Promoting children's oral health: Identifying provider-, practice-, and community-level characteristics associated with delivery of fluoride varnish in medical offices

项目摘要 龋齿是可以预防的，但代价高昂。2013年，儿童牙科治疗支出总额为87亿美元- 使其成为第五大最昂贵的儿童健康疾病。预防性口腔健康服务，如含氟清漆，可以 预防幼儿的龋齿。然而，只有不到50%的儿童每年都会去看牙医 由于成本的原因，牙医不愿治疗年幼的儿童，以及牙科劳动力短缺。增加对…的使用 预防性口腔健康服务、私人健康计划和所有州医疗补助计划现在涵盖 医务室内的氟化物清漆适用于所有6岁以下的儿童。现有证据表明，送货 在医务室使用含氟清漆可提高公共保险儿童的使用率并减少其腐烂。 尽管有这些好处，但很少有儿童在医务室接受含氟清漆。2014年，只有5%的符合条件的 马萨诸塞州的儿童接受了这项服务。之前关于识别障碍和策略的研究主要集中在 关于公共保险的儿童，并依赖于自我报告的提供者信息，因此一种新的“大数据”方法是 需要确定影响含氟清漆交付的供应商、实践、社区和政策层面的因素 在医务室。我们的混合方法研究将使用马萨诸塞州所有付款人索赔数据集，其中包括 公共和私人参保儿童的医疗和牙科索赔，以(1)描述儿童接受 预防性口腔健康服务，(2)估计强制性医疗保险对儿童健康的因果影响 接受预防性口腔保健服务；(3)审查影响提供预防性口腔保健服务的机制 以及(4)使用定性的正偏差方法来确定策略 以及促进或阻碍医疗提供者提供预防性口腔健康服务的背景因素。

Project Summary Tooth decay is preventable, yet costly. Spending on dental treatment for children totaled $8.7 billion in 2013— making it the fifth most costly child health condition. Preventive oral health services, like fluoride varnish, can prevent tooth decay in young children. However, fewer than 50% of children have an annual dental visit, likely due to cost, dentists’ reluctance to treat young children, and dental workforce shortages. To increase use of preventive oral health services, private health plans and all state Medicaid programs now cover delivery of fluoride varnish in medical offices to all children younger than 6 years. Existing evidence indicates that delivery of fluoride varnish in medical offices increases utilization and reduces decay in publicly insured children. Despite these benefits, few children receive fluoride varnish in medical offices. In 2014, only 5% of eligible children received this service in Massachusetts. Prior studies to identify barriers and strategies have focused on publicly insured children and relied on self-reported provider information, thus a new “big data” approach is needed to identify provider, practice, community-, and policy-level factors affecting delivery of fluoride varnish in medical offices. Our mixed-methods study will use Massachusetts All Payer Claims Dataset, which includes both medical and dental claims for publicly and privately insured children, to (1) describe children receiving preventive oral health services, (2) estimate the causal impact of mandatory medical coverage on children’s receipt of preventive oral health services, (3) examine the mechanisms affecting delivery of preventive oral health services in medical offices, and (4) use a qualitative positive deviance approach to identify strategies and contextual factors promoting or deterring medical providers’ delivery of preventive oral health services.