Promoting children's oral health: Identifying provider-, practice-, and community-level characteristics associated with delivery of fluoride varnish in medical offices

项目摘要 蛀牙是可以预防的，但代价高昂。2013年，儿童牙科治疗支出总额为87亿美元， 使其成为第五大最昂贵的儿童健康状况。预防性口腔保健服务，如氟化物保护漆， 预防儿童蛀牙。然而，只有不到50%的儿童每年进行牙科检查， 由于成本、牙医不愿治疗幼儿以及牙科劳动力短缺。增加使用 预防性口腔健康服务、私人健康计划和所有州医疗补助计划现在都包括提供 在医务室为所有6岁以下儿童涂上氟化物清漆。现有证据表明， 在医疗办公室使用氟涂料可以提高使用率，减少公共保险儿童的蛀牙。 尽管有这些好处，但很少有儿童在医疗办公室接受氟化物保护漆。2014年，只有5%的合格 儿童在马萨诸塞州接受这项服务。以前的研究，以确定障碍和战略的重点是 公共保险的儿童，并依赖于自我报告的提供者信息，因此，一种新的“大数据”方法， 需要确定供应商，实践，社区和政策层面的因素影响交付的氟化物清漆 在医疗办公室。我们的混合方法研究将使用马萨诸塞州所有付款人索赔数据集，其中包括 公共和私人保险儿童的医疗和牙科索赔，以（1）描述儿童接受 预防性口腔保健服务，（2）估计强制性医疗保险对儿童的因果影响 接受预防性口腔保健服务，（3）研究影响预防性口腔保健服务提供的机制， 医疗机构的卫生服务，以及（4）使用定性的积极偏离方法来确定策略 以及促进或阻碍医疗提供者提供预防性口腔健康服务的环境因素。

Project Summary Tooth decay is preventable, yet costly. Spending on dental treatment for children totaled $8.7 billion in 2013— making it the fifth most costly child health condition. Preventive oral health services, like fluoride varnish, can prevent tooth decay in young children. However, fewer than 50% of children have an annual dental visit, likely due to cost, dentists’ reluctance to treat young children, and dental workforce shortages. To increase use of preventive oral health services, private health plans and all state Medicaid programs now cover delivery of fluoride varnish in medical offices to all children younger than 6 years. Existing evidence indicates that delivery of fluoride varnish in medical offices increases utilization and reduces decay in publicly insured children. Despite these benefits, few children receive fluoride varnish in medical offices. In 2014, only 5% of eligible children received this service in Massachusetts. Prior studies to identify barriers and strategies have focused on publicly insured children and relied on self-reported provider information, thus a new “big data” approach is needed to identify provider, practice, community-, and policy-level factors affecting delivery of fluoride varnish in medical offices. Our mixed-methods study will use Massachusetts All Payer Claims Dataset, which includes both medical and dental claims for publicly and privately insured children, to (1) describe children receiving preventive oral health services, (2) estimate the causal impact of mandatory medical coverage on children’s receipt of preventive oral health services, (3) examine the mechanisms affecting delivery of preventive oral health services in medical offices, and (4) use a qualitative positive deviance approach to identify strategies and contextual factors promoting or deterring medical providers’ delivery of preventive oral health services.