PREVENTION OF EARLY CHILDHOOD CARIES IN MEDICAL PRACTICE

本研究的目的是评估已经资助和正在进行的预防低收入家庭儿童早期龋齿（ECC）的干预措施。2000年1月，干预行动在北卡罗莱纳州的10个县开始。儿科医生和护士正在提供预防性牙科服务，包括为36个月以下的婴幼儿进行筛查和涂氟化物清漆，并为他们的主要照顾者提供健康教育。社区协调员帮助确保在9个月大时进行第一次访问，之后每隔6个月进行一次访问。准实验设计将使用来自10个匹配国家的信息进行比较。评估包括三个独立的研究，旨在确定干预对ECC结果的影响。在第一项研究中，通过比较900名在9个月大时开始干预的3岁儿童与对照组儿童的非空化和空化龋齿病变的患病率和严重程度，来确定干预的短期有效性。来自干预和比较国家的历史控制将解释ECC的长期趋势。对护理人员的访谈将提供控制变量和次要结果，包括知识、行为和生活质量。第二项研究将在干预结束两年后，确定干预对5岁儿童ECC的延续效应。其理由是需要知道，在儿童不再符合条件之后，在他们参加以学校为基础的预防性牙科课程之前，早期的、基于医学的干预措施的结果是否仍然有效。从幼儿园学生的公共健康监测中得出的龋齿增量，包括20个研究县8000名学生中的95%，将与干预和对照儿童进行比较，这些儿童在第一次研究中观察到，以及同期对照和4年前的历史对照。医疗干预和牙医提供的预防服务之间的相互作用将使用医疗补助和CHIP牙科索赔进行测试。第三项研究将确定ECC干预对1岁和2岁儿童累积龋齿相关（CR）治疗的影响，以及3岁和4岁时由医疗补助和CHIP项目提供的牙科服务的费用。住院治疗的可能性将与总CR治疗和费用分开分析，因为它的费用。大多数分析将侧重于净干预成本（社区外展和提供者补偿）是否被CR治疗成本的减少所抵消。我们将做一个有限的评估成本与口腔健康相关的生活质量。

The purpose of this research is to evaluate an already funded and ongoing intervention to prevent early childhood caries (ECC) in children of low-income families. The intervention began in 10 North Carolina counties in Jan 2000. Pediatricians and nurses are providing preventive dental services, including screening and fluoride varnish applications for infants and toddlers up to 36 months of age, and health education for their primary caregivers. Community coordinators help ensure the fist visit at 9 months of age and at six-month intervals thereafter. The quasi-experimental design will use information from 10 matched counties for comparison. The evaluation consists of three separate studies designed to determine the impact of the intervention on ECC outcomes. In the first study, short-term effectiveness of the intervention will be determined by comparing the prevalence and severity of noncavitated and cavitated carious lesions in 900 3-year-olds, who began the intervention at 9 months of age, with children from the control group. Historical controls from the intervention and comparison counties will account for secular trends in ECC. An interview of caregivers will provide control variables and secondary outcomes, including knowledge, behaviors and quality of life. The second study will determine carryover effects of the intervention on ECC in children 5 years of age, two years after their participation in the intervention ends. Its justification is the need to know if results from early, medical-based interventions continue after children are no longer eligible and before they enroll in school-based preventive dentistry programs. Caries increments derived from public health surveillance of kindergarten students, which includes 95 percent of the 8,000 students in the 20 study counties, will be compared for intervention and control children who were observed in the first study, as well as concurrent controls and historical controls from 4 years before. Interactions between the medical-based interventions and preventive services provided by dentists will be tested using Medicaid and CHIP dental claims. The third study will determine the effects of the ECC interventions for 1- and 2- year-olds on cumulative caries-related (CR) treatment and costs of dental services provided by the Medicaid and CHIP programs through 3 and 4 years of age. The likelihood of hospital use will be analyzed separately from total CR treatment and costs because of its expense. Most analyses will focus on whether net intervention costs (community outreach and provider reimbursements) are offset by reductions in CR treatment costs. We will do a limited assessment of the cost pe oral health- related quality of life.