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. 2019 Apr;54(2):502-508.
doi: 10.1111/1475-6773.13056. Epub 2018 Sep 26.

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

Matthew S Cefalu  1 , Marc N Elliott  1 , Claude M Setodji  2 , Paul D Cleary  3 , Ron D Hays  4
Affiliations

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

Matthew S Cefalu et al. Health Serv Res. 2019 Apr.

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.

Keywords: Quality of care/patient safety (measurement); hospitals; patient experience.

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Figures

Figure 1
Figure 1
Scree plot of eigenvalues from the exploratory factor analysis of 25 indicators of hospital quality
See this image and copyright information in PMC

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