Dataset Information

Preventive Dental Care and Long-Term Dental Outcomes among ALL Kids Enrollees.

ABSTRACT:

Objective

To investigate whether early or regular preventive dental visit (PDV) reduces restorative or emergency dental care and costs for low-income children.

Study setting

Enrollees during 1998-2012 in the Alabama CHIP program, ALL Kids.

Study design

Retrospective cohort study using claims data for children continuously enrolled in ALL Kids for at least 4 years. Analyses are conducted separately for children 0-4 years, 4-9 years, and >9 years. For 0-4 years, the intervention of interest is whether they have at least one PDV before age 3. For the other two age groups, interventions of interest are if they have regular PDVs during each of the first 3 years, and if they have claims for a sealant in the first 3 years. Outcomes-namely restorative and emergency dental service and costs-are measured in the fourth year. To account for selection into PDV, a high-dimensional propensity scores approach is utilized.

Data extraction

Claims data were obtained from ALL Kids.

Principal findings

Only sealants are associated with a reduced likelihood of using restorative and emergency services and costs.

Conclusions

Whether PDVs without sealants actually reduce restorative/emergency pediatric dental services is questionable. Further research into benefits of PDV is needed.

SUBMITTER: Sen B

PROVIDER: S-EPMC5134206 | biostudies-literature | 2016 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Preventive Dental Care and Long-Term Dental Outcomes among ALL Kids Enrollees.

Sen Bisakha B Blackburn Justin J Kilgore Meredith L ML Morrisey Michael A MA Becker David J DJ Caldwell Cathy C Menachemi Nir N

Health services research 20160229 6

<h4>Objective</h4>To investigate whether early or regular preventive dental visit (PDV) reduces restorative or emergency dental care and costs for low-income children.<h4>Study setting</h4>Enrollees during 1998-2012 in the Alabama CHIP program, ALL Kids.<h4>Study design</h4>Retrospective cohort study using claims data for children continuously enrolled in ALL Kids for at least 4 years. Analyses are conducted separately for children 0-4 years, 4-9 years, and >9 years. For 0-4 years, the intervent ...[more]

PMID: 26927421

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Project description:ImportanceThere is a recommendation for children to have a dental home by 6 months of age, but there is limited evidence supporting the effectiveness of early preventive dental care or whether primary care providers (PCPs) can deliver it.ObjectiveTo investigate the effectiveness of preventive dental care in reducing caries-related treatment visits among Medicaid enrollees.Design, setting, and participantsHigh-dimensional propensity scores were used to address selection bias for a retrospective cohort study of children continuously enrolled in coverage from the Alabama Medicaid Agency from birth between 2008 and 2012, adjusting for demographics, access to care, and general health service use.ExposuresChildren receiving preventive dental care prior to age 2 years from PCPs or dentists vs no preventive dental care.Main outcome and measuresTwo-part models estimated caries-related treatment and expenditures.ResultsAmong 19 658 eligible children, 25.8% (n = 3658) received early preventive dental care, of whom 44% were black, 37.6% were white, and 16.3% were Hispanic. Compared with matched children without early preventive dental care, children with dentist-delivered preventive dental care more frequently had a subsequent caries-related treatment (20.6% vs 11.3%, P < .001), higher rate of visits (0.29 vs 0.15 per child-year, P < .001), and greater dental expenditures ($168 vs $87 per year, P < .001). Dentist-delivered preventive dental care was associated with an increase in the expected number of caries-related treatment visits by 0.14 per child per year (95% CI, 0.11-0.16) and caries-related treatment expenditures by $40.77 per child per year (95% CI, $30.48-$51.07). Primary care provider-delivered preventive dental care did not significantly affect caries-related treatment use or expenditures.Conclusions and relevanceChildren with early preventive care visits from dentists were more likely to have subsequent dental care, including caries-related treatment, and greater expenditures than children without preventive dental care. There was no association with subsequent caries-related treatment and preventive dental care from PCPs. We observed no evidence of a benefit of early preventive dental care, regardless of the provider. Additional research beyond administrative data may be necessary to elucidate any benefits of early preventive dental care.

Project description:BackgroundSwallowing/feeding difficulty is a serious hidden health problem in the older population. Although oral intake services based on the degree of this difficulty have been provided and revised in Japanese public long-term care (LTC) insurance since 2006, their implementation has not been examined. We evaluated the impact of policy changes on these services.MethodsThe nationwide database of LTC service uses in Japan was analysed for three oral intake services: Enhanced Oral Function in daycare facilities whose users were slightly disabled, Maintenance of Oral Ingestion and Transition to Oral Ingestion from tube feeding in residential facilities. Data were extracted for each June from 2015 to 2020 when monthly usage of these services was aligned and each June from 2009 to 2020 for the proportion of users according to LTC insurance certification. The major policy changes were the addition of municipal provision in Enhanced Oral Function and a requirement for multidisciplinary collaboration in Maintenance of Oral Ingestion in 2015. The impact of the medical fee reduction for developing percutaneous gastro-tubing to Transition to Oral Ingestion was also examined.ResultsBetween 2015 and 2020, the use of Enhanced Oral Function and Maintenance of Oral Ingestion increased and Transition to Oral Ingestion decreased, resulting in a total increase in use of 275,000 times or approximately 5,000 times per 100,000 among all older adults with LTC insurance certification. Concerning the proportion of users' disability status, the major users of Enhanced Oral Function in 2020 were slightly disabled and independent older adults (70%, up from 55% to 2009). Regarding the major users of Maintenance of Oral Ingestion between 2013 and 2020, care-need level 5 (most severe) decreased by 11%, whereas the total of care-need levels 4 and 3 increased by 9%. The use of Transition to Oral Ingestion, which had been declining, showed a further decline after reduction of the medical fee for percutaneous gastro-tubing in 2014.ConclusionsDue to policy changes, Enhanced Oral Function and Maintenance of Oral Ingestion have increased in the number of use among slightly disabled persons. However, this increase may be insufficient given the hidden swallowing/feeding difficulty.

Dataset Information

Preventive Dental Care and Long-Term Dental Outcomes among ALL Kids Enrollees.

Objective

Study setting

Study design

Data extraction

Principal findings

Conclusions

Publications

Preventive Dental Care and Long-Term Dental Outcomes among ALL Kids Enrollees.

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