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

项目摘要 这项拟议的研究试图确定门诊外科中心(ASCs)是否为 提供比医院门诊部(HOPD)更高质量的儿科牙科手术。为 与潜在健康状况有关的原因(例如智力和发育障碍)、获得 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。这个 ASCs的扩大可能会为改善获得机会和降低儿科手术成本提供机会 牙科手术，同时保持提供高质量的护理。尽管先前的研究总体上 表明在ASCs中进行的程序成本更低，质量更好或与之相当 这些研究集中在成人和老年人群中，许多人已经 没有使用严格的方法进行因果推理。使用三个数据源，这项拟议的研究将比较 成本(由付款人和患者支付的费用、网络外账单和费用衡量)和质量，如 通过接受及时护理来衡量(通过从诊断到手术的时间和到护理的距离来衡量)，安全 护理(通过手术后的住院时间、急诊科就诊和住院治疗来衡量)， 和公平照顾(通过检查对历史上易受伤害的群体的护理环境是否存在质量差异来评估， 由较低的社会经济地位、医疗补助登记人数、少数族裔/族裔和乡村定义)。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 35个州的保险公司和佛罗里达州的整个程序将使这两个问题的审查成为可能。 公共和私人保险人口，以及能够比较ASCs和 按付款人支付的HOPD。此外，为了消除人们对结果可能由以下事实驱动的担忧，研究表明 平均而言，ASCs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，包括使用倾向分数加权和利用对ASC的差异访问 各州。

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.