Detecting and Quantifying Circularity Bias When Composite Quality Ratings Are Used as Covariates: A Methodological Demonstration Using CMS Hospital Excess Readmissions Data
This paper demonstrates that including composite quality ratings as covariates in regression models introduces a circularity bias that systematically attenuates the estimated effects of structural predictors, a methodological hazard confirmed through CMS hospital readmission data and Monte Carlo simulations.