Table 1

Common issues with selected composite indicators of care quality

		CMS Overall Hospital Star Rating	AHRQ PSI90	Leapfrog Composite Patient Safety Score	MyNHS Overall Stroke Care Rating	NHS England Overall Patient Experience Score
Transparency	Are all important m ethodological details easily accessible in a public document?	Yes, but spread across several documents and web pages	Yes, but spread across several documents	Yes	No, searches of MyNHS and SSNAP websites did not find a comprehensive methods	Yes
Selection of individual measures	Are the measures used equally applicable across all rated hospitals?	No, some hospitals do not report all measures	Yes	Yes	Yes	Yes
Underlying measures and data	Is missing measure information handled in a way that can introduce bias?	Yes, pairwise deletion is used	Yes, effectively using mean imputation	Yes, pairwise deletion is used where proxy measures are not available	Yes, pairwise deletion is used	No missing measure information
	Are component measures adequately adjusted for case-mix?	Some but not all measures	Yes	Yes	Not discussed in identified methods	Yes
Use of banding onto consistent scales	Are measures standardised using banding?	No	No	No	Yes	No
Choice of weights	Is there an apparent justification for the weights used?	Yes, but reason for the precise weights used is unclear	Yes	Yes	No	No
	Is any sensitivity analysis of the choice of weights reported?	No	Yes	No	No	No
Uncertainty	Is the uncertainty in the final composite rating presented?	Not in the star rating	Yes	No	No	Yes