First preventive dental visit: Disparities in needs, costs + behavioral insights

首次预防性牙科就诊：需求差异、成本行为洞察

• 批准号: 7811018
• 负责人: PETER C DAMIANO
• 金额: $ 45.79万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-25 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7811018
• 关键词: 6 year old; Address; Affect; Age; Area; Attention; Behavior; Behavioral; Birth; Caring; Child; Chronic; Community Health Centers; Counseling; Country; Data; Databases; Decision Making; Dental; Dental Care; Dental caries; Dentists; Effectiveness; Electronic Health Record; Enrollment; Ethnic Origin; Evaluation; Focus Groups; Funding Agency; Future; Goals; Health Occupations; Health Services Accessibility; Health Services Research; Health Status; Home environment; Intervention; Iowa; Knowledge; Lead; Life; Medicaid; Medical; Medical Care Costs; Minority Groups; Modeling; Mothers; Nursery Schools; Oral health; Outcome; Parenting Education; Parents; Population; Preschool Child; Preventive; Provider; Psychosocial Factor; Public Policy; Race; Research; Research Personnel; Research Project Grants; Risk; Rural; Severities; Surveys; Survival Analysis; Time; Underserved Population; United States; Visit; Work; administrative database; behavioral/social science; care seeking; checkup examination; cost; data collection methodology; design; early childhood; health belief; health disparity; high risk; improved; insight; interdisciplinary approach; interest; parallel processing; parental influence; prevent; programs; psychosocial; public health relevance; public health research; social; socioeconomics; therapy design; treatment planning

DESCRIPTION (provided by applicant): This application addresses the broad challenge area: Health Disparities (09); Challenge Topic: Behavioral and Social Sciences to Reduce Oral Health Disparities (09-DE-101). Title: First preventive dental visit: Disparities in needs, costs + behavioral insights This study investigates the predictors and outcomes of age at first preventive dental visit (AFPDV) for Medicaid-enrolled children-a dentally underserved population. The age when a child receives their first dental check-up helps establish a dental home for the child and provides important preventive counseling for the mother. Medicaid-enrolled children are known to have less access to dental care. Of particular interest in this study are five Medicaid subpopulations at high risk of disparities in access to dental care and resulting oral health status: 1) Racial and ethnic minority children, 2) Rural children, 3) Children in federally designated Dental Health Professions Shortage Areas (HPSAs), 4) Children with less access to medical care and associated well child visits, and 5) Children who receive care at a Community Health Center (CHC). Since one in four children in the United States are enrolled in Medicaid, this study could potentially impact a large population of the most vulnerable children in the country. We are proposing a multifaceted, interdisciplinary set of studies to explore this issue: Study 1: Determinants of the age at first preventive dental visit for Medicaid-enrolled children. The first study investigates the predictors of age at first preventive dental visit using Iowa Medicaid claims data for preschool age children who were enrolled in the program within a month of birth in 2004. We will follow these children in the claims database until they have their first preventive dental visit, are no longer enrolled in Medicaid or turn six years old. Factors previously identified in dental use models will be included in these analyses with the added factor of utilization of well-child visits. We will use survival analyses to model these relationships. Study 2: An evaluation of the effectiveness of earlier FPDVs on the need for dental care at the first visit and the successful completion of treatment plans for Medicaid-enrolled children who sought care at a CHC in Iowa. Chart reviews will be used to find out how the needs of children at the time of their first dental visit and whether AFPDV affects outcomes, in particular, the completion of the treatment plan. The chart reviews will be performed at 9 Community Health Centers (CHCs) with electronic health records for 270 children in Iowa. Study 3: Impact of the AFPDV on future dental and medical care utilization and costs. Iowa Medicaid claims and administrative data will be used to determine if AFPDV affects future dental and medical care costs for preschool children. Using instrumental variable analyses we will model the factors related to dental use and cost with special attention to AFPDV. Study 4: Using the Health Belief Model and the Extended Parallel Process Model to determine factors associated with mothers' decision-making and preventive dental care seeking behavior related to FPDV. Focus groups will be used to help us understand what factors encourage and discourage parents from taking their children for preventive dental care. The results of these three studies will serve to inform the contents of a survey of parents with children in Medicaid. Previous results will help us to include the most critical factors and tailor the surveys to issues important to parents with children in Medicaid. These surveys will be designed to find out what prompts parents to take their children to the dentist for their first preventive dental visit and what might discourage them from preventive dental care. These data will be analyzed with OLS regression to determine what psycho-social factors are related to AFPDV. Goal: This program of research is designed to help us understand the most effective age for the first preventive dental visit. This work ultimately culminates in the design of an intervention with parents and providers to encourage the effective timing of children's first preventive dental visit. This study builds on extensive previous research by this team who has demonstrated the ability to successfully conduct studies regarding dental care for underserved children combining these large administrative databases and primary data collection methodologies. PUBLIC HEALTH RELEVANCE: This research project will investigate the predictors and outcomes of preschool age children's first preventive dental visit, improving our understanding of how age at first preventive dental visit is affected by the psychosocial, behavioral, and social factors and affects the outcomes of dental care over time. We will use this information to design an intervention to encourage the appropriate timing of a child's first preventive dental visit through education of the parent and providers.

