Developing and Evaluating Composite Measures of Cancer Care Quality.
BACKGROUND
Composite measures are useful for distilling quality data into summary scores; yet, there has been limited use of composite measures for cancer care.


OBJECTIVE
Compare multiple approaches for generating cancer care composite measures and evaluate how well composite measures summarize dimensions of cancer care and predict survival.


METHODS
We computed hospital-level rates for 13 colorectal, lung, and prostate cancer process measures in 59 Veterans Affairs hospitals. We computed 4 empirical-factor (based on an exploratory factor analysis), 3 cancer-specific (colorectal, lung, prostate care), and 3 care modality-specific (diagnosis/evaluation, surgical, nonsurgical treatments) composite measures. We assessed correlations among all composite measures and estimated all-cause survival for colon, rectal, non-small cell lung, and small cell lung cancers as a function of composite scores, adjusting for patient characteristics.


RESULTS
Four factors emerged from the factor analysis: nonsurgical treatment, surgical treatment, colorectal early diagnosis, and prostate treatment. We observed strong correlations (r) among composite measures comprised of similar process measures (r=0.58-1.00, P<0.0001), but not among composite measures reflecting different care dimensions. Composite measures were rarely associated with survival.


CONCLUSIONS
The empirical-factor domains grouped measures variously by cancer type and care modality. The evidence did not support any single approach for generating cancer care composite measures. Weak associations across different care domains suggest that low-quality and high-quality cancer care delivery may coexist within Veterans Affairs hospitals.
*Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC †Department of Health Care Policy, Harvard Medical School, Boston, MA ‡Divisions of General Internal Medicine and Palliative Care, Veterans Administration Greater Los Angeles Healthcare System §Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA ∥Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA.
Cleo A
CA
Samuel
Alan M
AM
Zaslavsky
Mary Beth
MB
Landrum
Karl
K
Lorenz
Nancy L
NL
Keating
D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000628:therapy; D055088:Early Detection of Cancer; D005163:Factor Analysis, Statistical; D005260:Female; D006787:Hospitals, Veterans / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000628:therapy; D019984:Quality Indicators, Health Care / Q000458:organization & administration* / Q000592:standards; D011787:Quality of Health Care / Q000458:organization & administration; D016019:Survival Analysis; D014481:United States; D014493:United States Department of Veterans Affairs