ADULT MEDICAID PATIENTS' DENTAL VISITS IN EDS

目的：评估马里兰州成年医疗补助患者使用医院急诊科治疗口腔疼痛和与牙齿和牙周组织相关的感染的模式。此外，还将审查由于取消向牙医报销成人医疗补助以治疗牙科紧急情况而导致的急诊就诊频率的变化。理由：牙痛是一个重大的公共健康问题。无法获得私人牙科服务的穷人和少数族裔可以利用急诊服务来治疗这些疾病和相关疾病。EDS通常缺乏牙科服务，因此，通常不能为口腔疾病提供明确的治疗。具体目标：1.确定1990年2月至1996年2月期间，马里兰州因口腔疼痛和与牙齿和牙周组织有关的感染而到医院急诊科就诊的医疗补助患者的比率；2.确定政策出台(1993年2月)取消牙医诊所紧急就诊的医疗补助报销后，就诊率是否发生了变化；3.确定牙科诊所就诊减少所节省的费用以及政策修订前后因增加急诊科就诊而产生的任何费用转移的预测。研究设计：这项研究考察了在1990年2月16日至1996年2月15日的六年期间，EDS用于治疗口腔疼痛和与牙齿和牙周组织相关的感染的情况。这项研究采用了观察性准实验设计，两个研究组的定义如下：成人医疗补助患者在1993年2月16日之前因牙科问题使用ED，而成人医疗补助患者在1993年2月15日之后使用ED治疗牙科问题。这项研究采用了一个自然的实验，即取消牙医报销的医疗补助政策的变化，来确定两个研究期。描述医疗补助患者使用急救药物的数据磁带将从马里兰州卫生和精神卫生部门维护的医疗补助管理信息系统中获得。该系统包括一个索赔数据库，可以从该数据库中识别与牙科相关的就诊(基于ICD-9-CM代码)，并可以量化费用。它还包括收件人档案，可以从这些档案中量化保险的人-年总数。利用这些资料，便可计算在一九九三年二月十六日之前和一九九三年二月十五日之后，符合医疗补助资格的每人每年前往牙科急症室求诊的次数和费用。将使用描述性和推断性统计方法来分析数据。

Broad Objective: To evaluate adult Maryland Medicaid patients' patterns of use of hospital emergency departments (EDs) for the treatment of mouth pain and infections associated with teeth and periodontal tissues. Additionally, changes in the frequency of ED dental visits resulting from the elimination of adult Medicaid reimbursement to dentists for the treatment of dental emergencies will be examined. Rationale: Pain from toothaches represents a significant public health problem. The poor and minorities who lack access to private dental services may utilize EDs for the treatment of these and related conditions. EDs generally lack dental services, and thus, are usually not capable of providing definitive treatment for oral conditions. Specific Aims: 1 - To determine the rate with which Medicaid patients visited hospital emergency departments (EDs) for the treatment of mouth pain and infections associated with the teeth and periodontal tissues in Maryland from February 1990 to February 1996; 2. To determine whether the rate of visits changed after the institution of a policy (in February of 1993) to eliminate Medicaid reimbursement for emergency visits to dentists' offices; 3. To determine projections of the cost savings from reduced dental office visits and any resulting cost shifting from increased ED visits for the periods before and after the policy revision. Research Design: This study examines the use of EDs, during the six-year period February 16, 1990 to February 15, 1996, for the treatment of mouth pain and infections associated with the teeth and periodontal tissues. The study employs an observational quasi- experimental design with two study groups defined as follows: adult Medicaid patients using the ED for dental problems prior to February 16, 1993 and adult Medicaid patients using the ED for dental problems after February 15, 1993. The study employs a natural experiment, the change in Medicaid policy which eliminated dentist reimbursement, to establish the two study periods. Data tapes describing Medicaid patients use of EDs will be obtained from the Medicaid Management Information System which is maintained by the Maryland Department of Health and Mental Hygiene. This system includes a claims database from which dental related visits can be identified (based on ICD-9-CM Codes) and costs can be quantified. It also includes recipient files from which the total number of person-years of coverage can be quantified. Using these sources of information, it will be possible to calculate the number and cost of dental related ED visits per person-year of Medicaid eligibility both before February 16, 1993 and after February 15, 1993. Descriptive and inferential statistical methods will be used to analyze the data.