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The problem with composite indicators
  1. Matthew Barclay1,
  2. Mary Dixon-Woods1,
  3. Georgios Lyratzopoulos1,2
  1. 1 THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
  2. 2 ECHO (Epidemiology of Cancer Healthcare and Outcomes) Group,Department of Behavioural Science and Health, University College London, London, UK
  1. Correspondence to Matthew Barclay, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge CB2 0AH, UK; matt.barclay{at}


‘The Problem with…’ series covers controversial topics related to efforts to improve healthcare quality, including widely recommended but deceptively difficult strategies for improvement and pervasive problems that seem to resist solution.

  • quality measurement
  • pay for performance
  • report cards
  • health services research

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  • Contributors MB conceived the article and drafted and revised the paper. MD-W and GL critically revised subsequent drafts. All authors approved the final version.

  • Funding This work was supported by MDW’s Wellcome Trust Investigator award WT09789. MD-W is a National Institute for Health Research (NIHR) Senior Investigator. GL is funded by a Cancer Research UK Advanced Clinician Scientist Fellowship award (grant number C18081/A18180).

  • Disclaimer The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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