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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.
Publication year - 2019
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.13056
Subject(s) - medicaid , medicine , quality (philosophy) , exploratory factor analysis , value based purchasing , quality management , purchasing , health care , operations management , psychometrics , clinical psychology , philosophy , management system , epistemology , economics , economic growth
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.