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

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

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

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.

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.