Dental Sealant Placements on Children's Teeth: Assessing Medicaid Policy Change

儿童牙齿上的牙科密封剂放置：评估医疗补助政策变化

• 批准号: 8750565
• 负责人: Christopher Okunseri
• 金额: $ 16.36万
• 依托单位: MARQUETTE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-15 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8750565
• 关键词: Accounting; Address; Adopted; Advisory Committees; Affect; Age-Years; Applications Grants; Area; Awareness; Bicuspid; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Child; Chronic; Code; Communities; County; Data; Data Analyses; Databases; Dental; Dental Care; Dental Hygienists; Dental caries; Dentistry; Dentists; Diagnostic; Documentation; Effectiveness; Enrollment; Ethnic Origin; Evaluation; Family; Future; Goals; Health; Health Professional; Health Services Accessibility; Healthcare; Improve Access; Incidence; Information Systems; Knowledge; Lesion; Measures; Medicaid; Minority Groups; Modeling; Molar tooth; Oral health; Outcome; Patients; Personal Satisfaction; Pit and Fissure Sealants; Plastics; Policies; Prevalence; Preventive; Procedures; Program Development; Provider; Public Health; Race; Recommendation; Research; Schools; Services; Surface; System; Testing; Time; Tooth Diseases; Tooth structure; United States; United States Public Health Service; Update; Wisconsin; base; cost effectiveness; demographics; disorder prevention; driving force; electronic data; evidence base; follow-up; health disparity; health related quality of life; high risk; improved; innovation; prevent; programs; public health relevance; residence; restorative treatment; rural area; screening; sound; statistics; systematic review; tooth surface; treatment program; trend; urban area; working group

DESCRIPTION (provided by applicant): Dental caries is a chronic condition and the most common preventable dental disease affecting children's oral health-related quality of life and well-being. Adequate access to preventive dental procedures remains a challenge for Medicaid-enrolled children. Placement of dental sealants is an evidence-based preventive procedure where a thin plastic coating is bonded into the deep grooves, pits and fissure surfaces of premolar and molar teeth to prevent dental caries (tooth decay). Despite documented evidence of the efficacy, cost-effectiveness and benefits of dental sealant placement, they still remain underutilized. In 2006, the Wisconsin Medicaid program changed its policy to allow dental hygienists in school based settings, to become Medicaid certified providers for dental sealant placement. It is unclear whether this policy change has resulted in an appreciable increase in access and utilization of dental sealants as well as reduced restorative care on first molars for Medicaid- enrolled children in Wisconsin. The goal of this project is to assess whether this policy change in a public health program and system has influenced access, oral health disparities and rates of dental sealant utilization in children considered to be at high risk for dental caries. Ths study will use Medicaid claims data for 2004 to 2013 from the Electronic Data Systems of Medicaid Evaluation and Decision Support (MEDS) database for the state of Wisconsin. Using the Wisconsin Medicaid Claims data we will: 1) assess the overall utilization rates of dental sealant placement among Medicaid- enrolled children pre- and post-policy period; 2) examine the association of patients' socio- demographics, provider characteristics, designation of Dental Health Professional Area (DHPSA) and county level characteristics using Urban Influence Codes on the utilization of dental sealants; and 3) test the association between sealants placed on first molars and restorative treatment for first molars over time. Descriptive statistics and multivariate regression models will be used to estimate the effect of the policy change on the rate at which Medicaid-eligible children receive dental sealants and restorative treatment on first molars. We will control for all available covariates including child's county of residence, age and year. The study will document relevant variables associated with the policy change and the effect on public health service systems and the benefit of collaborative practice of health professionals aimed at eliminating health disparities. This secondary data analysis project is innovative, addresses oral health care disparities and provides documentation that is supportive of community-grounded efforts aimed at improving oral health. Findings from this project may influence future expansion of the policy to other states yet to adopt it, increase awareness about the benefits of sealants as a preventive measure and promote public health program development.

描述（由申请人提供）：龋齿是一种慢性病，也是影响儿童口腔健康相关的生活质量和福祉的最常见牙齿疾病。足够的预防性牙科手术仍然是医疗补助儿童的挑战。放置牙科密封剂是一种基于证据的预防程序，将薄薄的塑料涂层粘合到前磨牙和摩尔牙齿的深凹槽，凹坑和裂缝表面，以防止龋齿（牙齿衰减）。尽管有证据表明牙齿密封剂放置的功效，成本效益和收益，但它们仍然不足。 2006年，威斯康星州的医疗补助计划改变了其政策，以允许在学校环境中牙科卫生员成为医疗补助认证的牙科密封剂置换提供商。目前尚不清楚这一政策变化是否导致牙科密封剂的获取和利用率明显增加，并减少了威斯康星州医疗补助招募的儿童的第一磨牙的修复护理。该项目的目的是评估该政策是否 公共卫生计划和系统的变化影响了被认为处于龋齿高风险的儿童的牙科密封剂利用率的获取，口腔健康差异和牙齿密封剂利用率。 THS研究将从威斯康星州的医疗补助评估和决策支持（MEDS）数据库的电子数据系统（MEDIAD评估和决策支持）中使用Medicaid索赔数据。使用威斯康星州医疗补助索赔数据我们将：1）评估医疗补助招募的儿童在政治前后的牙科密封剂放置的总体利用率； 2）使用城市影响力代码对牙科密封剂的利用，研究患者社会人口统计学，提供者特征，牙科健康专业领域（DHPSA）的指定和县级特征； 3）测试随着时间的推移，将密封剂与原始磨牙的恢复性处理之间的关联。描述性统计和多元回归模型将用于估计政策变化对符合医疗补助资格的儿童接受牙科密封剂和首次接受恢复治疗的速度的影响 磨牙。我们将控制所有可用的协变量，包括儿童县，年龄和 年。该研究将记录与政策变化以及对公共卫生服务系统的影响相关的相关变量，以及旨在消除健康差异的卫生专业人员的协作实践的好处。该二级数据分析项目具有创新性，解决了口腔保健差异，并提供了支持旨在改善口腔健康的社区基础努力的文档。该项目的调查结果可能会影响该政策的未来扩展到其他国家，以提高人们对密封剂作为预防措施的好处的认识，并促进公共卫生计划的开发。