STRATEGIES FOR MANAGEMENT OF DENTAL CARIES IN CHILDREN

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This study proposes to investigate changes in treatment and expenditures for dental services in the North Carolina Medicaid program over a 7-year period during which time a dental sealant benefit was introduced. The research is based on the premise that the use of dental sealants will reduce the level of dental caries in children, which can be measured through a reduction in those services necessary for its treatment. This reduction in treatment will in turn have an impact on overall reimbursements for dental services. In the initial phases of the project, a data file constructed in pilot work detailing the treatment experience of NC Medicaid dental users 5-17 years of age for a five-year period (FY1984-FY1988) will be expanded to facilitate analyses proposed for this project. The resulting file will consist of user data derived from the NC Medicaid Management Information System and characteristics of providers and their practice locations obtained primarily from the NC Cooperative Health Information System, a data base of licensed NC health professionals maintained by the UNC Health Services Research Center. The resulting summary file will contain one record per user during 1983-1990; an estimated 170,000 children 5-17 years of age treated by approximately 1600 general practitioners and 45 pediatric dentists. Three separate sets of analyses will be conducted using this common data base to address the impact of sealant use on the delivery of services at three levels-the Medicaid program itself, dental practices, and patients. In the first set of analyses (Aim #1) an interrupted time series design in which services and charges are aggregated by month will be used to determine program effects. 24 time series observations before sealant coverage and 60 after will be analyzed with OLS regression models. Both level and slope effects are expected as a result of the inclusion of sealants as a benefit in the Medicaid program. In the second set (Aim #2), the unit of analysis shifts to the practitioner. Initial efforts will be directed toward developing a multi-faceted description of sealant use based on providers' rate and intensity of use, overall claims volume, and age of children sealed. Using these findings, use of sealants from 1985 to 1990 will be examined to identify and classify types of adoption behaviors and associated factors. Finally, using a repeated measures design, observations consisting of annual rates of restorations will be compared between high sealant providers and non--(other)providers. The purpose of the final series of analyses (Aim #3) is to study a cohort of approximately 4,000 users who had first molars erupting after the sealant benefit has been in effect for at least six months. Descriptive and multivariate analyses will compare treatments and costs of those with and without a sealant claim during the subsequent 5 years. Further analyses will consider a "dose-response" effect resulting from number of sealants and an adjustment for potential selection bias in the providers' clinical decisions concerning sealant.