Reducing Oral Health Disparities in Children: Assessing the Multilevel Impact of a Standardized Preventive Dental Care System

摘要（Abstract） 我们的长期目标是通过以证据为基础的预防和治疗为关键， 这是减少儿童口腔健康差距的总体战略的一个组成部分。通用型小儿牙科 根据《平价医疗法案》（ACA），医疗保险已经覆盖， 与私人保险儿童平等的口腔保健是可以实现的，但与收入有关的口腔保健差距仍然很大。 了解牙科保健系统在创造或减轻口腔健康差异或改善口腔健康方面的作用。 健康已经被限制为过于简单的访问度量（例如，年度牙科就诊）和收费的程序（例如， 牙科治疗），这只允许一般的比较，严重混淆的质量护理和保险 类型.我们对龋病风险状况、诊断、预防性治疗和干预措施之间的联系知之甚少 对特定个体和人群的口腔健康的影响。这种知识上的差距现在可以克服了 通过我们提出的研究龋齿预防计划实施的牙科责任保健 为商业保险和医疗补助患者提供服务的组织。该程序内置于一个系统中， 包括诊断驱动、基于风险、临床决策支持护理的标准化模型， 电子健康记录（EHR）。本研究的目的是评估这种基于证据的 减少儿童口腔健康差异和改善儿童口腔健康的护理提供方法， 时间这项研究将利用复杂的牙科信息学，使我们能够使用大数据来测量和 在现实世界的临床背景下，比较检查未经治疗的龋齿和新龋齿的发病率随时间的变化。 在乎此外，使用俄勒冈州医疗补助索赔数据，我们可以评估交付系统的影响;利用 国家成本数据，我们可以模拟成本效益和可持续性;并使用访谈，我们可以确定 有影响力的以患者为中心的护理考虑因素，可以潜在地预测该计划的成功-所有 为今后的翻译和实施工作提供信息的重要信息。预期的结果将是 为交付系统和利益设计建立可持续、可扩展的路线图的经验基础， 政策制定者实现健康公平，并实现牙科的四重目标：更好的人口健康， 更好的护理体验、更低的人均成本和敬业的劳动力。

Summary (Abstract) Our long-term goal is to improve dental care quality through evidence-based prevention and treatment as a key component in the overall strategy to reduce disparities in children's oral health. Universal pediatric dental coverage has been enabled under the Affordable Care Act (ACA), and achieving access for Medicaid children equal to privately insured children is within reach, yet strong income-related oral health disparities remain. Understanding the dental care system's role in creating or mitigating oral health disparities or improving oral health has been limited to simplistic access metrics (e.g., annual dental visit) and procedures billed (e.g., dental treatment) which only allow general comparisons heavily confounded by quality of care and insurance type. We know little about how caries risk status, diagnoses, preventive therapies, and interventions are linked to oral health in specific individuals and in populations over time. This gap in knowledge can now be overcome through our proposed study of a caries prevention program implemented at a dental accountable care organization serving both commercially insured and Medicaid patients. The program is built into a system that includes a standardized model of diagnosis-driven, risk-based, clinical-decision-supported care documented in an electronic health record (EHR). The objective of this study is to assess the impact of this evidence-based care delivery approach on reducing pediatric oral health disparities and improving children's oral health over time. This study will leverage sophisticated dental informatics allowing us to use big data to measure and comparatively examine untreated caries and new caries incidence over time in the context of real-world clinical care. Additionally, using Oregon Medicaid claims data we can assess the delivery system impact; utilizing national cost data we can model cost-effectiveness and sustainability; and using interviews we can identify impactful patient-centered care considerations that can potentially predict the success of the program – all critical information to inform future translation and implementation efforts. The expected outcome will be the empirical foundation of a sustainable, scalable roadmap for the delivery system and benefit design called for by policy makers to achieve health equity and meet the Quadruple Aim in dentistry: better population health, better care experience, lower cost per capita, and an engaged workforce.