an A in a subcategory, but still receive an overall A grade in the three main categories. For example, a hospital could receive B grades in two of the subcategories for equity, but an A in the other subcategory, and still receive an overall A grade for the main equity category.

▪ Patient outcomes ”reflects a hospital’s performance as it relates to their patients’ health and experience of care.” The category is calculated using three main subcategories: clinical outcomes, patient safety and patient satisfaction.

The clinical outcomes component measures “how well the hospital keeps patients alive and prevents return trips to the hospital, over various periods of time.” This component is weighted the most in the patient outcomes category.

The patient safety component measures “how well hospitals avoid preventable patient safety errors.”

The patient satisfaction component measures “aspects of the hospital experience as reported by patients.” This component is weighted the least in the patient outcomes category.

▪ Value of care “reflects hospitals’ avoidance of unnecessary care and ability to achieve good outcomes without overspending.” The category is calculated using two main subcategories: avoiding overuse and cost efficiency. The factors are weighted at a 2:3 ratio respectively.

“Overuse (also known in the clinical community as low-value care) is the delivery of a health care service that is more likely to harm than benefit the patient,” the Lown Institute says. “The component comprises rates of overuse of 12 commonly overused medical services,” including knee arthoscopy, hysterectomy, renal artery stenting, head imaging for fainting and more.

In evaluating cost efficiency, the Lown Institute calculated a ratio of hospitals’ mortality rates compared to their Medicare costs.

“Hospitals with the lowest mortality and the lowest costs received the best scores in cost efficiency,” the Institute says.

▪ Equity ”combines assessments of community benefit spending, pay equity, and inclusivity to evaluate hospitals’ commitment to community health and civic leadership.” The category consists of three subcategories: pay equity, community benefit and inclusivity.

Pay equity measures “the difference in compensation of hospital executives compared to health care workers without advanced degrees.” This measure is weighted at 20% in the equity category.

Community benefit measures “hospital spending on charity care and other community health initiatives, as well as their service of Medicaid patients.” This measure is weighted at 40% in the equity category.

Inclusivity measures “the extent to which a hospital’s patient population reflects the demographics of the community in which it is located, based on race, income and education levels.” This measure is weighted at 40% in the equity category.

You can learn more about the Lown Institute’s methodology used for the Hospitals Index for Social Responsibility at lownhospitalsindex.org/rankings/our-methodology.

Duke Regional Hospital ranks No. 2 in nation

Of the more than 3,600 hospitals nationwide included in the Lown Institute’s Hospitals Index for Social Responsibility, Duke Regional Hospital in Durham ranked 2nd.

The hospital received A rankings in each of the Lown Institute’s categories of equity, value of care and patient outcomes.

Here’s a look at the breakdown of Duke Regional’s scoring:

▪ Equity: B in pay equity; B in community benefit; A in inclusivity. The hospital received four out of five stars for its inclusivity of patients across race, income and education, and five stars for its spending on charity care.

▪ Value of care: A in avoiding overuse; A in cost efficiency. The hospital received five stars in both metrics related to cost efficiency.

▪ Patient outcomes: A in clinical outcomes; A in patient safety; B in patient satisfaction. The hospital received five stars in all of the metrics related to clinical outcomes.

You can further explore Duke Regional Hospital’s scorecard at lownhospitalsindex.org/hospital/duke-regional-hospital.

WakeMed Raleigh receives straight A rankings in all categories

In addition to Duke Regional, WakeMed Raleigh Campus was also one of the 66 hospitals nationwide to receive straight A rankings across the Lown Institute’s three main categories.

The hospital ranked 52nd in the nation and 3rd in North Carolina.

Here’s a look at the breakdown of WakeMed Raleigh’s scores across the categories:

▪ Equity: B in pay equity; A in community benefit; B in inclusivity. The hospital received four out of five stars for how much it spends on charity care.

▪ Value of care: B in avoiding overuse; A in cost efficiency. The hospital received five stars in both metrics related to cost efficiency.

▪ Patient outcomes: A in clinical outcomes; B in patient safety; B in patient satisfaction.

You can further explore WakeMed Raleigh’s scorecard at lownhospitalsindex.org/hospital/wakemed-raleigh-campus.

How did other Triangle hospitals stack up in rankings?

In addition to Duke Regional and WakeMed Raleigh, three other Triangle hospitals received overall, composite A grades from the Lown Institute — though unlike Duke Regional and WakeMed Raleigh, these hospitals did not receive A grades in each of the three main categories.

▪ Rex Hospital in Raleigh ranked 11th in North Carolina, with a A grades in value of care and patient outcomes and a C grade in equity. While the hospital received middle-of-the-road B grades for pay equity and inclusivity, it ranked low — receiving a D grade — in community benefit, or how well the hospital is invested in the health of its surrounding community.

▪ Duke University Hospital in Durham ranked 16th in North Carolina, with A grades in value of care and patient outcomes and a C grade in equity. The hospital received C grades in community benefit and inclusivity, and a D grade in pay equity, or the ratio of compensation for hospital executives to wage workers.

▪ WakeMed Cary Hospital ranked 20th in North Carolina, with A grades in value of care and patient outcomes and a C grade in equity. The hospital received a B grade for pay equity, a C grade for inclusivity and a D grade for community benefit.

One Triangle hospital received an overall, composite B grade across the three main categories.

▪ Duke Raleigh Hospital ranked 34th in North Carolina, with an A grade in patient outcomes, a B grade in value of care and a C grade in equity.

One hospital received an overall, composite C grade across the three main categories.

▪ UNC Hospital in Chapel Hill ranked 42nd in North Carolina, with an A grade in value of care, a B grade in outcomes and a C grade in equity. Within the equity category, the hospital received a C grade for pay equity and a D grade for inclusivity.

The News & Observer previously reported that UNC Hospital also received two-straight C grades in another popular hospital ranking system dedicated to to hospital safety, and the hospital is also currently facing a threat of its Medicare funding being terminated over serious patient safety issues.

More information about hospital rankings

More information about the Lown Institute’s Hospitals Index for Social Responsibility is available at lownhospitalsindex.org.