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1.
Kathryn A. Atchison Jane A. Weintraub R. Gary Rozier 《Journal of the American Dental Association (1939)》2018,149(10):850-858
Background
The National Academies of Sciences, Engineering, and Medicine commissioned an environmental scan describing the status of health care integration of oral health and primary care services.Methods
The authors conducted an environmental scan of US integration activities with publications from January 2000 through August 2017. They categorized services as preventive oral health services (POHS) provided by medical care providers, POHS provided by dental providers in nondental settings, preventive health services provided by dental providers, or care coordination using dedicated personnel and technology. The authors chose 4 programs as case studies and interviewed key personnel in each program. One case study illustrates each category of integrated services; additional examples describe category variation.Results
The case study involving Into the Mouth of Babes illustrates medical professionals delivering POHS to children. The case study involving Grace Health presents dental hygienists embedded in the obstetrics-gynecology clinic to provide oral screening, prophylaxis, and education to pregnant women. At HealthPartners, medical care providers refer patients with diabetes to dentists and waive copays for periodontal care. The InterCommunity Health Network Coordinated Care Organization uses dedicated patient coordinators, technology, and coordinated payment and referral mechanisms to facilitate care.Conclusions
Integration of dental and medical care increased access to and coordination of patient care by means of offering health care services traditionally provided by the other profession.Practical Implications
Integration models demonstrate the incorporation of POHS by primary care professionals, the embedding of dental professionals into primary care clinics, and the incorporation of care coordination to increase the delivery of oral health care. Similarly, dentists identify and refer patients with medical needs or preventive gaps to medical homes. 相似文献2.
Lydie A. Lebrun-Harris María Teresa Canto Pamella Vodicka 《Journal of the American Dental Association (1939)》2019,150(4):246-258
Background
Research has identified significant gaps in preventive oral health care among certain subpopulations of US children. The authors of this study sought to estimate children’s preventive oral health care use and oral health and investigate associations with child, family, and health care characteristics.Methods
Data for this observational, cross-sectional study came from the 2016 National Survey of Children’s Health. Children aged 2 through 17 years were included (n = 46,100). Caregiver-reported measures were preventive dental visits, prophylaxis, toothbrushing or oral health care instructions, fluoride, sealants, fair or poor condition of the teeth, and problems with carious teeth or caries. Univariate, bivariate, and multivariable logistic regression analyses were conducted.Results
As reported by parents or caregivers, 8 in 10 children had a preventive dental visit in the past year but lower rates of specific services: 75% prophylaxis, 46% fluoride, 44% instructions, and 21% sealants. In addition, 12% had carious teeth or caries and 6% had fair or poor condition of the teeth. In adjusted analyses, young children (aged 2-5 years), children with no health insurance, and those from lower-income and lower-educated households had decreased likelihood of a preventive dental visit as well as specific preventive services. Children with preventive health care visits and a personal physician or nurse had increased likelihood of receiving preventive oral health care.Conclusions
Preventive oral health services are lagging among young children and children from lower socioeconomic backgrounds. Further studies are needed to identify interventions that encourage use of specific preventive services.Practical Implications
Dentists should work with caregivers and primary care providers to promote preventive oral health care, especially among young children and those from lower socioeconomic backgrounds. 相似文献3.
Maureen H. Craig JoAnna M. Scott Rebecca L. Slayton Amy L. Walker Donald L. Chi 《Journal of the American Dental Association (1939)》2019,150(1):42-48
Background
Preschool-aged children with special health care needs (CSHCN) from low-income households are at increased risk of developing poor oral health. The study goal was to assess preventive dental care use for CSHCN enrolled in Medicaid within Washington state’s Access to Baby and Child Dentistry (ABCD) program.Methods
The authors analyzed 2012 Medicaid eligibility and claims files for children younger than 6 years in the ABCD program (N = 206,488). The authors used medical diagnosis and eligibility data to identify each child’s special needs status (no or yes). The outcome was preventive dental care use (no or yes). The authors used modified Poisson regression models to estimate crude and covariate-adjusted prevalence rate ratios.Results
Of the 206,488 children in the study, 2.1% were CSHCN, and 114,570 used preventive dental care (55.5%). CSHCN used preventive care at rates similar to those of children without special health care needs (SHCN) (54.7% and 55.5%, respectively; P = .32). After adjustment for confounding variables, CSHCN were significantly less likely to use preventive dental care than were children without SHCN (prevalence rate ratio, 0.91; 95% confidence interval, 0.88 to 0.94; P < .001). Older preschool-aged children were significantly more likely to use preventive dental care than were younger preschool-aged children. A significantly higher proportion of preventive medical care users also used preventive dental care.Conclusions
CSHCN who were enrolled in Medicaid in Washington’s ABCD program were less likely to use preventive dental care than were children without SHCN who were enrolled in Medicaid.Practical Implications
Future intervention research investigators should evaluate ways to improve access to preventive dental care for CSHCN. Additional strategies may be needed to improve oral health behaviors for preschool-aged CSHCN receiving Medicaid. 相似文献4.
