Assessing contribution of the dental care system to oral health care disparities

评估牙科保健系统对口腔保健差异的贡献

• 批准号: 7694339
• 负责人: Nadereh Pourat
• 金额: $ 12.41万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-30 至 2011-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7694339
• 关键词: Address; Area; Caring; Categories; Characteristics; Child; Clinic; Communities; Data; Databases; Dental; Dental Care; Dental Care Delivery; Dental Insurance; Dental Staff; Dentists; Disadvantaged; Education; Elderly; Employment; Fees; Funding; Geographic Locations; Goals; Health Professional; Health Services Accessibility; Healthcare; Human Resources; Improve Access; Individual; Insurance; Length; Link; Location; Logistic Regressions; Low income; Measures; Medical; Modeling; Oral health; Play; Policies; Population; Private Practice; Provider; Research; Role; Services; Socioeconomic Factors; Socioeconomic Status; Solutions; Subgroup; Surveys; System; Time; Underserved Population; Visit; base; care systems; cost; design; discount; falls; health disparity; innovation; population based; population survey; programs; racial and ethnic

DESCRIPTION (provided by applicant): Limited access to dental care exacerbates oral health care disparities in underserved populations. The barriers in access at the individual level have been explored to a large extent; however, the impact of the dental care system on access is poorly understood. Reduced access has been linked to a lower overall supply of dentists, but little is known about the relationship between the specific characteristics of dental providers, such as education and practice setting, and access. The specific aims of this project are: 1) to assess the impact of dentist characteristics on access to dental care of underserved populations; and 2) to assess the potential differences in impact of dentist characteristics on specific categories of the underserved, such as children, low- income, and racial/ethnic populations. Using Andersen's conceptual framework of access to care, it is hypothesized that access to dental care is influenced by the context in which dental care is delivered, or the dental care system, in addition to individual characteristics. Measures of the dental care system are primarily conceptualized as personal and practice characteristics of dentists in the medical study service area where individuals reside. The data for this study include an existing population-based survey of individuals, an existing representative survey of dentists in private practice, and existing administrative data. The dependent variables (length of time since last dental visit and unmet dental care) and individual level independent variables will be obtained from the population survey. Independent variables measuring personal and practice characteristics of dentists will be obtained from the dentist survey. Examples of the latter measures are percentages of private practice dentists in the medical study service area who accept discounted fees, participate in public insurance programs, or have large practices (as indicated by number of various personnel and multiple practice locations). Additional independent variables on supply or availability of other dental care providers will be obtained from administrative data (e.g. designation of dental health professional shortage area, number of visits to community-based clinics). The impact of dentist characteristics on access will be examined in multinomial and dichotomous logistic regression models, controlling for individual and other predictors of access to dental care. Both models will be stratified by subgroups of underserved populations to assess potential differences in predictors of access among groups. Improving access to dental care is the solution most likely to reduce observed disparities in oral health of underserved populations. Research that identifies systemic barriers in access to care of the underserved populations is needed to inform policies designed to diminish oral health disparities. Project Narrative: Relevance Statement Improving access to dental care is the solution most likely to reduce observed disparities in oral health of underserved populations. Research that identifies systemic barriers in access to care of the underserved populations is needed to inform policies designed to diminish oral health disparities.

描述(由申请人提供)：有限的获得牙科保健的机会加剧了服务不足人群的口腔保健差距。已在很大程度上探索了个人层面的获取障碍；然而，人们对牙科保健系统对获取的影响知之甚少。获得机会的减少与牙医总供应量的减少有关，但人们对牙科提供者的具体特征(如教育和执业环境)与获得机会之间的关系知之甚少。该项目的具体目标是：1)评估牙医特征对服务不足人群获得牙科保健的影响；2)评估牙医特征对儿童、低收入和种族/族裔人群等特定类别服务不足人群的潜在影响差异。利用安徒生的获得保健的概念框架，假设获得牙科保健的机会除了个人特征外，还受到提供牙科保健的背景或牙科保健系统的影响。牙科保健系统的措施主要被概念化为个人居住的医学研究服务区中牙医的个人和实践特征。这项研究的数据包括现有的基于人口的个人调查，现有的对私人执业牙医的代表性调查，以及现有的管理数据。因变量(自上次牙科就诊以来的时间长短和未满足的牙科护理)和个体水平的自变量将从人口调查中获得。衡量牙医个人特征和执业特征的自变量将从牙医调查中获得。后一种措施的例子是医学研究服务领域中接受折扣费用、参加公共保险计划或拥有大量业务的私人执业牙医的百分比(由各种人员的数量和多个执业地点表示)。关于其他牙科保健提供者的供应或可获得性的其他独立变量将从行政数据中获得(例如，指定牙科保健专业人员短缺的地区、到社区诊所就诊的次数)。牙医特征对可获得性的影响将通过多项式和二分Logistic回归模型进行检验，控制个体和其他预测因素获得牙科护理。这两种模型都将按服务不足人群的亚群进行分层，以评估不同群体之间在可获得性预测因素方面的潜在差异。改善获得牙科保健的机会是最有可能减少服务不足人群口腔健康方面的差距的解决办法。需要进行研究，找出获得服务不足人群护理的系统性障碍，以便为旨在缩小口腔健康差距的政策提供信息。项目简介：相关性陈述改善获得牙科护理的机会是最有可能减少服务不足人群口腔健康方面观察到的差异的解决方案。需要进行研究，找出获得服务不足人群护理的系统性障碍，以便为旨在缩小口腔健康差距的政策提供信息。