Evaluation of an Innovative School-Based Initiative to Improve Receipt of Preventive Dental Care among Children Enrolled in Medicaid

对一项以学校为基础的创新举措的评估，该举措旨在提高参加医疗补助计划的儿童对预防性牙科护理的接受度

• 批准号: 9925178
• 负责人: Jean M Mitchell
• 金额: $ 37.45万
• 依托单位: GEORGETOWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9925178
• 关键词: Evaluation; Innovative; Based; Initiative; Improve

Project Summary Untreated tooth decay is the most common childhood chronic disease and is particularly acute among low-income children and adolescents, including those with Medicaid coverage. Lack of access to a dental provider, the high costs of care and lack of dental insurance coverage are the primary reasons why so many children do not obtain needed dental care. This proposed research will be the first to evaluate the causal impact of an innovative school-based program specifically tailored to address unmet dental needs among low-income children. This supply-side initiative enables dental hygienists employed by the Virginia Department of Health (VDH) to deliver preventive dental services to low-income children at “high-need” schools under the remote supervision of a public health dentist. A hygienist practicing under “remote supervision” has periodic communication with a public health dentist regarding patient care although the public health dentist has not performed an oral exam on the children screened and treated by the dental hygienist. The program was initially piloted during the 2009-2010 academic year in “high-need” schools located in three health districts with high levels of unmet dental care needs and was expanded statewide in July 2012. We propose to analyze Medicaid enrollment and claims records (MAX data) spanning the years 2006 through 2016 to evaluate the causal impact of this highly innovative school-based dental care delivery model. We will use difference-in-differences analysis to compare receipt of preventive dental services among children who attend schools where a dental hygienist practices under remote supervision to receipt of preventive dental services among children who attend “high-need” schools without this program. We will first evaluate the pilot program and then conduct a similar evaluation after the program was expanded and became available in additional health districts located throughout the state of Virginia. The rationale for evaluating both the pilot and expansion of this school-based initiative is twofold. First, the health districts selected to participate in the pilot program had very high levels of unmet dental care need and thus may yield a distorted picture of the true impact of the program. Second, an evaluation of a new program during its infancy may reflect implementation difficulties that are resolved over time. Thus, a comparison of the results from the pilot program and expansion of the program to additional health districts will address both of these concerns. Notably, the program itself represents a highly innovative solution to the dental care access crisis that exists among low-income children. Other policy solutions, such as increasing Medicaid reimbursement rates or the licensing of dental therapists—either have been found to be ineffective (Decker 2011; Buchmueller et al. 2015) or face intense opposition from practicing dentists (McElhaney 2014). Thus, our proposed evaluation will provide critical evidence and is likely to prompt other states to consider and enact similar legislation.

项目摘要 未经治疗的龋齿是最常见的儿童慢性病，尤其严重。 在低收入儿童和青少年中，包括那些有医疗补助覆盖的人。无法访问 牙科提供者、高昂的护理费用和缺乏牙科保险是造成这种情况的主要原因 许多儿童得不到所需的牙科护理。这项拟议的研究将是第一次评估 专门为解决牙科未达标而量身定做的创新校本计划的因果影响 低收入儿童的需要。这一供应方的倡议使受雇于 弗吉尼亚州卫生部将为低收入儿童提供预防性牙科服务 在公共卫生牙医的远程监督下的学校。一名卫生员在“遥控器”下执业 监督“定期与公共卫生牙医就病人护理进行沟通，尽管公众 健康牙医没有对经过牙科卫生员筛查和治疗的儿童进行口腔检查。 该计划最初是在2009-2010学年在三所“高需求”学校试行的 这项计划旨在帮助那些牙科护理需求未得到满足的健康地区，并于2012年7月在全州范围内推广。 我们建议分析2006年的医疗补助登记和索赔记录(最大数据) 到2016年，评估这一高度创新的校本牙科护理提供模式的因果影响。 我们将使用差异分析来比较儿童接受预防性牙科服务的情况 在学校里，牙科卫生员在远程监督下执业，接受预防性牙科治疗 在没有这项计划的情况下进入“高需求”学校的儿童的服务。我们将首先对试点项目进行评估 计划，然后在计划扩展并在 弗吉尼亚州各地的其他医疗区。同时评估试点项目和项目的理由 这项以学校为本的倡议的扩展是双重的。第一，选定参与试点的卫生区 该计划有非常高水平的未得到满足的牙科保健需求，因此可能会扭曲真实情况 该计划的影响。其次，对一项新计划在萌芽阶段的评估可能反映其实施情况。 困难是随着时间的推移而解决的。因此，试点计划和扩大试点的结果进行了比较 将该计划推广到更多的卫生区将解决这两个问题。 值得注意的是，该计划本身代表了针对牙科护理准入危机的高度创新的解决方案 存在于低收入儿童中。其他政策解决方案，如提高医疗补助报销率或 牙科治疗师的执照--两者都被发现是无效的(Decker 2011；Buchmueller等人)。 或面临执业牙医的强烈反对(McElhaney 2014)。因此，我们提议的评价将 提供关键证据，并可能促使其他州考虑和颁布类似的立法。