An econometric approach to aggregating multiple cardiovascular outcomes in German hospitals

Eur J Health Econ. 2023 Jul;24(5):785-802. doi: 10.1007/s10198-022-01509-y. Epub 2022 Sep 16.


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: Accelerated failure time model; Cardiovascular diseases; Hospital; Quality of care.

MeSH terms

  • Germany
  • Hospital Mortality
  • Hospitals, Private*
  • Hospitals, Public
  • Humans
  • Likelihood Functions
  • Myocardial Infarction* / therapy
  • Ownership