Comparing Quality of Care for Pediatric Dental Procedures Conducted in Ambulatory Surgical Centers and Hospital Outpatient Departments

比较门诊手术中心和医院门诊部进行的儿科牙科手术的护理质量

• 批准号: 10491152
• 负责人: Ashley Kranz
• 金额: $ 40万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-30 至 2024-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10491152
• 关键词: Comparing; Quality; Care; Pediatric; Dental

Project Summary This proposed study seeks to determine if ambulatory surgical centers (ASCs) offer a less costly setting for delivering high-quality pediatric dental surgical procedures than hospital outpatient departments (HOPDs). For reasons related to underlying health conditions (e.g., intellectual and developmental disabilities), access to care, and disease burden, some children require dental surgical procedures under general anesthesia. The expansion of ASCs may offer opportunities for improving access and reducing the cost of pediatric surgical dental procedures while maintaining the delivery of high-quality care. Although prior research generally suggests that procedures conducted in ASCs are less costly and have better or comparable quality to procedures conducted in HOPDs, these studies have focused on adult and elderly populations and many have not used rigorous methods for causal inference. Using three data sources, this proposed study will compare cost (measured by payments by payers and patients, out-of-network bills, and charges) and quality, as measured by receipt of timely care (measured by time from diagnosis to procedure and distance to care), safe care (measured by inpatient stays following procedures, emergency department visits, and hospitalizations), and equitable care (assessed by examining if quality differs by setting of care for historically vulnerable groups, defined by low socioeconomic status, Medicaid enrollment, minority race/ethnicity, and rurality). Use of three datasets, namely the universe of procedures paid by Medicaid, a sample of procedures paid by commercial insurers in 35 states, and the universe of procedures in Florida, will enable examination of this question in both publicly and privately insured populations, as well as enable the comparison of cost and quality in ASCs and HOPDs by payer. Additionally, to address concerns that results may be driven by the fact that studies suggest that ASCs may treat healthier patients on average, this proposed study will utilize multiple approaches to risk- adjustment, including using propensity score weighting and exploiting differential access to ASCs across states.

项目概要 这项拟议的研究旨在确定门诊手术中心 (ASC) 是否可以提供成本较低的环境 提供比医院门诊部 (HOPD) 更高质量的儿科牙科手术。为了 与潜在健康状况（例如智力和发育障碍）、获得医疗服务的机会有关的原因 由于护理和疾病负担，一些儿童需要在全身麻醉下进行牙科手术。这 ASC 的扩张可能会为改善儿科手术机会并降低其成本提供机会 牙科手术，同时保持提供高质量的护理。虽然之前的研究一般 表明在 ASC 中进行的程序成本更低，并且质量更好或与 在 HOPD 中进行的程序，这些研究主要针对成年人和老年人群，并且许多研究 没有使用严格的方法进行因果推理。这项拟议的研究将使用三个数据源进行比较 成本（通过付款人和患者的付款、网络外账单和收费来衡量）和质量，如 通过及时接受护理来衡量（通过从诊断到手术的时间以及到护理的距离来衡量），安全 护理（通过手术后的住院时间、急诊科就诊和住院来衡量）， 和公平的护理（通过检查历史上弱势群体的护理环境是否存在质量差异来进行评估， 定义为低社会经济地位、医疗补助入学率、少数族裔/民族和农村地区）。使用三 数据集，即医疗补助支付的程序范围，商业支付的程序样本 35 个州的保险公司以及佛罗里达州的整个程序将能够在两个州审查这个问题 公共和私人保险人群，以及能够比较 ASC 和 付款人的 HOPD。此外，为了解决人们对结果可能由研究表明的事实驱动的担忧 平均而言，ASC 可以治疗更健康的患者，这项拟议的研究将利用多种方法来降低风险 调整，包括使用倾向得分加权和利用不同的 ASC 访问权限 州。