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Sally C. Stearns, PhD R. Gary Rozier, DDS, MPH Jeongyoung Park, PhD

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Presentation on theme: "Sally C. Stearns, PhD R. Gary Rozier, DDS, MPH Jeongyoung Park, PhD"— Presentation transcript:

1 Expanding Preventive Dental Care in Medical Offices for Young Children Enrolled in Medicaid
Sally C. Stearns, PhD R. Gary Rozier, DDS, MPH Jeongyoung Park, PhD Bhavna T. Pahel, BDS, MPH Rocio Quiñonez, DMD, MS, MPH The University of North Carolina at Chapel Hill American Public Health Association Annual Meeting Washington, D.C.: November 5, 2007 Funded by: NIDCR # R03 DE017350, NIDCR # R01 DE , CMS/HRSA/CDC # ORS Nov. 5, 2007, Time: 11:15-11:30 am

2 Background Dental decay - most common chronic disease among preschool children in U.S. 1 in 4 children born into poverty Twice as much tooth decay as affluent peers <1 in 5 Medicaid children use preventive dental care General dentists Not trained to provide care to infants and toddlers Poorly reimbursed by Medicaid Alternative setting for preventive dental care Pediatric primary care >90% of preschool children have well visits Shortage of pediatric dentists

3 North Carolina Model “Into the Mouths of Babes (IMB)”
Medicaid reimburses for up to 6 visits before age 3 Screening, risk assessment and dental referrals (as needed) Parent counseling Topical fluoride therapy

4 Research Questions 1. Does IMB affect use of dental care (access)?
1a. Care in medical & dental offices (Preventive, Restorative)? 1b. Physician referrals for dental treatment? 2. Does IMB reduce need for restorative care (effectiveness)? Competing outcome – Expect some increase (in referrals) and some decrease (preventive effect of IMB) in dentist services.

5 Methods & Data : Access Analysis (1a) Likelihood of use of preventive & restorative care
Study design Pre-post quasi-experimental design Intent-to-treat analysis using difference-in-differences regression Model includes child (age, gender, race), provider supply (dentists, physicians), and area (urban/ rural, fluoridation) characteristics Data sources 3½ years of longitudinal Medicaid claims files (Jan’00 - Jun’03) Child-month records for ~292,000 children Likelihood of use of preventive and restorative care ITT - Once a provider in county started billing for services, assumed everybody had access to IMB DD – compares slope pre and post for the Tx and Control groups

6 Results : Access Analysis (1a) Likelihood of use of preventive & restorative care
Visits/month per 1,000 children 80% increase Likelihood of use of preventive and restorative care 100% increase Medical office visits Dental office visits

7 Results : Access Analysis (1a) Likelihood of use of restorative care
Intent-to-treat analysis For 1000 children age 24 months 6.8 children treated in absence of IMB 7.3 children treated after IMB implementation Likelihood of use of restorative Tx

8 Methods & Data : Access Analysis (1b) Physician referrals for dental treatment
Study design Cross-sectional analysis of 27,000 children ( ) Two-level logistic regression model Model includes child (age, gender, race), provider supply (dentists, physicians), and area (urban/ rural, fluoridation) characteristics Data sources Patient encounter forms merged with Medicaid claims Dental caries and referral information at 1st IMB visit Study design Bullet 1 – who had EF completed during first visit

9 Results : Access Analysis (1b) Physician referrals for dental treatment
Effect of untreated decay on likelihood of referral Overall effect of untreated decay OR=15.4 (95% CI [7.5, 31.7]) Effect of untreated decay stratified by urban/rural county Metro counties (OR=31.9) Non-metro counties (OR=12.7)

10 Methods & Data : Effectiveness Analysis (2) Effect of IMB among the treated
Study design Cohort treatment study Compare children with 4+ IMB visits to no IMB visits Two part regressions – # treatments conditional upon some treatment Likelihood of treatment for tooth decay Data source Medicaid claims (Jan’00 - Jun’03) 98,411 children with no IMB treatments 1,472 children with 4+ IMB visits

11 Results : Effectiveness Analysis (2) Effect of IMB among the treated
Effect of 0 vs. 4-6 IMB visits on Expected Dental Treatments Per 1000 Children up to Four Years of Age By Tooth Category No IMB 4-6 IMB Visits Reduction in # Treatments % Reduction in Treatment All Teeth 1697 1433 – 264 15.6% Anterior Teeth 584 356 – 226* 39.0% Posterior Teeth 598 527 – 70 11.9% Significant Reduction in Restorations on Anterior Teeth * Significant at P ≤.05

12 Conclusions and Policy Implications
IMB program Increased access to preventive dental care in medical and dental offices Increased access to dental treatment services Reduced need for restorations in anterior teeth Future plans Extend effectiveness analyses for additional 3 years of follow-up Assess cost-effectiveness Improved oral health Reduced restorations in anterior teeth for those with 4+ visits Model has promise Analysis during implementation phase means children with existing decay could not get beneficial effect of IMB Training of providers leads to increased referrals Expect additional improvements in access once program fully implemented

13 Questions?


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