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

Purpose An 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. Methods Quality 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. Results For 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. Conclusion A 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. Highlights ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the Hansjorg Wyss Department of Plastic Surgery, NYU Langone Hospitals, New York, NY. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Institutional Review Board of NYU Grossman School of Medicine gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors. * (U.S.) : United States (CMS) : Centers for Medicare and Medicaid Services (ICHOM) : International Consortium for Health Outcomes Measurement (ADA) : American Dental Association (DQA) : Dental Quality Alliance (ECC) : early childhood caries (FQHC) : federally qualified health center (NSC) : minimally invasive non-surgical care (SC) : surgical restorative care without adjunctive sedation or general anesthesia (SCGA) : surgical restorative care with general anesthesia (PRSSQ) : parental-reported symptom and service quality questionnaire (SDF) : silver diamine fluoride (HCP) : health care providers (GA) : general anesthesia (Q) : quality (ECOHIS) : Early Child Oral Health Impact Scale (C-OIDP) : Child-Oral Impacts on Daily Performance (D-CAHPS) : Dental Consumer Assessments of Healthcare Providers and Systems (C) : cost (RVU) : Relative Value Units (V) : value (ASA) : American Society of Anesthesiologists (LDI) : University of Pennsylvania Leonard Davis Institute of Health Economics (ACA) : Affordable Care Act (FDI) : Fédération Dentaire Internationale (AOHSS) : Adult Oral Health Standard Set