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6.
Daisy Patino Michelle R. McQuistan Fang Qian Marcela Hernandez Karin Weber-Gasparoni Mark D. Macek 《Journal of the American Dental Association (1939)》2018,149(12):1038-1048
Background
Hispanics disproportionately experience preventable oral health conditions in the United States. This study aimed to determine the oral health knowledge (OHK) of Hispanic adults in Iowa to identify potential gaps in knowledge.Methods
This cross-sectional study included a convenience sample of self-identifying Hispanic adults. Data pertaining to oral health literacy and demographic, cultural, and dental characteristics were collected. OHK was assessed with the Conceptual Measure of Oral Health Knowledge, and it was categorized as low or high. Bivariate analyses and multiple logistic regression models were conducted to identify the variables related to OHK (P < .05). Institutional review board approval was obtained.Results
Three hundred thirty-eight participants completed the questionnaire, 68% of participants completed the questionnaire in Spanish, and 51% of all participants had low OHK. Participants were less likely to correctly answer questions pertaining to children’s oral health, periodontal disease, and oral cancer. Low OHK was associated with having less than 12th grade education, lack of dental insurance, and preference for a Spanish-speaking oral health care provider.Conclusions and Practical Implications
OHK appears to be low in this population. Increasing OHK may help decrease oral health disparities and improve oral health outcomes. Furthermore, it is important that oral health care providers have an understanding of barriers that can impede patients’ understanding of the health care system. Specifically, minority populations, such as Hispanics, may have a harder time because of certain cultural differences that exist among this ethnic group. 相似文献7.
Nicoleta Serban Christopher Bush Scott L. Tomar 《Journal of the American Dental Association (1939)》2019,150(4):294-304.e10
Background
The authors’ aims were to compare, according to strata, dentists’ participation in Medicaid and Medicaid provider-level caseload measured as the number of patients or visits for preventive or restorative care for 2 comparison years.Methods
The data sources were the 2012-2013 Medicaid Analytic eXtract claims and 2013 National Plan and Provider Enumeration System data sets. The authors measured Medicaid participation as the proportion of dentists participating in Medicaid among those in the National Plan and Provider Enumeration System. The authors measured provider-level caseload according to the number of patients or visits. The authors stratified oral health care providers according to state; whether practicing in rural, suburban, or urban communities; and provider type.Results
The differences in participation rates for rural versus suburban and versus urban communities ranged from ?4% through 27% and ?6% through 37%, respectively. The 2012 state median number of patients per provider for preventive care ranged from 99 through 358. The provider-level caseload increased from rural to urban and from other provider to general dentist to pediatric dentist. The difference in caseload from 2012 to 2013 was not statistically significant except for the pediatric dentist type.Conclusions
This study’s results suggest that the realized caseload for children enrolled in Medicaid varies according to provider type and urbanicity. The state median caseload for preventive care is lower than the 500:1 patient to provider ratio used as the minimum caseload in access estimates from other studies.Practical Implications
This study’s results can assist states in gauging the level of oral health care provided to children insured by Medicaid compared with that in other states, with implications for the specification of oral health policies. 相似文献8.
Douglas A. Conrad Peter Milgrom R. Mike Shirtcliff Howard L. Bailit Sharity Ludwig Jeanne Dysert Gary Allen Joana Cunha-Cruz 《Journal of the American Dental Association (1939)》2018,149(5):348-352
Background
Dentists increasingly are employed in large group practices that use financial incentive systems to influence provider performance. The authors describe the design and initial implementation of a pay-for-performance (P4P) incentive program for a large capitated Oregon group dental practice that cares primarily for patients receiving Medicaid. The authors do not assess the effectiveness of the incentive system on provider and staff member performance.Methods
The data come from use of care files and integrated electronic health records, provider and staff member surveys, and interviews and community surveys from 6 counties. Quarterly individual- and team-level incentives focused on 3 performance metrics.Results
The program was challenged by many complex administrative issues. The key issues included designing a P4P system for different types of providers and administrative staff members who were employed centrally and in different communities, setting realistic performance metrics, building information systems that provided timely information about performance, and educating and gaining the support of a diverse workforce. Adjustments are being made in the incentive scheme to meet these challenges.Conclusions
This is the first report of a P4P compensation system for dental care providers and supporting staff members. The complex administrative challenges will require several years to address.Practical Implications
Large, capitated dental practice organizations will employ more dental care providers and administrative staff members to care for patients who receive Medicaid and patients who are privately insured. It is critical to design and implement a P4P system that the workforce supports. 相似文献9.
