Methods to derive composite indicators used for quality and safety measurement and monitoring in healthcare: a scoping review

Introduction: The use of composite measures of quality in healthcare is widespread and designing such measures involves many technical decisions. Their use can be controversial due to concerns around transparency, appropriateness and uncertainty. This scoping review identified the methodologies adopted and methods used to derive composite measures of quality in healthcare and presents a toolbox for their development. Methods: PRISMA-ScR guidelines were followed and five electronic databases and grey literature searched. Data was extracted on 11 stages of development, adapting a framework developed by the European Commission Joint Research Centre. A scoring scheme identified publications with significant information on stages of development. Results: Methodology publications (n = 65) offered technical guidance and raised concerns about aspects of the development process. Publications developing composite measures (n = 325) presented varying levels of information. Most scored well on measure selection, data analysis, deconstruction, and presentation. However, information scores for the use of theoretical frameworks, treatment of missing data and uncertainty analysis were low. Conclusion: Checklists developed from this review provide an actionable framework to guide composite measure development in a robust and transparent manner. Examples of best practice support the use of these checklists, assisting those developing and interpreting composite measures. Systematic Review Registration: https://bmjopen.bmj.com/content/13/7/e071382.long.