Root Canal Therapy in Children: Analysis of Disparities and Value

项目概要/摘要 本研究计划旨在确定恒牙根管治疗的结果， 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。 这是很重要的，因为最常见的牙髓手术，根管治疗，是在15岁以上进行的。 在美国，每年有100万次用于治疗牙痛和感染。到目前为止，关于根的文献 在美国，根管治疗的结果主要基于成年人群，即使儿童也接受根管治疗， 根管治疗儿童恒牙列的治疗与成人不同， 差异和行为因素。关于根管治疗频率的最新信息 来自美国牙科协会2005-2006年进行的牙科服务调查。的 缺乏关于根管治疗程序利用的信息，缺乏与患者人口统计学的联系， 在儿科人群中缺乏对这种治疗的可靠结果分析，这突出了需要 在这一领域的最新、严格的研究。 为了解决这一知识差距，克服以往研究的局限性， 将用于评估儿童牙痛和感染的临床管理的多个方面， 具体而言，1）在一个大的、基于人群的样本中对治疗和结局进行定量评估;以及2） 临床医生治疗计划和决策的定性评估。 该职业发展奖的具体目标是：1）评估root的流行程度和结果 儿童恒牙的根管治疗，并确定与初始根相关的因素 使用纽约和马萨诸塞州的行政索赔数据的根管治疗生存率; 2）探索牙科/ 急诊室（ER）使用率和与接受根管治疗的牙齿相关的支出;以及 3)影响恒牙根管治疗临床决策的因素 儿科人群通过半结构化的临床医生访谈。我们将评估与临床 特征，例如患者年龄、牙齿类型、医生类型、修复时间和修复类型， 根管治疗的效果我们预计/预期差异将因付款人类型和地区而异- 基于贫困水平，临床特征与下游利用率和成本相关 照顾。定性研究可能揭示：1）临床医生对治疗的舒适度和期望 儿童人群，2）临床医生进行根管治疗的能力，和/或3）经济激励 是临床决策过程中的因素。 通过支持调查目标的综合培训计划，该补助金将为PI提供 必要的支持，成为一个独立的临床研究者谁调查的比较价值， 牙科治疗的结果，生活质量和成本效益。

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.