Sizing things up: despite the recent wave of hospital consolidation, bigger doesn't always mean better in quality of care.

• Author: Martin, Edward
• Position: Feature

Under the lights over the operating table, the broken femur glistens as white as fine china. The surgeon bends closer and, as if winding a clock, screws a threaded rod through the neck of the thighbone and deep into the ball of the hip joint of a woman in her 70s. As he tightens it, a jagged crack between the ball and the femur slowly closes. Tomorrow, the patient will sit up, and a day later, using a walker, she will take her first steps since the fall that once would have left her an invalid.

It is 3 p.m., and the 11 operating rooms of Alamance Regional Medical Center are emptying. Surgical nursing manager Joyce Jones stands in a hallway, her hair tucked in a blue scrub bonnet. She tallies the day's work: two transurethral resections--prostate-cancer surgeries--and a variety of other operations. "We do volume orthopedics here. There are a lot of fractures, total joint replacements, sports injuries, spinal fusions and procedures like that."

On the outskirts of Burlington, Alamance Regional Medical Center has

238 beds, about a fourth as many as the state's largest hospitals. Despite years of health-care consolidation, it remains "staunchly autonomous," as Executive Vice President John Currin Jr. puts it, and financially healthy. Completed in 1995, its wavelike roofline has won architectural acclaim. That's not its only distinction.

Alamance Regional is among smaller Tar Heel hospitals that defy the traditional wisdom regarding the quality of health care. While research shows that hospital size is a factor--bigger often meaning better--it is not the only factor. Alamance's hip-repair patient is less likely to suffer complications from the surgery than a similar patient at a larger hospital in Greensboro, Charlotte or Raleigh. Statistically, outcomes for broken-hip patients here are nearly identical to those at Presbyterian Orthopaedic in Charlotte, one of the state's best specialty hospitals.

At Craven Regional Medical Center, a 312-bed hospital in New Bern, a patient undergoing a carotid endarterectomy--an operation to bypass a blocked neck artery to the brain--is less likely to suffer complications than at 1,019-bed Duke University Medical Center in Durham. At 222-bed Margaret R. Pardee Memorial Hospital in Hendersonville, a patient getting a knee replacement fares as well as he would at 800-bed Mission St. Joseph's Health System in Asheville.

These findings were gleaned from studies by Lakewood, Colo.-based Health Grades

NORTH CAROLINA'S best hospitals

The best hospitals aren't always found in the biggest cities. The ratings on this page list the state's top 10 hospitals in each specialty in alphabetical order. Those whose names are in italics have fewer than 400 beds and excel in various specialties.

Colorado-based Health Grades Inc., which compiled the lists for BUSINESS NORTH CAROLINA, uses Medicare data and a formula that adjusts for hospitals that receive sicker patients. It reports on about 5,000 hospitals in 25 procedures. Limited reports are free on the Internet. The company also consults with hospitals, insurers and others on a paid basis.

New York-based U.S. News & World Report magazine ranks 50 hospitals in 17 specialties and overall, based on Medicare records, American Hospital Association and other data and a physician survey. Reports are free on the Internet.

Solucient, an Illinois-based consultant, examines discharges from nearly 3,000 hospitals that handle about 80% of the nation's patients, plus Medicare data. It sells data and consulting services to 5,500 hospitals and other clients. It also issues annual top-100 lists.

AARP, The Magazine, commissions nonprofit Consumers' Checkbook, based in Chicago, to rank the nation's top 50 hospitals, based on risk-adjusted death rates, physician surveys, scores by the Joint Commission on Accreditation of Healthcare Organizations and other data. The information is free on the Internet.

CLINICAL EXCELLENCE

FirstHealth Moore Regional Hospital, Pinehurst Mission St. Joseph's Health System, Asheville

Ranked in top 3.3% of hospitals nationwide for combined performance in cardiac surgery and cardiology, orthopedics, stroke, pulmonary and vascular care. Inc., which rates more than 5,000 of the nation's hospitals. They're echoed by other analysts, including Solucient, an Evanston, Ill.-based consulting company that analyzes discharges from nearly 3,000 hospitals a year, plus Medicare data and other sources.

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In the more than 15 years since a wave of...