Dental Sealant Placements on Children's Teeth: Assessing Medicaid Policy Change

描述（由申请人提供）：龋齿是一种慢性疾病，也是影响儿童口腔健康相关生活质量和福祉的最常见的可预防牙科疾病。充分获得预防性牙科手术仍然是参加医疗补助计划的儿童面临的一个挑战。放置牙科密封剂是一种基于证据的预防程序，将一层薄塑料涂层粘合到前磨牙和磨牙的深沟，窝和裂缝表面，以防止龋齿（蛀牙）。尽管有证据证明牙科密封剂放置的功效，成本效益和益处，但它们仍然没有得到充分利用。2006年，威斯康星州医疗补助计划改变了其政策，允许牙科医生在学校的设置，成为医疗补助认证的提供者，为牙齿密封剂的安置。目前还不清楚这一政策变化是否导致了威斯康星州医疗补助登记儿童获得和使用牙科密封剂的明显增加，以及第一磨牙修复护理的减少。该项目的目标是评估这项政策是否 公共卫生计划和系统的变化影响了被认为是龋齿高风险儿童的获得、口腔健康差异和牙科密封剂使用率。这项研究将使用2004年至2013年医疗补助索赔数据，从电子数据系统的医疗补助评估和决策支持（MEDS）数据库的威斯康星州。使用威斯康星州医疗补助索赔数据，我们将：1）评估医疗补助登记儿童在政策前后的牙科密封剂放置的总体使用率; 2）使用城市影响代码检查患者的社会人口统计学、提供者特征、牙科健康专业区（DHPSA）指定和县级特征对牙科密封剂使用的关联;以及3）测试放置在第一磨牙上的密封剂与第一磨牙的修复治疗之间随时间的关联。描述性统计和多元回归模型将用于估计政策变化对符合医疗补助条件的儿童首次接受牙科封闭剂和修复治疗的比率的影响。 臼齿我们将控制所有可用的协变量，包括儿童居住的县、年龄和 年这项研究将记录与政策变化有关的变量，对公共卫生服务系统的影响，以及卫生专业人员旨在消除健康差距的合作实践的好处。这个二级数据分析项目是创新的，解决了口腔保健的差异，并提供了文件，是支持社区为基础的努力，旨在改善口腔健康。该项目的发现可能会影响该政策未来扩展到其他尚未采用该政策的州，提高人们对密封剂作为预防措施的好处的认识，并促进公共卫生计划的发展。

DESCRIPTION (provided by applicant): Dental caries is a chronic condition and the most common preventable dental disease affecting children's oral health-related quality of life and well-being. Adequate access to preventive dental procedures remains a challenge for Medicaid-enrolled children. Placement of dental sealants is an evidence-based preventive procedure where a thin plastic coating is bonded into the deep grooves, pits and fissure surfaces of premolar and molar teeth to prevent dental caries (tooth decay). Despite documented evidence of the efficacy, cost-effectiveness and benefits of dental sealant placement, they still remain underutilized. In 2006, the Wisconsin Medicaid program changed its policy to allow dental hygienists in school based settings, to become Medicaid certified providers for dental sealant placement. It is unclear whether this policy change has resulted in an appreciable increase in access and utilization of dental sealants as well as reduced restorative care on first molars for Medicaid- enrolled children in Wisconsin. The goal of this project is to assess whether this policy change in a public health program and system has influenced access, oral health disparities and rates of dental sealant utilization in children considered to be at high risk for dental caries. Ths study will use Medicaid claims data for 2004 to 2013 from the Electronic Data Systems of Medicaid Evaluation and Decision Support (MEDS) database for the state of Wisconsin. Using the Wisconsin Medicaid Claims data we will: 1) assess the overall utilization rates of dental sealant placement among Medicaid- enrolled children pre- and post-policy period; 2) examine the association of patients' socio- demographics, provider characteristics, designation of Dental Health Professional Area (DHPSA) and county level characteristics using Urban Influence Codes on the utilization of dental sealants; and 3) test the association between sealants placed on first molars and restorative treatment for first molars over time. Descriptive statistics and multivariate regression models will be used to estimate the effect of the policy change on the rate at which Medicaid-eligible children receive dental sealants and restorative treatment on first molars. We will control for all available covariates including child's county of residence, age and year. The study will document relevant variables associated with the policy change and the effect on public health service systems and the benefit of collaborative practice of health professionals aimed at eliminating health disparities. This secondary data analysis project is innovative, addresses oral health care disparities and provides documentation that is supportive of community-grounded efforts aimed at improving oral health. Findings from this project may influence future expansion of the policy to other states yet to adopt it, increase awareness about the benefits of sealants as a preventive measure and promote public health program development.