An econometric approach to aggregating multiple cardiovascular outcomes in German hospitals
Angela Meggiolaro,
Carl Blankart,
Tom Stargardt and
Jonas Schreyögg ()
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Angela Meggiolaro: Universität Hamburg
Tom Stargardt: Universität Hamburg
Jonas Schreyögg: Universität Hamburg
The European Journal of Health Economics, 2023, vol. 24, issue 5, No 9, 785-802
Abstract:
Abstract 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.
Keywords: Quality of care; Hospital; Accelerated failure time model; Cardiovascular diseases (search for similar items in EconPapers)
JEL-codes: I11 (search for similar items in EconPapers)
Date: 2023
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DOI: 10.1007/s10198-022-01509-y
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