An econometric approach to aggregating multiple cardiovascular outcomes in German hospitals

Meggiolaro, Angela; Blankart, Carl Rudolf; Stargardt, Tom; Schreyögg, Jonas (2023). An econometric approach to aggregating multiple cardiovascular outcomes in German hospitals. European journal of health economics, 24(5), pp. 785-802. Springer 10.1007/s10198-022-01509-y

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Objective
Development of an aggregate quality index to evaluate hospital performance in cardiovascular events treatment.

Methods
We applied a two-stage regression approach using an accelerated failure time model based on variance weights to estimate hospital quality over four cardiovascular interventions: elective coronary bypass graft, elective cardiac resynchronization therapy, and emergency treatment for acute myocardial infarction. Mortality and readmissions were used as outcomes. For the estimation we used data from a statutory health insurer in Germany from 2005 to 2016.

Results
The precision-based weights calculated in the first stage were higher for mortality than for readmissions. In general, teaching hospitals performed better in our ranking of hospital quality compared to non-teaching hospitals, as did private not-for-profit hospitals compared to hospitals with public or private for-profit ownership.

Discussion
The proposed approach is a new method to aggregate single hospital quality outcomes using objective, precision-based weights. Likelihood-based accelerated failure time models make use of existing data more efficiently compared to widely used models relying on dichotomized data. The main advantage of the variance-based weights approach is that the extent to which an indicator contributes to the aggregate index depends on the amount of its variance.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Faculty Institutions > sitem Center for Translational Medicine and Biomedical Entrepreneurship > Healthcare Regulation and Management
04 Faculty of Medicine > Faculty Institutions > sitem Center for Translational Medicine and Biomedical Entrepreneurship
11 Centers of Competence > KPM Center for Public Management

UniBE Contributor:

Blankart, Rudolf

Subjects:

300 Social sciences, sociology & anthropology > 350 Public administration & military science
300 Social sciences, sociology & anthropology > 330 Economics

ISSN:

1618-7598

Publisher:

Springer

Funders:

Organisations 721402 not found.

Language:

English

Submitter:

Carl Rudolf Berchtold Blankart

Date Deposited:

23 Sep 2022 16:18

Last Modified:

20 May 2023 00:11

Publisher DOI:

10.1007/s10198-022-01509-y

PubMed ID:

36112269

BORIS DOI:

10.48350/173219

URI:

https://boris.unibe.ch/id/eprint/173219

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