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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.
Abstract

OBJECTIVE: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. CONCLUSIONS: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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