Effectiveness and improvement of rural, school-based, caries prevention programs

说明(申请人提供)：我们建议采用比较有效性和质量改进的方法来改善口腔健康和降低农村校本龋齿预防项目的成本。我们将检验综合防龋法比增量防龋法更有效的假设。意义：龋齿是一种可以预防的细菌感染，但25%的美国学龄儿童患有未经治疗的龋齿--是哮喘的五倍。农村、种族和少数民族人口的患病率翻了一番。疾病控制和预防中心建议的有效预防干预措施是可用的。然而，它们往往没有得到充分利用，很少对临床效果进行评估。方法：采用队列设计，纵向评价和比较农村小学综合防龋制和增量防龋制。使用这些比较数据，我们将为临床和成本效益生成、实施和测试口腔健康改善模型。具体目标：1)制定程序手册，使用NHANES诊断标准标准化和校准龋齿诊断，实施用于记录、提交和分析的电子可读表格。2)比较评估临床和成本效益，模式最佳护理和时机，以及导师站点改进计划。3)建立防龋备选模型数据库，并开放该数据库供临床和科研使用。影响和创新：据我们所知，这将是第一个具有广度和深度的比较有效性研究(包括经济评估)，以确定和传播有效的预防方案。一个额外的好处是创建了一个丰富的数据库，用于在其他地点建立预防模型。环境和调查人员：福赛斯有一个世纪的历史。哈佛大学附属口腔健康研究所。我们将把这位天才和 波士顿大学数据协调中心和基于学校的龋齿预防项目服务于4个州10个农村县的67所学校的约10,000名儿童。 公共卫生相关性：相关性(见说明)：该项目采用相对有效性和质量改进方法，以改善农村学校为基础的龋齿预防计划中的口腔健康并降低成本。与城市人口相比，农村人口的需求是巨大的。农村人口人均牙医更少，水中加氟更少，保险费率更低，出行距离更远，贫困率更高，所有这些都增加了 更高的龋齿发生率。

DESCRIPTION (provided by applicant): We propose to improve oral health and reduce costs of rural school-based caries prevention programs using comparative effectiveness and quality improvement methods. We will test the hypothesis that comprehensive caries prevention is more effective than incremental prevention. Significance: Caries is a preventable bacterial infection, yet 25% of U.S. school children have untreated decay - five-times more than asthma. The prevalence doubles for rural, racial and ethnic minority populations. Effective preventive interventions, recommended by the Centers for Disease Control and Prevention, are available. However, they are often underused and rarely evaluated for clinical effectiveness. Approach: Using a cohort design, we will longitudinally evaluate and compare comprehensive and incremental caries prevention programs in rural elementary schools. Using this comparative data we will generate, implement and test oral health improvement models for clinical and cost-effectiveness. Specific Aims: 1) Develop a manual of procedures, standardize and calibrate caries diagnosis using NHANES diagnostic criteria, implement electronic readable forms for recording, submission, and analysis. 2) Comparatively evaluate clinical and cost-effectiveness, model optimal care and timing, and mentor site improvement programs. 3) Create a data base to generate alternate models for caries prevention and open this data base for clinical and research use. Impact and Innovation: To our knowledge, this will be the first comparative effectiveness study (including economic assessment) with the breadth and depth to identify and disseminate effective prevention protocols. An added benefit will be the creation of a rich data base for modeling prevention in other locations. Environment and Investigators: Forsyth is a century old. Harvard affiliated, oral health research institute. We will marry this talent with the Boston University Data Coordinating Center and school-based caries prevention programs serving ~10,000 children in 67 schools, in 10 rural counties, in 4 states. PUBLIC HEALTH RELEVANCE: RELEVANCE (See Instructions): This project employs comparative effectiveness and quality improvement methods to improve oral health and reduce costs in rural school-based cavity prevention programs. The need in rural compared to urban populations is great. Rural populations have fewer dentists per population, less water fluoridation, lower insurance rates, greater travel distances, higher poverty rates, all adding to higher rates of dental cavities.