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  3. Correlations among measures of quality in HIV care in the United States: cross sectional study
Research

Correlations among measures of quality in HIV care in the United States: cross sectional study

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39364.520278.55 (Published 22 November 2007) Cite this as: BMJ 2007;335:1085
  1. Ira B Wilson, professor1,
  2. Bruce E Landon, associate professor of health care policy and medicine2,
  3. Peter V Marsden, professor3,
  4. Lisa R Hirschhorn, assistant professor of medicine4,
  5. Keith McInnes, lecturer2,
  6. Lin Ding, biostatistician2,
  7. Paul D Cleary, professor and dean5
  1. 1Department of Medicine, Institute for Clinical Research and Health Care Policy, Tufts-New England Medical Center, Boston, MA 02111, USA
  2. 2Health Care Policy and Medicine, Department of Health Care Policy, Harvard Medical School, Boston, MA 02115
  3. 3Department of Sociology, 630 William James Hall, Cambridge, MA 02138
  4. 4Harvard Medical School Division of AIDS, Landmark Center 2 East, Boston, MA, 02215
  5. 5School of Public Health, Yale University, New Haven, CT 06520-8034
  1. Correspondence to: I B Wilson iwilson{at}tufts-nemc.org
  • Accepted 3 September 2007

Abstract

Objective To determine whether a selected set of indicators can represent a single overall quality construct.

Design Cross sectional study of data abstracted during an evaluation of an initiative to improve quality of care for people with HIV.

Setting 69 sites in 30 states.

Data sources Medical records of 9020 patients.

Main outcome measures Adjusted performance rates at site level for eight measures of quality of care specific to HIV and a site level summary performance score (the number of measures for which the site was in the top quarter of the distribution).

Results Of 28 site level correlations between measures, two were greater than 0.40, two were between 0.30 and 0.39, four were between 0.20 and 0.29, and the 20 remaining were all less than 0.20. One site was in the top quarter for seven measures, but no sites were in the top quarter for six or eight of the measures. Across the eight quality measures, sites were in the top quarter no more often than predicted by a chance (binomial) distribution.

Conclusions The quality suggested by one measured indicator cannot necessarily be generalised to unmeasured indicators, even if this might be expected for clinical or other reasons.

Footnotes

  • We thank Carol Cosenza and Patricia Gallagher of the Center for Survey Research who assisted with instrument development and survey administration and our colleagues at the Health Resources and Services Administration and at the Institute for Healthcare Improvement who participated in and facilitated the EQHIV study.

  • Contributors: All authors made substantial contribution to conception, design, analysis, and interpretation of data, drafting the article, and revising it critically for important intellectual content and final approval. IBW is guarantor.

  • Funding: Agency for Healthcare Research and Quality (R-01HS10227), and the Lifespan/Tufts/Brown Center for AIDS Research (grant No P30A142853). IBW was supported in part by a mid-career investigator award in patient oriented research from the National Center for Research Resources (K24 RR020300).

  • Competing interests: None declared.

  • Ethical approval: The committee on human studies of Harvard Medical School approved the study protocol.

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

  • Accepted 3 September 2007
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