Composite Indicators for Performance Evaluation in Healthcare

Key Performance Indicators (KPIs) are essential tools for assessing and ensuring high standards of quality and efficiency in the delivery of healthcare services within the National Health System. This study focuses on four critical dimensions of healthcare quality: Accessibility, Equity, Effectiveness and Efficiency each of which must be evaluated using composite KPIs that reflect their inherent complexity and interconnections. Healthcare quality data includes a mix of quantitative and qualitative variables, often nominal or ordinal in nature, and typically involve large datasets. A major challenge is the dimensionality reduction of this complex data into a manageable set of indicators that retain meaningful insights. To address this, we employ Principal Component Analysis (PCA), a widely accepted statistical technique, alongside Exploratory and Confirmatory Factor Analysis, to identify and extract the most relevant components. This research aims to develop a structured system of KPIs tailored to evaluate the quality and adequacy of primary care services provided by public health facilities in the Puglia Region. Through multivariate analysis specifically PCA we construct, aggregate, and weight KPIs to build a comprehensive performance evaluation model. This model is designed to highlight the relative importance of each indicator, thereby supporting evidence-based decision-making and continuous improvement in healthcare delivery.