Hospital quality indicators provide valuable insights for quality improvement, empower patients to choose providers, and have become a cornerstone of value-based payment. As outcome indicators are cumbersome and expensive to measure, many health systems have relied on proxy indicators, such as structure and process indicators. In this paper, we assess the extent to which publicly reported structure and process indicators are correlated with outcome indicators, to determine if these provide useful signals to inform the public about the outcomes. Quality indicators for three conditions (breast and colorectal cancer, and hip replacement surgery) for Dutch hospitals (2011–2018) were collected. Structure and process indicators were compared to condition-specific outcome indicators and in-hospital mortality ratios in a between-hospital comparison (cross-sectional and between-effects models) and in within-hospital comparison (fixed-effects models). Systematic association could not be observed for any of the models. Both positive and negative signs were observed where negative associations were to be expected. Despite sufficient statistical power, the share of significant correlations was small [mean share: 13.2% (cross-sectional); 26.3% (between-effects); 13.2% (fixed-effects)]. These findings persisted in stratified analyses by type of hospital and in models using a multivariate approach. We conclude that, in the context of compulsory public reporting, structure and process indicators are not correlated with outcome indicators, neither in between-hospital comparisons nor in within-hospital comparisons. While structure and process indicators remain valuable for internal quality improvement, they are unsuitable as signals for informing the public about hospital differences in health outcomes.

医院质量指标为质量改进提供有价值的见解，赋予患者选择供应商的能力，并已成为基于价值的支付的基石。由于结果指标测量起来既繁琐又昂贵，许多卫生系统依赖于代理指标，例如结构和过程指标。在本文中，我们评估了公开报告的结构和流程指标与结果指标的相关程度，以确定这些指标是否提供了有用的信号，让公众了解结果。收集了荷兰医院（2011-2018 年）三种疾病（乳腺癌和结直肠癌以及髋关节置换手术）的质量指标。在院间比较（横断面和效应间模型）和院内比较（固定效应模型）中，将结构和过程指标与特定条件的结果指标和院内死亡率进行比较。任何模型都没有观察到系统关联。在预期出现负相关的情况下，观察到了积极和消极的迹象。尽管有足够的统计能力，但显着相关性的份额很小[平均份额：13.2%（横截面）；26.3%（效应间）；13.2%（固定效应）]。这些发现在按医院类型进行的分层分析和使用多变量方法的模型中仍然存在。我们得出结论，在强制公开报告的背景下，结构和过程指标与结果指标不相关，既不是院间比较，也不是院内比较。虽然结构和流程指标对于内部质量改进仍然很有价值，但它们不适合作为向公众告知医院健康结果差异的信号。