title: Creating Unidimensional Global Measures of Physician Practice Quality Based on Health Insurance Claims Data.
abstract: To explore the extent to which commonly used claims-based process quality indicators can be used to create an internally valid global composite measure of physician practice quality.
  
  
  
  Health insurance claims data (October 2007-May 2010) from 134 physician practices in Seattle, WA.
  
  
  
  We use confirmatory and exploratory factor analysis to develop theory- and empirically driven internally valid composite measures based on 19 quality indicators.
  
  
  
  Health insurance claims data from nine insurance companies and self-funded employers were collected and aggregated by third-party organization.
  
  
  
  Our results did not support a single global measure using the entire set of quality indicators. We did identify an acceptable multidimensional model (RMSEA = 0.059; CFI = 0.934; TLI = 0.910). The four dimensions in our data were diabetes, depression, preventive care, and generic drug prescribing.
  
  
  
  Our study demonstrates that commonly used process indicators can be used to create a small set of useful composite measures. However, the lack of an internally valid single unidimensional global measure has important implications for policy approaches meant to improve quality by rewarding "high-quality physicians."
authors.affiliation: RAND Corporation, Pittsburgh, PA.
authors.forename: Grant R
authors.initials: GR
authors.lastname: Martsolf
authors.affiliation: Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Carle
authors.affiliation: Health Policy and Administration, Pennsylvania State University, University Park, PA.
authors.forename: Dennis P
authors.initials: DP
authors.lastname: Scanlon
mesh_terms: D003863:Depression; D003920:Diabetes Mellitus; D014943:Global Health; D006801:Humans; D007345:Insurance Claim Review; D007348:Insurance, Health; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011315:Preventive Medicine; D019984:Quality Indicators, Health Care / Q000592:standards*; D014861:Washington
keywords: Quality measurement; composite measurement; physician practices