PREVENTION OF EARLY CHILDHOOD CARIES IN MEDICAL PRACTICE

这项研究的目的是评估一项已经资助并正在进行的干预措施，以预防低收入家庭儿童的幼儿期龋病(ECC)。干预行动于2000年1月在北卡罗来纳州的10个县开始。儿科医生和护士正在提供预防性牙科服务，包括为36个月以下的婴儿和幼儿进行筛查和氟化物清漆应用，以及为他们的主要照顾者提供健康教育。社区协调员帮助确保在9个月大的时候进行第一次探访，此后每隔6个月进行一次探视。准实验设计将使用来自10个匹配县的信息进行比较。这项评估由三项独立的研究组成，旨在确定干预对ECC结果的影响。在第一项研究中，将通过比较900名3岁儿童和对照组儿童的非空洞和空洞龋损的患病率和严重程度来确定干预的短期有效性。这些儿童在9个月大时开始干预。来自干预县和对照县的历史控制将解释ECC的长期趋势。对照顾者的访谈将提供控制变量和次要结果，包括知识、行为和生活质量。第二项研究将在干预结束两年后，确定干预对5岁儿童ECC的残留影响。其理由是需要知道，在儿童不再有资格参加以学校为基础的预防性牙科项目之前，早期以医学为基础的干预措施是否会继续产生结果。来自幼儿园学生公共健康监测的龋病增量，包括20个研究县8000名学生中的95%，将与第一项研究中观察到的儿童的干预和控制，以及4年前的同期对照和历史对照进行比较。将使用Medicaid和CHIP牙科索赔来测试基于医疗的干预措施和牙医提供的预防性服务之间的相互作用。第三项研究将确定针对1岁和2岁儿童的ECC干预措施对3岁和4岁儿童的累积龋齿相关(CR)治疗和医疗补助和CHIP计划提供的牙科服务成本的影响。医院使用的可能性将与CR治疗总额和费用分开分析，因为它的费用。大多数分析将侧重于净干预费用(社区推广和提供者补偿)是否被CR治疗费用的减少所抵消。我们将对与口腔健康相关的生活质量进行有限的成本评估。

The purpose of this research is to evaluate an already funded and ongoing intervention to prevent early childhood caries (ECC) in children of low-income families. The intervention began in 10 North Carolina counties in Jan 2000. Pediatricians and nurses are providing preventive dental services, including screening and fluoride varnish applications for infants and toddlers up to 36 months of age, and health education for their primary caregivers. Community coordinators help ensure the fist visit at 9 months of age and at six-month intervals thereafter. The quasi-experimental design will use information from 10 matched counties for comparison. The evaluation consists of three separate studies designed to determine the impact of the intervention on ECC outcomes. In the first study, short-term effectiveness of the intervention will be determined by comparing the prevalence and severity of noncavitated and cavitated carious lesions in 900 3-year-olds, who began the intervention at 9 months of age, with children from the control group. Historical controls from the intervention and comparison counties will account for secular trends in ECC. An interview of caregivers will provide control variables and secondary outcomes, including knowledge, behaviors and quality of life. The second study will determine carryover effects of the intervention on ECC in children 5 years of age, two years after their participation in the intervention ends. Its justification is the need to know if results from early, medical-based interventions continue after children are no longer eligible and before they enroll in school-based preventive dentistry programs. Caries increments derived from public health surveillance of kindergarten students, which includes 95 percent of the 8,000 students in the 20 study counties, will be compared for intervention and control children who were observed in the first study, as well as concurrent controls and historical controls from 4 years before. Interactions between the medical-based interventions and preventive services provided by dentists will be tested using Medicaid and CHIP dental claims. The third study will determine the effects of the ECC interventions for 1- and 2- year-olds on cumulative caries-related (CR) treatment and costs of dental services provided by the Medicaid and CHIP programs through 3 and 4 years of age. The likelihood of hospital use will be analyzed separately from total CR treatment and costs because of its expense. Most analyses will focus on whether net intervention costs (community outreach and provider reimbursements) are offset by reductions in CR treatment costs. We will do a limited assessment of the cost pe oral health- related quality of life.