First preventive dental visit: Disparities in needs, costs + behavioral insights

描述（由申请人提供）：本申请涉及广泛的挑战领域：健康差距（09）；挑战主题：行为和社会科学减少口腔健康差距（09-DE-101）。标题：首次预防性牙科就诊：需求、成本和行为洞察的差异本研究调查了医疗补助登记儿童首次预防性牙科就诊年龄（AFPDV）的预测因素和结果。孩子接受第一次牙科检查的年龄有助于为孩子建立牙科之家，并为母亲提供重要的预防咨询。参加医疗补助的儿童获得牙科护理的机会较少。本研究特别关注的是五个在获得牙科保健和口腔健康状况方面存在高风险差异的医疗补助亚人群：1)种族和少数民族儿童，2)农村儿童，3)联邦指定的牙科卫生专业短缺地区（hpsa）的儿童，4)获得医疗保健和相关儿童就诊机会较少的儿童，以及5)在社区卫生中心（CHC）接受护理的儿童。由于美国有四分之一的儿童参加了医疗补助计划，这项研究可能会影响该国大量最脆弱的儿童。我们提出了一项多方面的、跨学科的研究来探讨这个问题：研究1：医疗补助登记儿童首次预防性牙科就诊年龄的决定因素。第一项研究利用爱荷华州医疗补助计划的数据，调查了2004年出生一个月内参加该计划的学龄前儿童首次预防性牙科就诊的年龄预测因素。我们将在索赔数据库中跟踪这些孩子，直到他们第一次进行预防性牙科检查，不再参加医疗补助计划或年满六岁。以前在牙科使用模型中确定的因素将包括在这些分析中，并增加了利用儿童探病的因素。我们将使用生存分析来模拟这些关系。研究2：评估早期FPDVs对在爱荷华州一家CHC就诊的医疗补助登记儿童首次就诊时牙科护理需求的有效性和成功完成治疗计划的效果。我们会利用图表检讨，了解儿童首次牙科诊症时的需要，以及AFPDV是否会影响治疗结果，特别是治疗计划的完成情况。图表审查将在爱荷华州的9个社区卫生中心（CHCs）进行，其中有270名儿童的电子健康记录。研究3:AFPDV对未来牙科和医疗保健利用和成本的影响。爱荷华州医疗补助索赔和行政数据将用于确定AFPDV是否会影响学龄前儿童未来的牙科和医疗保健费用。使用工具变量分析，我们将模拟与牙科使用和成本相关的因素，特别关注AFPDV。研究四：运用健康信念模型和扩展平行过程模型确定与FPDV相关的母亲决策和预防性牙科保健寻求行为的相关因素。焦点小组将帮助我们了解哪些因素鼓励和阻碍父母带孩子进行预防性牙科保健。这三项研究的结果将为有子女参加医疗补助计划的父母的调查提供信息。先前的结果将帮助我们纳入最关键的因素，并根据对有孩子参加医疗补助计划的父母重要的问题来调整调查。这些调查的目的是找出是什么促使父母带孩子去牙医那里进行第一次预防性牙科检查，以及是什么阻碍了他们进行预防性牙科护理。这些数据将进行OLS回归分析，以确定哪些心理社会因素与AFPDV相关。目的：这项研究计划旨在帮助我们了解第一次预防性牙科就诊的最有效年龄。这项工作最终在与父母和提供者的干预设计中达到高潮，以鼓励儿童第一次预防性牙科就诊的有效时机。该研究建立在该团队之前广泛的研究基础上，该团队已经证明有能力成功地开展有关服务不足儿童牙科保健的研究，并结合这些大型管理数据库和原始数据收集方法。

DESCRIPTION (provided by applicant): This application addresses the broad challenge area: Health Disparities (09); Challenge Topic: Behavioral and Social Sciences to Reduce Oral Health Disparities (09-DE-101). Title: First preventive dental visit: Disparities in needs, costs + behavioral insights This study investigates the predictors and outcomes of age at first preventive dental visit (AFPDV) for Medicaid-enrolled children-a dentally underserved population. The age when a child receives their first dental check-up helps establish a dental home for the child and provides important preventive counseling for the mother. Medicaid-enrolled children are known to have less access to dental care. Of particular interest in this study are five Medicaid subpopulations at high risk of disparities in access to dental care and resulting oral health status: 1) Racial and ethnic minority children, 2) Rural children, 3) Children in federally designated Dental Health Professions Shortage Areas (HPSAs), 4) Children with less access to medical care and associated well child visits, and 5) Children who receive care at a Community Health Center (CHC). Since one in four children in the United States are enrolled in Medicaid, this study could potentially impact a large population of the most vulnerable children in the country. We are proposing a multifaceted, interdisciplinary set of studies to explore this issue: Study 1: Determinants of the age at first preventive dental visit for Medicaid-enrolled children. The first study investigates the predictors of age at first preventive dental visit using Iowa Medicaid claims data for preschool age children who were enrolled in the program within a month of birth in 2004. We will follow these children in the claims database until they have their first preventive dental visit, are no longer enrolled in Medicaid or turn six years old. Factors previously identified in dental use models will be included in these analyses with the added factor of utilization of well-child visits. We will use survival analyses to model these relationships. Study 2: An evaluation of the effectiveness of earlier FPDVs on the need for dental care at the first visit and the successful completion of treatment plans for Medicaid-enrolled children who sought care at a CHC in Iowa. Chart reviews will be used to find out how the needs of children at the time of their first dental visit and whether AFPDV affects outcomes, in particular, the completion of the treatment plan. The chart reviews will be performed at 9 Community Health Centers (CHCs) with electronic health records for 270 children in Iowa. Study 3: Impact of the AFPDV on future dental and medical care utilization and costs. Iowa Medicaid claims and administrative data will be used to determine if AFPDV affects future dental and medical care costs for preschool children. Using instrumental variable analyses we will model the factors related to dental use and cost with special attention to AFPDV. Study 4: Using the Health Belief Model and the Extended Parallel Process Model to determine factors associated with mothers' decision-making and preventive dental care seeking behavior related to FPDV. Focus groups will be used to help us understand what factors encourage and discourage parents from taking their children for preventive dental care. The results of these three studies will serve to inform the contents of a survey of parents with children in Medicaid. Previous results will help us to include the most critical factors and tailor the surveys to issues important to parents with children in Medicaid. These surveys will be designed to find out what prompts parents to take their children to the dentist for their first preventive dental visit and what might discourage them from preventive dental care. These data will be analyzed with OLS regression to determine what psycho-social factors are related to AFPDV. Goal: This program of research is designed to help us understand the most effective age for the first preventive dental visit. This work ultimately culminates in the design of an intervention with parents and providers to encourage the effective timing of children's first preventive dental visit. This study builds on extensive previous research by this team who has demonstrated the ability to successfully conduct studies regarding dental care for underserved children combining these large administrative databases and primary data collection methodologies. PUBLIC HEALTH RELEVANCE: This research project will investigate the predictors and outcomes of preschool age children's first preventive dental visit, improving our understanding of how age at first preventive dental visit is affected by the psychosocial, behavioral, and social factors and affects the outcomes of dental care over time. We will use this information to design an intervention to encourage the appropriate timing of a child's first preventive dental visit through education of the parent and providers.