Promoting children's oral health: Identifying provider-, practice-, and community-level characteristics associated with delivery of fluoride varnish in medical offices

促进儿童口腔健康：确定与医疗办公室提供氟化物清漆相关的提供者、实践和社区层面的特征

• 批准号: 10668989
• 负责人: Ashley Kranz
• 金额: $ 35.33万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-14 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10668989
• 关键词: Affect; Attitude; Belief; Big Data; Caregivers; Cessation of life; Characteristics; Child; Child Health; Childhood; Communities; Control Groups; Cost Sharing; Data; Data Set; Deductibles; Dental; Dental Care; Dental caries; Dentists; Disease; Eligibility Determination; Emergency department visit; Environment; Fluoride Varnishes; Future; Health; Health Benefit; Health Care Reform; Health Insurance; Health Services; Healthy People 2020; Hospitalization; Insurance Carriers; Interview; Massachusetts; Medicaid; Medical; Methods; Oral health; Pain; Patient Self-Report; Patients; Policies; Preventive; Preventive service; Privatization; Provider; Quality of life; Recommendation; Research; Research Personnel; Risk; Schools; Services; Socioeconomic Status; Statutes and Laws; Surveys; Training; United States Preventative Services Task Force; Visit; Well Child Visits; Work; aged; contextual factors; cost; health plan; improved; informant; medical examination; medical specialties; pediatrician; prevent; primary care provider; programs; provider behavior; rurality

Project Summary Tooth decay is preventable, yet costly. Spending on dental treatment for children totaled $8.7 billion in 2013— making it the fifth most costly child health condition. Preventive oral health services, like fluoride varnish, can prevent tooth decay in young children. However, fewer than 50% of children have an annual dental visit, likely due to cost, dentists’ reluctance to treat young children, and dental workforce shortages. To increase use of preventive oral health services, private health plans and all state Medicaid programs now cover delivery of fluoride varnish in medical offices to all children younger than 6 years. Existing evidence indicates that delivery of fluoride varnish in medical offices increases utilization and reduces decay in publicly insured children. Despite these benefits, few children receive fluoride varnish in medical offices. In 2014, only 5% of eligible children received this service in Massachusetts. Prior studies to identify barriers and strategies have focused on publicly insured children and relied on self-reported provider information, thus a new “big data” approach is needed to identify provider, practice, community-, and policy-level factors affecting delivery of fluoride varnish in medical offices. Our mixed-methods study will use Massachusetts All Payer Claims Dataset, which includes both medical and dental claims for publicly and privately insured children, to (1) describe children receiving preventive oral health services, (2) estimate the causal impact of mandatory medical coverage on children’s receipt of preventive oral health services, (3) examine the mechanisms affecting delivery of preventive oral health services in medical offices, and (4) use a qualitative positive deviance approach to identify strategies and contextual factors promoting or deterring medical providers’ delivery of preventive oral health services.

项目概要 蛀牙是可以预防的，但代价高昂。 2013 年儿童牙科治疗支出总计 87 亿美元—— 使其成为第五大最昂贵的儿童健康疾病。预防性口腔保健服务，例如氟化物清漆，可以 预防幼儿蛀牙。然而，只有不到 50% 的儿童每年都会去看牙医， 由于成本、牙医不愿治疗幼儿以及牙科劳动力短缺。为了增加使用 预防性口腔保健服务、私人健康计划和所有州医疗补助计划现在涵盖提供 在医疗办公室为所有 6 岁以下儿童涂氟化物清漆。现有证据表明交付 在医疗办公室使用氟化物清漆可提高公共保险儿童的利用率并减少腐烂。 尽管有这些好处，但很少有儿童在诊所接受氟化漆。 2014 年，只有 5% 的人符合资格 马萨诸塞州的儿童接受了这项服务。先前识别障碍和策略的研究重点是 针对公共保险儿童并依赖于自我报告的提供者信息，因此一种新的“大数据”方法是 需要确定影响氟化物清漆交付的提供商、实践、社区和政策层面的因素 在医疗办公室。我们的混合方法研究将使用马萨诸塞州所有付款人索赔数据集，其中包括 公共和私人保险儿童的医疗和牙科索赔，以 (1) 描述接受保险的儿童 预防性口腔保健服务，(2) 估计强制性医疗保险对儿童的因果影响 接受预防性口腔保健服务，(3) 检查影响提供预防性口腔保健服务的机制 医疗办公室的卫生服务，以及 (4) 使用定性正偏差方法来确定策略 促进或阻止医疗提供者提供预防性口腔保健服务的背景因素。