描述（由申请人提供）：该应用程序解决了广泛的挑战领域：健康差异（09）；挑战主题：减少口腔健康差异的行为和社会科学 (09-DE-101)。标题：首次预防性牙科就诊：需求、成本和行为见解的差异 这项研究调查了参加医疗补助计划的儿童（牙科服务不足的人群）首次预防性牙科就诊 (AFPDV) 年龄的预测因素和结果。孩子第一次接受牙科检查的年龄有助于为孩子建立牙科之家，并为母亲提供重要的预防咨询。众所周知，参加医疗补助的儿童获得牙科护理的机会较少。本研究特别感兴趣的是在获得牙科护理和由此产生的口腔健康状况方面存在差异的高风险的五个医疗补助亚人群：1) 种族和少数民族儿童，2) 农村儿童，3) 联邦政府指定的牙科健康职业短缺地区 (HPSA) 的儿童，4) 获得医疗护理和相关儿童保健机会较少的儿童，以及 5) 在社区健康中心 (CHC) 接受护理的儿童。由于美国四分之一的儿童参加了医疗补助计划，这项研究可能会影响该国大量最弱势的儿童。我们提议进行一系列多方面、跨学科的研究来探讨这个问题：研究 1：参加医疗补助计划的儿童首次预防性牙科就诊年龄的决定因素。第一项研究使用爱荷华州医疗补助报销数据对 2004 年出生一个月内加入该计划的学龄前儿童调查首次预防性牙科就诊年龄的预测因素。我们将在报销数据库中跟踪这些儿童，直到他们进行第一次预防性牙科就诊、不再加入医疗补助或年满六岁。先前在牙科使用模型中确定的因素将包含在这些分析中，并增加了儿童就诊利用的因素。我们将使用生存分析来模拟这些关系。研究 2：评估早期 FPDV 对首次就诊时牙科护理需求的有效性，以及对在爱荷华州 CHC 寻求护理的参加医疗补助的儿童成功完成治疗计划的有效性。图表审查将用于了解儿童在第一次看牙医时的需求以及 AFPDV 是否影响结果，特别是治疗计划的完成。图表审查将在爱荷华州 9 个社区健康中心 (CHC) 进行，这些中心拥有 270 名儿童的电子健康记录。研究 3：AFPDV 对未来牙科和医疗护理利用及成本的影响。爱荷华州医疗补助索赔和管理数据将用于确定 AFPDV 是否影响学龄前儿童未来的牙科和医疗护理费用。使用工具变量分析，我们将对与牙科使用和成本相关的因素进行建模，特别关注 AFPDV。研究 4：使用健康信念模型和扩展并行过程模型来确定与 FPDV 相关的母亲决策和预防性牙科护理寻求行为相关的因素。焦点小组将用于帮助我们了解哪些因素鼓励和阻止父母带孩子进行预防性牙科护理。这三项研究的结果将为一项针对医疗补助中有孩子的父母的调查内容提供信息。之前的结果将帮助我们纳入最关键的因素，并针对对医疗补助中有孩子的父母重要的问题进行调查。这些调查旨在找出是什么促使父母带孩子去看牙医进行第一次预防性牙科检查，以及什么可能阻止他们进行预防性牙科护理。这些数据将通过 OLS 回归进行分析，以确定哪些心理社会因素与 AFPDV 相关。目标：该研究计划旨在帮助我们了解首次预防性牙科就诊的最有效年龄。这项工作最终与家长和医疗服务提供者一起设计了一项干预措施，以鼓励儿童有效地选择第一次预防性牙科就诊的时间。这项研究建立在该团队之前的广泛研究的基础上，该团队已证明有能力结合这些大型管理数据库和主要数据收集方法成功地开展有关服务不足儿童牙科护理的研究。 公共卫生相关性：该研究项目将调查学龄前儿童首次预防性牙科就诊的预测因素和结果，提高我们对首次预防性牙科就诊年龄如何受到社会心理、行为和社会因素的影响以及随着时间的推移影响牙科护理结果的理解。我们将利用这些信息来设计一项干预措施，通过对家长和提供者进行教育，鼓励孩子在适当的时间进行第一次预防性牙科就诊。