Effectiveness and improvement of rural, school-based, caries prevention programs

描述（由申请人提供）：我们建议使用比较有效和质量改进的方法来改善农村学校预防龋齿项目的口腔健康和降低成本。我们将检验全面预防龋齿比增量预防更有效的假设。意义：龋齿是一种可预防的细菌感染，然而25%的美国学龄儿童患有未经治疗的龋齿，是哮喘的五倍。在农村、种族和少数民族人口中，患病率翻了一番。疾病控制和预防中心推荐的有效预防干预措施是可用的。然而，它们往往未被充分利用，也很少被评估临床有效性。方法：采用队列设计，我们将纵向评估和比较农村小学综合和增量预防龋齿项目。利用这些比较数据，我们将生成、实施和测试口腔健康改善模型，以提高临床和成本效益。具体目标：1)制定程序手册，使用NHANES诊断标准对龋齿诊断进行标准化和校准，实施电子可读表格进行记录、提交和分析。2)比较评估临床和成本效益，建立最佳护理和时间模型，指导现场改进方案。3)建立数据库，生成预防龋齿的备选模型，并开放该数据库供临床和研究使用。影响和创新：据我们所知，这将是第一个具有广度和深度的比较有效性研究（包括经济评估），以确定和传播有效的预防方案。一个额外的好处将是创建一个丰富的数据库，用于在其他位置建模预防。环境与调查：福赛斯已经有一个世纪的历史了。哈佛大学附属口腔健康研究所。我们要把这个天赋和

DESCRIPTION (provided by applicant): We propose to improve oral health and reduce costs of rural school-based caries prevention programs using comparative effectiveness and quality improvement methods. We will test the hypothesis that comprehensive caries prevention is more effective than incremental prevention. Significance: Caries is a preventable bacterial infection, yet 25% of U.S. school children have untreated decay - five-times more than asthma. The prevalence doubles for rural, racial and ethnic minority populations. Effective preventive interventions, recommended by the Centers for Disease Control and Prevention, are available. However, they are often underused and rarely evaluated for clinical effectiveness. Approach: Using a cohort design, we will longitudinally evaluate and compare comprehensive and incremental caries prevention programs in rural elementary schools. Using this comparative data we will generate, implement and test oral health improvement models for clinical and cost-effectiveness. Specific Aims: 1) Develop a manual of procedures, standardize and calibrate caries diagnosis using NHANES diagnostic criteria, implement electronic readable forms for recording, submission, and analysis. 2) Comparatively evaluate clinical and cost-effectiveness, model optimal care and timing, and mentor site improvement programs. 3) Create a data base to generate alternate models for caries prevention and open this data base for clinical and research use. Impact and Innovation: To our knowledge, this will be the first comparative effectiveness study (including economic assessment) with the breadth and depth to identify and disseminate effective prevention protocols. An added benefit will be the creation of a rich data base for modeling prevention in other locations. Environment and Investigators: Forsyth is a century old. Harvard affiliated, oral health research institute. We will marry this talent with the Boston University Data Coordinating Center and school-based caries prevention programs serving ~10,000 children in 67 schools, in 10 rural counties, in 4 states. PUBLIC HEALTH RELEVANCE: RELEVANCE (See Instructions): This project employs comparative effectiveness and quality improvement methods to improve oral health and reduce costs in rural school-based cavity prevention programs. The need in rural compared to urban populations is great. Rural populations have fewer dentists per population, less water fluoridation, lower insurance rates, greater travel distances, higher poverty rates, all adding to higher rates of dental cavities.