Can Composite Measures Provide a Different Perspective on Provider Performance Than Individual Measures?

Area of Science:

• Healthcare Quality Measurement
• Performance Evaluation
• Health Services Research

Background:

• Composite measures aggregate individual performance metrics into a summary score for facility evaluation.
• Current understanding of the unique insights provided by composite measures is limited.

Purpose of the Study:

• To investigate if high/low performers on composite measures also demonstrate high/low performance on most constituent individual measures.
• To assess the alignment between composite performance and individual measure performance in healthcare facilities.

Main Methods:

• Utilized data from two prior studies (hospitals and Veterans Health Administration nursing homes) and new data on hospital readmissions.
• Employed two-dimensional tables to categorize facilities based on high/low performance on both composite and individual component measures.

Main Results:

• In one study, over a third of top-quintile composite performers were top performers on at most one of five individual measures.
• In another study, over 40% of high-performing nursing homes on the composite excelled on eight or fewer of 28 individual measures.
• Twenty percent of low performers on a composite measure were low performers on only one of three individual measures.

Conclusions:

• Composite measures can identify facilities with generally good or poor performance across multiple areas.
• However, these facilities may not consistently achieve high or low performance on the majority of the individual measures comprising the composite score.