ADULT MEDICAID PATIENTS' DENTAL VISITS IN EDS

广泛目标：评估马里兰州医疗补助成年患者使用医院急诊科 (ED) 治疗口腔疼痛以及与牙齿和牙周组织相关的感染的模式。 此外，还将检查由于取消对牙医治疗牙科紧急情况的成人医疗补助报销而导致的急诊牙科就诊频率的变化。 理由：牙痛引起的疼痛是一个重大的公共卫生问题。 无法获得私人牙科服务的穷人和少数族裔可以利用急诊室来治疗这些及相关疾病。 急诊室通常缺乏牙科服务，因此通常无法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，马里兰州接受医疗补助的患者前往医院急诊科 (ED) 治疗口腔疼痛以及与牙齿和牙周组织相关的感染的比例； 2. 确定取消对牙医诊所紧急就诊的医疗补助报销的政策（1993 年 2 月）制定后就诊率是否发生变化； 3. 确定政策修订前后期间因减少牙科诊所就诊而节省的成本以及因增加急诊就诊而产生的任何成本转移的预测。 研究设计：本研究考察了1990年2月16日至1996年2月15日六年期间ED的使用情况，用于治疗口腔疼痛以及与牙齿和牙周组织相关的感染。 该研究采用观察性准实验设计，两个研究组定义如下：1993 年 2 月 16 日之前使用 ED 治疗牙科问题的成年医疗补助患者和 1993 年 2 月 15 日之后使用 ED 治疗牙科问题的成年医疗补助患者。该研究采用自然实验，即取消牙医报销的医疗补助政策的变化，来建立两个研究期。 描述医疗补助患者使用急诊室的数据磁带将从马里兰州健康和心理卫生部维护的医疗补助管理信息系统中获取。 该系统包括一个索赔数据库，可以从中识别与牙科相关的就诊（基于 ICD-9-CM 代码）并量化成本。 它还包括收件人文件，可以从中量化覆盖范围的人年总数。 利用这些信息来源，将可以计算 1993 年 2 月 16 日之前和 1993 年 2 月 15 日之后每人每年医疗补助资格的牙科相关急诊就诊的次数和费用。将使用描述性和推论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.