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: 10652740
• 负责人: Ashley Kranz
• 金额: $ 10万
• 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/10652740
• 关键词: Comparing; Quality; Care; Pediatric; Dental; 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 all 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.

项目摘要 这项拟议的研究旨在确定卧床外科手术中心（ASC）是否提供了较不昂贵的设置 与医院门诊部（HOPDS）相比，提供高质量的小儿牙科手术程序。为了 与潜在的健康状况（例如智力和发展障碍）有关的原因，访问 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程序。这 ASC的扩展可能会提供改善入学和降低小儿手术成本的机会 牙科程序在维持高质量护理的同时。尽管一般的先前研究 表明在ASC中进行的程序的成本较低，并且具有更好或可比的质量 这些研究集中在Hopds中，都集中在成人和老年人口上，许多研究已 未使用严格的因果推断方法。使用三个数据源，这项拟议的研究将比较 费用（由付款人和患者的付款衡量，网络外账单以及费用）以及质量 通过收到及时的护理（通过从诊断到手术和护理距离的时间来衡量）来衡量，安全 护理（通过住院时间衡量，以下程序，急诊室就诊和住院治疗）， 和公平护理（通过检查质量是否通过设置历史脆弱的群体来评估是否有所不同， 由低社会经济地位，医疗补助入学率，少数民族种族/种族和农村定义）。使用三个 数据集，即医疗补助支付的程序宇宙，商业支付的程序样本 所有州的保险公司以及佛罗里达州的程序宇宙将使这两个问题都可以在这两个问题上进行检查 公共和私人保险人口，并可以比较ASC的成本和质量 付款人的跳。此外，为了解决问题可能会导致研究表明的事实所驱动的问题 ASC可以平均治疗更健康的患者，这项拟议的研究将利用多种方法来进行风险 - 调整，包括使用倾向得分加权并利用对ASC的差异访问 国家。