ArticleInternational journal of health policy and management2025
Comprehensive Evaluation of Quality Indicators: Analyzing the Dutch Breast Cancer Audit.
Article in International journal of health policy and management, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
- Assessing the real-world value of hemophilia care: how suitable are patient-centered outcomes for hospital-level comparisons?International journal for quality in health care : journal of the International Society for Quality in Health Care · 2026Article
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundQuality indicators (QIs) are widely used to benchmark hospital performance and improve quality of care but are often based on expert opinion rather than data-driven assessment. This study aims to evaluate QIs, using a framework that assesses four criteria: Feasibility, discriminative ability, validity, and reliability.
methodsWe used data from the Dutch breast cancer registry (NABON Breast Cancer Audit, NBCA) and included all surgically treated breast cancer patients in the Netherlands between 2021-2023. Eighteen QIs were evaluated. Feasibility was determined by QI numerator completeness, with >90% data availability considered feasible. Discriminative ability was assessed by between-hospital variation in QI scores, where an interquartile range (IQR) >10% indicated good discrimination. Validity was evaluated by the impact of case-mix adjustment and considered low when (pseudo-) R² <0.10. The (pseudo-)R² reflects the proportion of variance in QI scores explained by all case-mix variables in a regression model. Reliability was assessed by rankability, the proportion of between-hospital variation not due to chance and, therefore, explainable by quality of care. Rankability >75% was considered high.
resultsAfter exclusion of one QI with feasibility <1%, feasibility ranged from 80.2%-100%, and 15 QIs were feasible. Overall, the IQR ranged from 1 to 36, with 8 QIs having an IQR higher than 10, indicating good discriminative ability. The (pseudo-)R² ranged from 0.01-0.53, with 11 QIs showing low case-mix impact. Rankability ranged from 0-69%, with none of the QIs having a high rankability. None of the QIs met all preset criteria, but six QIs met at least three out of four criteria.
conclusionThe QIs employed by the Dutch breast cancer registry fulfilled most criteria, but rankability is a concern and requires specific attention, especially for public reporting. Our results show the importance of considering feasibility, discriminative ability, validity, and reliability when evaluating QIs, and these should also be taken into account when developing new QIs.
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