Root Canal Therapy in Children: Analysis of Disparities and Value

儿童根管治疗：差异和价值分析

• 批准号: 10225519
• 负责人: Lorel E Burns
• 金额: $ 16.85万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10225519
• 关键词: Accident and Emergency department; Address; Adult; Adverse event; Affect; Age; American Dental Association; Anatomy; Area; Award; Behavioral; Caring; Characteristics; Child; Child Care; Childhood; Clinical; Clinical Management; Competence; Data; Decision Making; Dental; Dental Care; Dental Specialties; Dentists; Development; Development Plans; Educational Background; Endodontics; Ethnic Origin; Frequencies; Geographic Locations; Goals; Grant; Health Services Research; Infection; Insurance; Interview; K-Series Research Career Programs; Knowledge; Literature; Longevity; Massachusetts; Measures; Mentorship; Methods; New York; Outcome; Outcome Study; Patients; Policies; Population; Positioning Attribute; Poverty; Prevalence; Privatization; Procedures; Process; Publishing; Qualitative Research; Quality of life; Race; Research; Research Design; Research Personnel; Research Proposals; Resources; Root Canal Therapy; Sampling; Structure; Surveys; Survival Rate; Time; Tooth structure; Toothache; Training; Translating; Treatment Protocols; Treatment outcome; United States; United States National Institutes of Health; Update; base; care costs; care outcomes; career; career development; clinical decision-making; clinical practice; clinically relevant; comparative; cost effectiveness; demographics; dental infection; evidence base; expectation; financial incentive; health care disparity; improved; performance based measurement; permanent tooth; population based; preservation; primary outcome; research and development; restoration; sex; skills; therapy outcome; treatment comparison; treatment planning

PROJECT SUMMARY/ ABSTRACT This research proposal will aim to determine outcomes of root canal therapy performed in permanent teeth in a pediatric population with a focus on healthcare disparities, value and the impact of clinician decision-making. This is significant because the most common endodontic procedure, root canal therapy, is performed over 15 million times annually in the US as management for tooth pain and infection. To date, the literature on root canal therapy outcomes in the US is based primarily on adult populations, even as children also undergo root canal therapy. Treatment of the permanent dentition in children differs from that of adults due to anatomical differences and behavioral factors. The most recent information available on endodontic procedure frequency is from the American Dental Association Survey of Dental Services Rendered, conducted in 2005-2006. The lack of information about endodontic procedure utilization, the absence of linkages to patient demographics, and the dearth of robust outcomes analyses for this treatment in a pediatric population highlight the need for updated, rigorous research in this area. To address this gap in knowledge and overcome limitations of previous studies, a mixed-methods approach will be used to evaluate multiple facets of the clinical management of dental pain and infection in children, specifically, 1) quantitative assessment of treatment and outcomes in a large, population-based sample; and 2) qualitative appraisal of clinician treatment planning and decision-making. The specific aims of this career development award are to: 1) evaluate the prevalence and outcomes of root canal therapy of permanent teeth in a pediatric population and determine the factors associated with initial root canal therapy survival using administrative claims data from New York and Massachusetts; 2) Explore dental / emergency room (ER) utilization rates and spending associated with teeth that undergo root canal therapy; and 3) characterize factors affecting clinical decision-making for endodontic treatment of permanent teeth in the pediatric population through semi-structured clinician interviews. We will evaluate the associations of clinical characteristics, such as patient age, tooth type, practitioner type, time to restoration and type of restoration, with outcomes of root canal therapy. We anticipate/expect that disparities will vary by payer type and area- based poverty level and that clinical characteristics are associated with downstream utilization rates and cost of care. The qualitative exploration may reveal that 1) clinician’s comfort and expectations with treating the pediatric population, 2) clinician’s competency performing endodontic treatment, and/or 3) financial incentives are factors in the clinical decision-making process. With an integrated training plan that supports the investigative aims, this grant will provide the PI with the necessary support to become an independent clinician-investigator who investigates the comparative value of dental treatments with regard to outcomes, quality of life, and cost effectiveness.

项目概要/摘要 该研究计划旨在确定在恒牙中进行根管治疗的结果 儿科人群，重点关注医疗保健差异、价值和临床医生决策的影响。 这一点很重要，因为最常见的牙髓治疗——根管治疗——的实施时间超过 15 在美国，每年有 100 万次用于治疗牙齿疼痛和感染。 美国的根管治疗结果主要基于成年人，即使儿童也接受根管治疗 由于解剖学原因，儿童恒牙列的治疗与成人不同。 关于牙髓手术频率的最新信息。 来自美国牙科协会 2005-2006 年提供的牙科服务调查。 缺乏有关牙髓手术使用的信息，缺乏与患者人口统计数据的联系， 由于缺乏针对儿科人群的这种治疗的强有力的结果分析，凸显了需要 该领域的最新、严谨的研究。 为了解决这一知识差距并克服先前研究的局限性，混合方法 将用于评估儿童牙痛和感染临床管理的多个方面， 具体来说，1）在基于人群的大型样本中对治疗和结果进行定量评估；2） 临床医生治疗计划和决策的定性评估。 该职业发展奖的具体目标是：1）评估根的流行率和结果 对儿科人群恒牙进行根管治疗并确定与初始牙根相关的因素 使用纽约和马萨诸塞州的行政索赔数据进行根管治疗生存率 2) 探索牙科/ 急诊室 (ER) 利用率和与接受根管治疗的牙齿相关的支出；以及 3）影响恒牙牙髓治疗临床决策的特征因素 我们将通过半结构化临床医生访谈来评估儿科人群的临床关联。 特征，例如患者年龄、牙齿类型、医生类型、修复时间和修复类型， 我们预计/预计差异会因付款人类型和地区而异。 基于贫困水平，临床特征与下游利用率和成本相关 定性探索可能揭示 1) 临床医生对治疗的舒适度和期望。 儿科人群，2) 临床医生进行牙髓治疗的能力，和/或 3) 经济激励 是临床决策过程中的因素。 通过支持调查目标的综合培训计划，这笔赠款将为 PI 提供 成为一名独立的临床研究者，调查其比较价值所需的支持 牙科治疗的效果、生活质量和成本效益。