STRATEGIES FOR MANAGEMENT OF DENTAL CARIES IN CHILDREN

本研究旨在调查治疗和支出的变化 北卡罗来纳州医疗补助计划中的牙科服务， 在此期间，引入了牙科密封剂的好处。 的 研究是基于这样一个前提，即使用牙科密封剂将 降低儿童龋齿的水平，这可以通过测量 通过减少治疗所需的服务。 这 减少治疗反过来又会影响整体 牙科服务的报销。 在项目的初始阶段， 详细介绍NC Medicaid牙科用户治疗经验的工作5-17 五年期（1984 - 1988财政年度）的年龄将扩大到 为该项目的分析提供便利。 生成的文件将 由来自NC Medicaid Management的用户数据组成 信息系统和供应商的特点及其实践 主要从NC获得的位置 Cooperative Health 信息系统，获得许可的NC卫生专业人员的数据库 由美国健康服务研究中心维护。 所得 摘要文件将包含1983-1990年期间每个用户的一个记录; 估计有170 000名5至17岁的儿童接受了大约 1600名全科医生和45名儿科牙医。 将使用这些通用数据进行三组单独的分析 基地，以解决密封剂的使用对提供服务的影响， 三个层次-医疗补助计划本身，牙科实践， 患者 在第一组分析（目标#1）中， 按月汇总服务和费用的系列设计将 用于确定方案效果。 24个时间序列观察 密封剂覆盖前和密封剂覆盖后60天将用OLS进行分析 回归模型 水平和坡度效应都是预期的， 将密封剂作为一项福利纳入医疗补助计划的结果 程序. 在第二组（目标#2）中，分析单位转移到 从业者。 初步的努力将针对发展一个 基于供应商费率的密封剂使用的多方面描述， 使用强度、总索赔量和封存儿童的年龄。 利用这些发现，将审查1985年至1990年密封剂的使用情况 识别和分类收养行为的类型， 因素 最后，使用重复测量设计，观察 包括年增长率，将比较高 密封剂供应商和非（其他）供应商。 决赛的目的 一系列分析（目标3）是研究一个约4000人的队列 使用者谁有第一磨牙爆发后，密封剂的好处已经 有效期至少六个月 描述性和多变量 分析将比较治疗和费用的那些与没有 在随后的5年里，密封剂索赔。 进一步分析将 考虑密封剂数量引起的“剂量反应”效应， 对提供者临床治疗中潜在的选择偏差进行调整 有关密封剂的决定。

This study proposes to investigate changes in treatment and expenditures for dental services in the North Carolina Medicaid program over a 7-year period during which time a dental sealant benefit was introduced. The research is based on the premise that the use of dental sealants will reduce the level of dental caries in children, which can be measured through a reduction in those services necessary for its treatment. This reduction in treatment will in turn have an impact on overall reimbursements for dental services. In the initial phases of the project, a data file constructed in pilot work detailing the treatment experience of NC Medicaid dental users 5-17 years of age for a five-year period (FY1984-FY1988) will be expanded to facilitate analyses proposed for this project. The resulting file will consist of user data derived from the NC Medicaid Management Information System and characteristics of providers and their practice locations obtained primarily from the NC Cooperative Health Information System, a data base of licensed NC health professionals maintained by the UNC Health Services Research Center. The resulting summary file will contain one record per user during 1983-1990; an estimated 170,000 children 5-17 years of age treated by approximately 1600 general practitioners and 45 pediatric dentists. Three separate sets of analyses will be conducted using this common data base to address the impact of sealant use on the delivery of services at three levels-the Medicaid program itself, dental practices, and patients. In the first set of analyses (Aim #1) an interrupted time series design in which services and charges are aggregated by month will be used to determine program effects. 24 time series observations before sealant coverage and 60 after will be analyzed with OLS regression models. Both level and slope effects are expected as a result of the inclusion of sealants as a benefit in the Medicaid program. In the second set (Aim #2), the unit of analysis shifts to the practitioner. Initial efforts will be directed toward developing a multi-faceted description of sealant use based on providers' rate and intensity of use, overall claims volume, and age of children sealed. Using these findings, use of sealants from 1985 to 1990 will be examined to identify and classify types of adoption behaviors and associated factors. Finally, using a repeated measures design, observations consisting of annual rates of restorations will be compared between high sealant providers and non--(other)providers. The purpose of the final series of analyses (Aim #3) is to study a cohort of approximately 4,000 users who had first molars erupting after the sealant benefit has been in effect for at least six months. Descriptive and multivariate analyses will compare treatments and costs of those with and without a sealant claim during the subsequent 5 years. Further analyses will consider a "dose-response" effect resulting from number of sealants and an adjustment for potential selection bias in the providers' clinical decisions concerning sealant.