Root Canal Therapy in Children: Analysis of Disparities and Value

项目摘要/摘要 这项研究提案旨在确定在恒牙中进行根管治疗的结果。 儿科人群，重点关注医疗保健差异、价值和临床医生决策的影响。 这一点很重要，因为最常见的牙髓治疗程序，即根管治疗，是在15岁以上进行的。 在美国，每年有数百万次用于治疗牙齿疼痛和感染。到目前为止，关于根的文献 在美国，根管治疗的结果主要是基于成人人群，即使儿童也接受根管治疗 渠道疗法。由于解剖学原因，儿童恒牙列的治疗与成人不同 差异和行为因素。有关根管治疗频率的最新信息 来自2005-2006年间进行的美国牙科协会牙科服务调查。这个 缺乏有关牙髓治疗程序使用情况的信息，缺乏与患者人口统计数据的联系， 在儿科人群中，缺乏对这种治疗方法的强有力的结果分析，这突显了 在这一领域进行最新的、严谨的研究。 为了解决这一知识差距并克服以前研究的局限性，采用混合方法 将用于评估儿童牙科疼痛和感染的临床管理的多个方面， 具体地说，1)在以人口为基础的大样本中对治疗和结果进行定量评估；以及2) 临床医生治疗计划和决策的定性评价。 这个职业发展奖的具体目的是：1)评估根的患病率和结果 儿童恒牙的根管治疗及其影响因素的研究 使用纽约和马萨诸塞州的行政索赔数据进行根管治疗存活；2)探索牙科/ 与接受根管治疗的牙齿相关的急诊室使用率和费用；以及 3)描述影响恒牙根管治疗临床决策的因素 通过半结构化临床医生访谈的儿科人群。我们将评估与临床相关的 特征，如患者年龄、牙齿类型、医生类型、修复时间和修复类型， 与根管治疗的结果相关。我们预计支付者类型和地区的差异将有所不同- 基于贫困水平，临床特征与下游使用率和成本相关 关爱。定性的探讨可以揭示1)临床医生对治疗的舒适度和期望值 儿科人群，2)临床医生进行牙髓治疗的能力，和/或3)经济激励 是临床决策过程中的因素。 凭借支持调查目标的综合培训计划，这笔赠款将为私家侦探提供 必要的支持，以成为一名独立的临床医生-研究员，研究 关于结果、生活质量和成本效益的牙科治疗。

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.