Table 1

Common issues with selected composite indicators of care quality

CMS Overall Hospital Star RatingAHRQ PSI90Leapfrog Composite Patient Safety ScoreMyNHS Overall Stroke Care RatingNHS England Overall Patient Experience Score
TransparencyAre all important m
ethodological details easily accessible in a public document?
Yes, but spread across several documents and web pagesYes, but spread across several documentsYesNo, searches of MyNHS and SSNAP websites did not find a comprehensive methodsYes
Selection of individual measuresAre the measures used equally applicable across all rated hospitals?No, some hospitals do not report all measuresYesYesYesYes
Underlying measures and dataIs missing measure information handled in a way that can introduce bias?Yes, pairwise deletion is usedYes, effectively using mean imputationYes, pairwise deletion is used where proxy measures are not availableYes, pairwise deletion is usedNo missing measure information
Are component measures adequately adjusted for case-mix?Some but not all measuresYesYesNot discussed in identified methodsYes
Use of banding onto consistent scalesAre measures standardised using banding?NoNoNoYesNo
Choice of weightsIs there an apparent justification for the weights used?Yes, but reason for the precise weights used is unclearYesYesNoNo
Is any sensitivity analysis of the choice of weights reported?NoYesNoNoNo
UncertaintyIs the uncertainty in the final composite rating presented?Not in the star ratingYesNoNoYes