ORAL HEALTH AND DIABETES

描述：这项研究的主要目标是比较糖尿病患者和 非糖尿病患者的口腔健康状况、牙科服务使用情况和费用 牙科护理。设计是一项利用记录的回溯性研究 Kaiser Permanente Northwest是俄勒冈州波特兰地区的一家大型医疗保健组织。 首席调查员进行了一系列初步研究，以 确保要使用的数据库1)可用，2)准确，3) 有效。 这项研究将把来自5个电子数据库的个人数据连接到 KPNW HMO：1)MIPS，会员信息处理系统，具有 追溯到1982年的386,000人的记录；2)KPNW糖尿病 自1988年以来拥有12,755名HMO活跃成员记录的登记处； 3)团队数据库，其中包含所有牙科诊所就诊的数据和 155,000名成员的程序(未提供开始日期)；4)LIS、 实验室信息系统，为医学信息系统提供综合基础 实验室程序，包括所有人的结果解释和报告 门诊工作，包括解剖病理学和临床 实验室检测结果；以及5)TOP，门诊药房系统， 记录KPNW门诊药店开出的每一张处方日期 回到1986年。 糖尿病研究小组将从近5000名成员中挑选出来 这个HMO计划的人患有糖尿病，并使用HMO的牙科计划。这个 对照小组将从使用卫生保健组织牙科的KPNW成员中抽出 计划。这些群体将根据年龄和性别进行分层，并在这些方面进行匹配 特点。 从电子数据库中提取感兴趣的变量包括：1)使用 牙科服务，2)平均就诊次数，3)平均拔牙次数， 4)牙科服务类型的平均数量(诊断、预防、 修复、牙周、口腔手术和其他)，5)平均牙科费用 服务(整体和特定类型的牙科服务)，6)水平 糖尿病控制(以血红蛋白A1c和果糖胺(或 糖化蛋白)试验，以及目前的糖尿病药物。 有关牙齿缺失和牙齿缺失程度的数据将从 按年龄、性别和种族随机抽取的个体的牙科图表 来自糖尿病组和非糖尿病组。三百余人的初步研究 对患者进行了这些X线片和图表的有效性检查 记录与训练有素的临床医生的牙齿缺失计数的比较 主考官。这表明准确率超过90%，大多数错误都是由于 没有注意到牙科病历中实际存在的数据。数据 全面描述了分析计划，以及对 两项研究的组成部分的样本量的确定 缺牙和无牙的数量。该提案以一项 关于未来研究和假设生成的部分。

DESCRIPTION: The primary goal of this study is to compare diabetics and non-diabetes regarding oral health status, use of dental services and cost of dental care. The design is a retrospective study utilizing the records of Kaiser Permanente Northwest, a large HMO in the Portland, Oregon area. The principal investigator has conducted a series of preliminary studies to ensure that the databases to be used are 1) available, 2) accurate, and 3) valid. The study will link individuals' data from 5 electronic databases within the KPNW HMO: 1) MIPS, the Membership Information Processing System, which has records on 386,000 individuals dating back to 1982; 2) the KPNW Diabetes Registry which has records on 12,755 active HMO members dating back to 1988; 3) the TEAM Database which has data on all dental office visits and procedures on 155,000 members (no starting date provided); 4) the LIS, the Laboratory Information System, which provides an integrated base for medical laboratory procedures including results interpretation and reporting for all outpatient work including anatomical pathology as well as clinical laboratory test results; and 5) TOPS, The Outpatient Pharmacy System, which records every prescription dispensed by KPNW's outpatient pharmacies dating back to 1986. The study group with diabetes will be drawn from the nearly 5,000 members of this HMO plan who have diabetes and use the HMO's dental plan. The comparison group will be drawn from KPNW members who use the HMO's dental plan. The groups will be stratified on age and gender and matched on these characteristics. Variables of interest to be taken from electronic databases include: 1) use of dental services, 2) mean number of visits, 3) mean number of extractions, 4) mean number of types of dental services (diagnostic, preventive, restorative, periodontal, oral surgery and other), 5) mean costs of dental services (overall and within specific type of dental services), 6) level of diabetic control (as measured by hemoglobin A1c and by the fructosamine (or glycated protein) test, and 7) current diabetic medications. The data for missing teeth and level of edentulism will be obtained from a dental chart of a random sample of individuals selected by age, sex and race from the diabetic and non-diabetic groups. A preliminary study on over 300 patients was conducted of the validity of these radiographic and charting records as compared to counts of missing teeth by a trained clinical examiner. This revealed an accuracy of over 90% with most errors being due to failure to note data that were actually in the dental chart. The data analysis plan is fully described as is the sample size calculation for the determination of sample sizes for the component of the study on both the number of missing teeth and edentulism. The proposal concludes with a section on future studies and hypothesis generation.