An Empirical Study of Ambulatory Surgery Services in Multilevel Context

Ambulatory Surgery Centers (ASC) offer timely and cost-saving support for emergency health services.  As a fast-growing sector of public healthcare, ASC service access has been monitored by the Office of Statewide Health Planning and Development (OSHPD) using the ZIP Code Tabulation Areas (ZCTA) as a unit of observation.  To assess what works, for whom, and in which context, a Context, Input, Process, and Product (CIPP) model has been employed to guide selection of variables from American Community Survey (ACS).  The CIPP model fits ICEHS’ healthography – “How Where you Live Affects Your Health and Well-being”. 

Like OSHPD, ACS data from the Census Bureau uses ZCTA as a measurement unit.  The purpose of this project is to evaluate the ASC impact using the multilevel data from OSHPD and ACS.  While emergency health services are needed across all age groups, California is the only state that has designated tobacco tax to support healthcare for children ages 0-5.  Through applying the method of multilevel modeling, this research reveals significant factors of family income, population density, and the proportion of families with young children in a community.  In addition, the percent of families with health insurance has demonstrated moderate effect size on ASC access at the county level.  The multilevel analyses reflect the data structure in which communities are nested within counties, and reconfirm the factor identification from the CIPP model.  We submit this late-breaker abstract because of a delay from renewing OSHPD data license for a student co-author in NYU Medical School.