Root Canal Therapy in Children: Analysis of Disparities and Value

儿童根管治疗：差异和价值分析

• 批准号: 10225519
• 负责人: Lorel E Burns
• 金额: $ 16.85万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10225519
• 关键词: Accident and Emergency department; Address; Adult; Adverse event; Affect; Age; American Dental Association; Anatomy; Area; Award; Behavioral; Caring; Characteristics; Child; Child Care; Childhood; Clinical; Clinical Management; Competence; Data; Decision Making; Dental; Dental Care; Dental Specialties; Dentists; Development; Development Plans; Educational Background; Endodontics; Ethnic Origin; Frequencies; Geographic Locations; Goals; Grant; Health Services Research; Infection; Insurance; Interview; K-Series Research Career Programs; Knowledge; Literature; Longevity; Massachusetts; Measures; Mentorship; Methods; New York; Outcome; Outcome Study; Patients; Policies; Population; Positioning Attribute; Poverty; Prevalence; Privatization; Procedures; Process; Publishing; Qualitative Research; Quality of life; Race; Research; Research Design; Research Personnel; Research Proposals; Resources; Root Canal Therapy; Sampling; Structure; Surveys; Survival Rate; Time; Tooth structure; Toothache; Training; Translating; Treatment Protocols; Treatment outcome; United States; United States National Institutes of Health; Update; base; care costs; care outcomes; career; career development; clinical decision-making; clinical practice; clinically relevant; comparative; cost effectiveness; demographics; dental infection; evidence base; expectation; financial incentive; health care disparity; improved; performance based measurement; permanent tooth; population based; preservation; primary outcome; research and development; restoration; sex; skills; therapy outcome; treatment comparison; treatment planning

PROJECT SUMMARY/ ABSTRACT This research proposal will aim to determine outcomes of root canal therapy performed in permanent teeth in a pediatric population with a focus on healthcare disparities, value and the impact of clinician decision-making. This is significant because the most common endodontic procedure, root canal therapy, is performed over 15 million times annually in the US as management for tooth pain and infection. To date, the literature on root canal therapy outcomes in the US is based primarily on adult populations, even as children also undergo root canal therapy. Treatment of the permanent dentition in children differs from that of adults due to anatomical differences and behavioral factors. The most recent information available on endodontic procedure frequency is from the American Dental Association Survey of Dental Services Rendered, conducted in 2005-2006. The lack of information about endodontic procedure utilization, the absence of linkages to patient demographics, and the dearth of robust outcomes analyses for this treatment in a pediatric population highlight the need for updated, rigorous research in this area. To address this gap in knowledge and overcome limitations of previous studies, a mixed-methods approach will be used to evaluate multiple facets of the clinical management of dental pain and infection in children, specifically, 1) quantitative assessment of treatment and outcomes in a large, population-based sample; and 2) qualitative appraisal of clinician treatment planning and decision-making. The specific aims of this career development award are to: 1) evaluate the prevalence and outcomes of root canal therapy of permanent teeth in a pediatric population and determine the factors associated with initial root canal therapy survival using administrative claims data from New York and Massachusetts; 2) Explore dental / emergency room (ER) utilization rates and spending associated with teeth that undergo root canal therapy; and 3) characterize factors affecting clinical decision-making for endodontic treatment of permanent teeth in the pediatric population through semi-structured clinician interviews. We will evaluate the associations of clinical characteristics, such as patient age, tooth type, practitioner type, time to restoration and type of restoration, with outcomes of root canal therapy. We anticipate/expect that disparities will vary by payer type and area- based poverty level and that clinical characteristics are associated with downstream utilization rates and cost of care. The qualitative exploration may reveal that 1) clinician’s comfort and expectations with treating the pediatric population, 2) clinician’s competency performing endodontic treatment, and/or 3) financial incentives are factors in the clinical decision-making process. With an integrated training plan that supports the investigative aims, this grant will provide the PI with the necessary support to become an independent clinician-investigator who investigates the comparative value of dental treatments with regard to outcomes, quality of life, and cost effectiveness.

项目摘要/摘要 该研究建议将旨在确定在恒牙中进行的根管治疗的结果 儿科人群着重于医疗保健分布，价值和临床决策的影响。 这很重要，因为最常见的牙髓方法是根管疗法，在15次以上进行 美国每年在美国作为牙齿疼痛和感染的管理。迄今为止，有关根的文献 美国的运河治疗结果主要基于成人人群，即使儿童也经历了根源 运河疗法。由于解剖学而导致的儿童永久牙列的治疗与成年人的治疗不同 差异和行为因素。有关牙髓过程频率的最新信息 来自2005年至2006年进行的美国牙科协会牙科服务调查。这 缺乏有关牙髓程序利用的信息，缺乏与患者人口统计的联系， 在儿科人群中对这种治疗的强大结果分析的死亡强调了需要 在该领域进行了更新，严格的研究。 为了解决知识的差距并克服以前研究的局限性，混合方法方法 将用于评估儿童牙齿疼痛和感染的临床管理的多个方面， 具体而言，1）基于人群的大型样本中对治疗和结果的定量评估；和2） 定性评估临床治疗计划和决策。 该职业发展奖的具体目的是：1）评估根源的流行和结果 小儿种群中恒牙的运河治疗，并确定与初始根有关的因素 运河治疗使用纽约和马萨诸塞州的行政索赔数据生存； 2）探索牙齿 / 急诊室（ER）利用率和与接受根管治疗的牙齿相关的支出；和 3）表征影响临床决策的因素 通过半结构化临床访谈的儿科人群。我们将评估临床的关联 特征，例如患者年龄，牙齿类型，从业者类型，修复时间和恢复类型， 与根管治疗的结果。我们期望/期望差距会因付款人类型和领域而异 基于贫困水平和临床特征与下游利用率和成本有关 照顾。定性探索可能表明1）临床对待临床的舒适感和期望 儿科人口，2）临床能力执行牙髓治疗，/或3）经济激励措施 是临床决策过程中的因素。 通过支持调查目标的集成培训计划，该赠款将为PI提供 成为独立的临床评估者的必要支持，他研究了 关于结果，生活质量和成本效益的牙科治疗。