Comparing Providers for the Treatment of Early Childhood Caries with a Value-based Rating Methodology: A Cross-sectional study

Abstract

ABSTRACTPurposeAn adapted Porter-Teisberg model of value-based health outcomes and cost was applied to comparatively rate providers who treat children with early childhood caries, by treatment modalities, facilities, and geographic location.MethodsQuality was measured by a Parental-Reported Symptom and Service Quality questionnaire, adapted from the Early Child Oral Health Impact Scale, Child-Oral Impacts on Daily Performance, and Dental Consumer Assessments of Healthcare Providers and Systems tools. Cost was measured by the labor cost for all providers involved in treatment and adjusted by dividing by total relative value units for the types and total number of procedures for all treatment visits. Value was calculated as the quotient of the weighted quality score and the adjusted cost, multiplied by a coefficient. To compare the value score by states and by facilities, Tukey’s multiple comparison test was used and a sensitivity analysis using the non-parametric Dunn’s Kruskal-Wallis multiple comparison test was conducted.ResultsFor surgical treatment with general anesthesia, Tennessee ranked the highest, followed by Arizona, Hawaii, and New York. These four states had significantly higher value metrics than Florida, Massachusetts, and Maryland. Maryland had a significantly higher value score for surgical treatment without general anesthesia. While patients were seen for non-surgical treatment only in Maryland and New York, Maryland also had a significantly higher value for this treatment modality.ConclusionA value-based rating system of providers, by geographic region and treatment facility, can assist patients to better compare and select providers; third-party payers, such as insurance companies and government programs, to better compare outcomes and costs for provider systems and clinic facilities; and providers to benchmark their comparative ratings on an internal and external basis for continuous quality improvement.HighlightsNon-surgical management of early childhood caries yields the most value.Surgical intervention with or without general anesthesia is less valued by patients.Ranking treatment modalities by value is a useful tool for patients.Using a parental-reported symptom and service quality questionnaire assesses quality.Provider value can be determined by dividing quality of care by the cost of delivery.