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

减少儿童口腔健康差异：评估标准化预防性牙科护理系统的多层次影响

• 批准号: 9883043
• 负责人: Elizabeth Mertz
• 金额: $ 65.04万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-01 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9883043
• 关键词: Accountability; Affordable Care Act; Big Data; Businesses; Caries prevention; Caring; Child; Childhood; Clinical; Communities; Cost Savings; Data; Dental; Dental Care; Dental Care Delivery; Dental Informatics; Dental caries; Dentistry; Development; Diagnosis; Disease; Electronic Health Record; Enrollment; Equation; Foundations; Frequencies; Future; Goals; Health; Health Care Reform; Health Services Accessibility; Health Services Research; Health Status; Healthcare; Household; Improve Access; Incidence; Income; Individual; Insurance; Insurance Coverage; Intervention; Interview; Investments; Knowledge; Laboratories; Link; Low income; Measures; Medicaid; Modeling; Oral health; Oregon; Outcome; Parents; Patient-Centered Care; Patients; Policies; Policy Maker; Population; Prevalence; Prevention; Prevention program; Preventive Intervention; Preventive dental care; Preventive service; Preventive therapy; Procedures; Protocols documentation; Provider; Quality of Care; Reporting; Research Methodology; Resources; Risk; Role; Science; Societies; Standardization; System; Testing; Time; Tooth structure; Translations; Visit; Work; base; care delivery; care systems; clinical care; clinical decision support; comparative; cost; cost effective; cost effectiveness; demographics; design; disparity reduction; evidence base; experience; health disparity; health equity; improved; indexing; innovation; member; overtreatment; population health; pressure; programs; provider networks; satisfaction; service utilization; socioeconomics; success

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.

概括 我们的长期目标是通过循证预防和治疗作为关键来提高牙科护理质量 减少儿童口腔健康差异的总体战略的一部分。 已根据《平价医疗法案》(ACA) 实现了覆盖，并为儿童提供了医疗补助 与私人保险儿童同等的待遇是可以实现的，但与收入相关的口腔健康差距仍然存在。 了解牙科护理系统在造成或减轻口腔健康差异或改善口腔方面的作用 健康状况仅限于简单化的访问指标（例如每年牙科就诊）和收费程序（例如 牙科治疗）只允许进行一般比较，这与护理质量和保险严重混淆 我们对龋齿风险状况、诊断、预防治疗和干预措施之间的关系知之甚少。 随着时间的推移，这种知识差距现在可以被克服。 通过我们对牙科责任护理机构实施的龋齿预防计划的拟议研究 该计划内置于一个系统中，为商业保险和医疗补助患者提供服务。 包括诊断驱动、基于风险、临床决策支持的护理的标准化模型，记录于 本研究的目的是评估这种基于证据的影响。 减少儿科口腔健康差异和改善儿童口腔健康的护理提供方法 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分析。 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 此外，利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； 我们可以根据国家成本数据对成本效益和可持续性进行建模，并通过访谈来确定 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 为未来的翻译和实施工作提供信息的关键信息将是预期的结果。 为交付系统和效益设计提供可持续、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、更低的人均成本以及敬业的劳动力。