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.

摘要（摘要） 我们的长期目标是通过基于证据的预防和治疗作为关键来提高牙科护理质量 整体策略的组成部分，以减少儿童口腔健康中的分布。普遍的小儿牙科 根据《平价医疗法案》（ACA）启用了承保范围，并获得了医疗补助儿童的访问权限 与私人保险的儿童相等，但仍有与收入相关的强大的口腔健康差异。 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 健康仅限于简单的访问指标（例如年度牙科访问）和收费程序（例如， 牙科治疗）仅允许一般比较护理和保险的质量严重混淆 类型。我们几乎不了解风险状态，诊断，预防疗法和干预措施如何链接 随着时间的流逝，特定个人和人群的口腔健康。现在可以克服知识的差距 通过我们对在牙科责任护理中实施的龋齿预防计划的拟议研究 为商业保险和医疗补助患者提供服务的组织。该程序内置在一个系统中 包括标准化的诊断驱动，基于风险的，临床支持的护理的模型 电子健康记录（EHR）。这项研究的目的是评估这种基于证据的影响 减少小儿口腔健康差异并改善儿童口腔健康的护理交付方法 时间。这项研究将利用复杂的牙科信息，使我们能够使用大数据来衡量和 在现实世界中，随着时间的流逝，相对检查的未经处理的汽车和新的龋齿发病率 关心。此外，使用俄勒冈州医疗补助索赔数据，我们可以评估输送系统的影响；使用 国家成本数据我们可以建模成本效益和可持续性；并使用采访我们可以识别 有影响力的以患者为中心的护理考虑因素，可以预测该计划的成功 - 所有人 关键信息以告知未来的翻译和实施工作。预期的结果将是 可持续，可扩展的路线图的经验基础，用于交付系统和福利设计 实现卫生公平并实现牙科的四倍目标的政策制定者：更好的人口健康， 更好的护理经验，人均成本较低以及订婚的劳动力。