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Open Access Publications from the University of California

Hospital quality indicators are not unidimensional: A reanalysis of Lieberthal and Comer.

  • Author(s): Cefalu, Matthew S
  • Elliott, Marc N
  • Setodji, Claude M
  • Cleary, Paul D
  • Hays, Ron D
  • et al.


To evaluate the dimensionality of hospital quality indicators treated as unidimensional in a prior publication.

Data source/study design

Pooled cross-sectional 2010-2011 Hospital Compare data (10/1/10 and 10/1/11 archives) and the 2012 American Hospital Association Annual Survey.

Data extraction

We used 71 indicators of structure, process, and outcomes of hospital care in a principal component analysis of Ridit scores to evaluate the dimensionality of the indicators. We conducted an exploratory factor analysis using only the indicators in the Centers for Medicare & Medicaid Services' Hospital Value-Based Purchasing.

Principal findings

There were four underlying dimensions of hospital quality: patient experience, mortality, and two clinical process dimensions.


Hospital quality should be measured using a variety of indicators reflecting different dimensions of quality. Treating hospital quality as unidimensional leads to erroneous conclusions about the performance of different hospitals.

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