STRATEGIES FOR MANAGEMENT OF DENTAL CARIES IN CHILDREN

这项研究建议调查治疗和费用的变化。 北卡罗来纳州医疗补助计划的牙科服务超过7年 在此期间，引入了牙科封闭剂福利。这个 研究的前提是，使用牙科密封剂将 降低儿童的龋齿水平，这是可以测量的 通过减少治疗所需的服务。这 治疗的减少反过来又会对总体 牙科服务的报销。 在项目的初始阶段，在Pilot中构建的数据文件 详细介绍NC医疗补助牙科用户的治疗经验5-17 五年(1984财年至1988财年)的年龄将扩大到 促进为该项目提出的分析。生成的文件将 由从NC Medicaid管理派生的用户数据组成 信息系统与服务提供者的特点及其实践 主要从NC合作健康中心获得的地点 信息系统，注册NC健康专业人员的数据库 由北卡罗来纳大学健康服务研究中心维护。由此产生的 在1983-1990年间，摘要文件将包含每个用户一条记录； 估计有170,000名5-17岁的儿童接受了大约 全科医生1600人，儿科牙医45人。 将使用这些公共数据进行三组不同的分析 解决密封剂使用对服务交付的影响的基地 三个层面-医疗补助计划本身，牙科实践，以及 病人。在第一组分析(目标1)中，中断的时间 按月汇总服务和费用的系列设计将 用于确定程序效果。24个时间序列观测 密封剂覆盖前和60后将用OLS进行分析 回归模型。水平和坡度效果都应作为 将密封剂作为一项福利纳入医疗补助的结果 程序。在第二组(目标#2)中，分析单位转移到 从业者。最初的努力将针对开发一种 基于供应商的费率和对密封剂使用的多方面描述 使用强度、总索赔量和儿童密封年龄。 利用这些发现，将检查1985-1990年间密封剂的使用情况 识别和分类收养行为的类型和相关 各种因素。最后，采用重复测量设计，观察 由年修复率组成的修复率会比较高 密封胶供应商和非(其他)供应商。决赛的目的是 一系列分析(目标3)是研究大约4,000人的队列 密封剂福利后第一磨牙萌出的用户 有效期至少为六个月。描述性和多变量 分析将比较接受和不接受治疗的患者的治疗和费用。 在接下来的5年中，密封胶索赔。进一步的分析将 考虑由密封剂的数量和 对医疗服务提供者临床中潜在的选择偏差的调整 关于密封剂的决定。

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.