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（申请人提供）：龋齿是一种慢性疾病，也是最常见的可预防的牙齿疾病，影响儿童的口腔健康生活质量和福祉。对于参加医疗补助的儿童来说，充分获得预防性牙科手术仍然是一个挑战。放置牙密封剂是一种基于证据的预防程序，将一层薄薄的塑料涂层粘合到前磨牙和磨牙的深槽、凹坑和裂缝表面，以防止龋齿（蛀牙）。尽管文献证据的有效性，成本效益和牙科密封剂的好处，他们仍然没有充分利用。2006年，威斯康辛州医疗补助计划改变了政策，允许以学校为基础的牙科保健师成为医疗补助认证的牙科密封剂安置提供者。目前尚不清楚这一政策变化是否导致了威斯康辛州参加医疗补助计划的儿童获得和使用牙科密封剂的机会明显增加，以及第一磨牙修复护理的减少。这个项目的目标是评估这个政策是否