Addressing Oral Health Disparities in Medicaid-Enrolled Special Needs Children wi

描述（由申请人提供）：K 08指导临床科学家研究职业发展奖的拟议申请由Donald Chi提交，他是一名牙医，在儿童牙科和牙科公共卫生方面接受过高级临床培训。Chi博士目前是爱荷华州大学口腔健康服务研究的博士候选人。该奖项将使Chi博士能够实现他的长期目标，即成为一名独立资助的临床医生学者，开展跨学科研究计划，解决口腔健康方面的差距，并为有特殊医疗需求的儿童提供牙科护理。他的直接职业目标是通过开发，测试和完善一个新的多层次的概念模型来扩展他的论文研究，为患有慢性病的医疗补助儿童提供牙科护理。池博士提出了以下五个与其职业发展相关的目标：（1）提高对低收入有特殊需要儿童获得护理的概念理解;（2）学习和应用新的基于学科和理论的研究方法;（3）为未来的R 01申请收集试点数据;（4）提高写作技能和专业网络;以及（5）发展导师技能。此外，他将通过以下三个研究目标来测试拟议研究计划的中心假设-医疗保健系统，社区，提供者，家庭和儿童获得牙科护理的决定因素是复杂的，相互关联的，并且根据正在检查的访问类型而具有不同的相对重要性：（1）使用行政数据确定获得医疗补助的慢性病儿童获得牙科护理的多层次决定因素;（2）使用调查数据评估行为因素与接受医疗补助的慢性病儿童获得牙科护理的相关程度;以及（3）使用临床数据评估获得牙科护理与医疗补助登记的慢性病儿童未满足的牙科需求水平之间的关系。这项研究将指导未来的访问研究，并帮助制定多层次的干预措施，以改善患有慢性病的医疗补助儿童的口腔健康。拟议的职业发展和研究活动将在高度支持性的研究密集型环境中进行。Peter Milgrom，DDS和Colleen Huebner，PhD是各自领域的国家专家，也是华盛顿大学牙科学院西北减少口腔健康差异中心的主任，他们将监督Chi博士的研究和职业发展活动。此外，Chi博士还将获得John Neff博士（临床风险评估软件的联合开发者）、Lloyd Mancl博士（生物统计学家）和Elizabeth Momany博士（爱荷华州医疗补助数据专家）的咨询意见。最后，所有活动将由外部咨询委员会监督，该委员会由Jeffrey Murray博士（爱荷华州大学儿科教授）、Peter Damiano博士（爱荷华州大学预防和社区牙科教授）和Diane Martin博士（华盛顿大学卫生服务教授）组成。这个跨机构，跨学科的导师团队将促进池博士从目前的研究经验到指导临床科学家发展阶段，然后到独立的自然发展。 公共卫生相关性：缺乏关于有特殊医疗保健需求的公共保险儿童获得牙科保健的研究。该项目旨在确定和了解获得医疗补助的慢性病儿童获得牙科保健的多层次决定因素。我们的工作将用于制定临床和政策战略，旨在减少口腔健康差距，改善这些弱势儿童的口腔健康。

DESCRIPTION (provided by applicant): The proposed application for a K08 Mentored Clinical Scientist Research Career Development Award is being submitted by Donald Chi, a dentist with advanced clinical training in pediatric dentistry and dental public health. Dr. Chi is currently a PhD candidate in Oral Health Services Research at the University of Iowa. This award will allow Dr. Chi to meet his long-term goal of becoming an independently-funded clinician scholar with an interdisciplinary research program that addresses disparities in oral health and access to dental care for children with special health care needs. His immediate career goal is to extend his dissertation research on access to dental care for Medicaid-enrolled children with a chronic condition by developing, testing, and refining a new multi-level conceptual model on access. Dr. Chi proposes the following five aims related to his career development: (1) improve conceptual understanding of access to care for low-income children with special needs; (2) learn and apply new discipline- and theory-based research methods; (3) collect pilot data for a future R01 application; (4) improve writing skills and professional networks; and (5) develop mentorship skills. In addition, he will test the central hypothesis of the proposed research plan - that the health care system-, community-, provider-, family-, and child-level determinants of access to dental care are complex, interrelated, and vary in relative importance depending on type of access being examined - through the following three research aims: (1) identify the multi-level determinants of access to dental care for Medicaid-enrolled children with a chronic condition using administrative data; (2) evaluate the extent to which behavioral factors are associated with access to dental care for Medicaid-enrolled children with a chronic condition using survey data; and (3) assess the relationship between access to dental care and the level of unmet dental need for Medicaid-enrolled children with a chronic condition using clinical data. This research will guide future studies on access and help in the development of multi-level interventions that will improve the oral health of Medicaid-enrolled children with a chronic condition. The proposed career development and research activities will take place in highly supportive, research-intensive environments. Peter Milgrom, DDS and Colleen Huebner, PhD, national experts in their respective fields and Directors of the Northwest Center to Reduce Oral Health Disparities at the University of Washington School of Dentistry, will supervise Dr. Chi's research and career development activities. In addition, Dr. Chi will receive consulting advice from John Neff, MD (co-developer of Clinical Risk Grouping software); Lloyd Mancl, PhD (biostatistician); and Elizabeth Momany, PhD (Iowa Medicaid data expert). Finally, all activities will be overseen by an External Advisory Committee consisting of Jeffrey Murray, MD (Professor of Pediatrics, University of Iowa); Peter Damiano, DDS, MPH (Professor of Preventive and Community Dentistry, University of Iowa); and Diane Martin, PhD (Professor of Health Services, University of Washington). This cross-institutional, interdisciplinary mentorship team will facilitate Dr. Chi's natural progression from current research experiences to the mentored clinical scientist development phase and then to independence. Public Health Relevance: There is a dearth of research on access to dental care for publicly-insured children with special health care needs. This project seeks to identify and understand the multi-level determinants of access to dental care for Medicaid-enrolled children with a chronic condition. Our work will be used to develop clinical and policy strategies designed to reduce oral health disparities and to improve the oral health of these vulnerable children.