ORAL HEALTH AND DIABETES

描述：本研究的主要目的是比较糖尿病患者和 非糖尿病患者的口腔健康状况、牙科服务使用情况和费用 牙科护理。 该设计是一项回顾性研究， Kaiser Permanente Northwest是俄勒冈州波特兰的一家大型健康维护组织。 首席研究员进行了一系列初步研究， 确保使用的数据库1）可用，2）准确，3） 有效的. 这项研究将把来自5个电子数据库的个人数据连接起来， KPNW HMO：1）MIPS，会员信息处理系统， 1982年以来386，000人的记录; 2）KPNW糖尿病 登记处拥有12，755名活跃的HMO成员的记录，可追溯到1988年; 3)拥有所有牙科诊所就诊数据的TEAM数据库， 155，000名成员的程序（没有提供开始日期）; 4）LIS， 实验室信息系统，为医学检验提供了一个完整的基础 实验室程序，包括所有人的结果解释和报告 门诊工作，包括解剖病理学以及临床 实验室测试结果;和5）TOPS，门诊药房系统， 记录了KPNW门诊药房开出的每一张处方 回到1986年。 糖尿病研究小组将从近5,000名成员中选出， 有糖尿病并使用HMO牙科计划的人。 的 比较组将从KPNW成员谁使用卫生组织的牙科 计划 将根据年龄和性别对各组进行分层，并在这些方面进行匹配 特色 从电子数据库中获取的感兴趣的变量包括：1）使用 牙科服务，2）平均就诊次数，3）平均拔牙次数， 4)牙科服务类型的平均数（诊断，预防， 修复、牙周、口腔手术和其他），5）牙科的平均费用 （总体和具体类型的牙科服务），6） 糖尿病控制（通过血红蛋白A1 c和果糖胺（或 糖化蛋白）测试，和7）目前的糖尿病药物。 缺失牙齿和缺牙程度的数据将从 按年龄、性别和种族随机选择的个体的牙科图表 糖尿病组和非糖尿病组。 对300多个国家的初步研究 患者进行了这些放射线和图表的有效性 记录与受过训练的临床医生进行的缺失牙齿计数相比， 考官。 这显示了超过90%的准确性与大多数错误是由于 没有注意到牙科图表中的实际数据。 数据 分析计划和样本量计算均得到充分描述， 确定研究组成部分的样本量， 缺牙和缺牙的数量。 该提案最后提出了一个 关于未来研究和假设生成的部分。

DESCRIPTION: The primary goal of this study is to compare diabetics and non-diabetes regarding oral health status, use of dental services and cost of dental care. The design is a retrospective study utilizing the records of Kaiser Permanente Northwest, a large HMO in the Portland, Oregon area. The principal investigator has conducted a series of preliminary studies to ensure that the databases to be used are 1) available, 2) accurate, and 3) valid. The study will link individuals' data from 5 electronic databases within the KPNW HMO: 1) MIPS, the Membership Information Processing System, which has records on 386,000 individuals dating back to 1982; 2) the KPNW Diabetes Registry which has records on 12,755 active HMO members dating back to 1988; 3) the TEAM Database which has data on all dental office visits and procedures on 155,000 members (no starting date provided); 4) the LIS, the Laboratory Information System, which provides an integrated base for medical laboratory procedures including results interpretation and reporting for all outpatient work including anatomical pathology as well as clinical laboratory test results; and 5) TOPS, The Outpatient Pharmacy System, which records every prescription dispensed by KPNW's outpatient pharmacies dating back to 1986. The study group with diabetes will be drawn from the nearly 5,000 members of this HMO plan who have diabetes and use the HMO's dental plan. The comparison group will be drawn from KPNW members who use the HMO's dental plan. The groups will be stratified on age and gender and matched on these characteristics. Variables of interest to be taken from electronic databases include: 1) use of dental services, 2) mean number of visits, 3) mean number of extractions, 4) mean number of types of dental services (diagnostic, preventive, restorative, periodontal, oral surgery and other), 5) mean costs of dental services (overall and within specific type of dental services), 6) level of diabetic control (as measured by hemoglobin A1c and by the fructosamine (or glycated protein) test, and 7) current diabetic medications. The data for missing teeth and level of edentulism will be obtained from a dental chart of a random sample of individuals selected by age, sex and race from the diabetic and non-diabetic groups. A preliminary study on over 300 patients was conducted of the validity of these radiographic and charting records as compared to counts of missing teeth by a trained clinical examiner. This revealed an accuracy of over 90% with most errors being due to failure to note data that were actually in the dental chart. The data analysis plan is fully described as is the sample size calculation for the determination of sample sizes for the component of the study on both the number of missing teeth and edentulism. The proposal concludes with a section on future studies and hypothesis generation.