Amrita Mukherjee Alicia A. Livinski Joseph Millum Steffany Chamut Shahdokht Boroumand Timothy J. Iafolla Margo R. Adesanya Bruce A. Dye 《Journal of the American Dental Association (1939)》2017,148(4):211-220
Background
Ethics in health care and research is based on the fundamental principle of informed consent. However, informed consent in geriatric dentistry is not well documented. Poor health, cognitive decline, and the passive nature of many geriatric patients complicate this issue.Methods
The authors completed this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The authors searched the PubMed (MEDLINE), Web of Science, PsycINFO, and Cochrane Library databases. The authors included studies if they involved participants 65 years or older and discussed topics related to informed consent beyond obtaining consent for health care. The authors explored informed consent issues in dentistry and other biomedical care and research.Results
The authors included 80 full-text articles on the basis of the inclusion criteria. Of these studies, 33 were conducted in the United States, 29 addressed consent issues in patients with cognitive impairment, 29 were conducted in patients with medical conditions, and only 3 involved consent related to dental care or research.Conclusions
Informed consent is a neglected topic in geriatric dental care and research. Substantial knowledge gaps exist between the understanding and implementation of consent procedures. Additional research in this area could help address contemporary consent issues typically encountered by dental practitioners and to increase active participation from the geriatric population in dental care and research.Practical Implications
This review is the first attempt, to the authors’ knowledge, to identify informed consent issues comprehensively in geriatric dentistry. There is limited information in the informed consent literature covering key concepts applicable to geriatric dentistry. Addressing these gaps could assist dental health care professionals in managing complex ethical issues associated with geriatric dental patients. 相似文献10.
Shwetha V. Kumar Suhasini Bangar Ana Neumann Krishna Kumar Kookal Alfa Yansane Oluwabunmi Tokede Enihomo Obadan-Udoh Elizabeth Mertz Kristen Simmons Joshua Even Joanna Mullins Joel White Elsbeth Kalenderian Muhammad Walji 《Journal of the American Dental Association (1939)》2018,149(9):756-764.e1
Background
Although sealants are highly effective in preventing caries in children, placement rates continue to be low. The authors’ goals were to implement and assess the performance of 2 existing sealant quality measures against a manual audit of charts at 4 dental institutions and to identify measurement gaps that may be filled by using data from electronic health records.Methods
The authors evaluated the performance of 2 quality measures designed for claims-based data: the Dental Quality Alliance (DQA) sealant measure, which includes patients at risk of developing elevated caries, and the Oregon Health Authority (OHA) sealant measure (irrespective of caries risk). The authors adapted and validated these measures at 4 sites: 3 dental schools and 1 large dental accountable care organization.Results
The overall modified DQA and modified OHA measure scores in the 6- through 9-year-old age group were 37.0% and 31.6% and in the 10- through 14-year-old age group were 15.8% and 6.6%, respectively. Results from the manual review of charts showed that 67.6% of children who did not receive sealants did not have any teeth to seal because their molars had not yet erupted, had been extracted, had been sealed previously, or had existing caries or restorations.Conclusions
Both the DQA and OHA measures, which rely mainly on Current Dental Terminology procedure codes, led to underestimation of the care delivered from a practice perspective. Future sealant quality measures should exclude patients whose teeth cannot be sealed.Practical Implications
This study’s results support the suitability of using electronic health record data for assessing the quality of oral health care, particularly for measuring sealant placement in children. 相似文献11.
William Riley Mark Doherty Kailey Love 《Journal of the American Dental Association (1939)》2019,150(3):178-185
Background
Dental practice has remained relatively insulated from payment upheavals in the broader health care system. The prevailing value-based payment (VBP) models in health care are largely absent in oral health care. The authors present an oral health care value-based payment framework for dentistry.Methods
The authors developed a VBP framework for oral health care, which describes 9 distinct methods to create VBP approaches in dentistry. The framework is based on the Centers for Medicare & Medicaid Services Learning Action Network framework for health care payment reform.Results
The oral health care value-based payment framework includes 4 payment categories and 9 separate payment mechanisms. These 9 payment mechanisms range on a value continuum, each with different financial risks and rewards as well as distinct value implications.Conclusions
Although dental practice has made extraordinary advances in restorative dentistry, payers and policy makers are advocating for greater value outcomes. VBP models seek to deliver better care more efficiently by means of providing oral health providers the resources needed to increase the value proposition. With relatively minor modifications in practice patterns, VBP models can be developed and implemented for oral health care.Practical Implications
This article can be used as a road map to take steps toward oral health care VBP approaches. The framework highlights how dentistry can learn from payment reforms under way in the health care system and present a model for oral health care payment and care delivery reform, and provides recommendations to advance oral health care VBP. 相似文献12.
13.
Background
Only some states provide coverage of nonemergency dental services for adult Medicaid enrollees. This study examined the association between coverage of Medicaid adult nonemergency dental services and dental services use and expenditures.Methods
The authors analyzed data from the 2000 through 2015 Medical Expenditure Panel Survey Household Component for adults 21 years or older enrolled in Medicaid. The authors examined a range of outcomes such as dental visits, preventive and 5 other types of dental services, and total and out-of-pocket dental expenditures. Multivariate regression models were used to estimate the differences in outcomes for Medicaid enrollees between states that provided coverage of nonemergency dental services and states that did not, controlling for potentially confounding factors.Results
Compared with Medicaid enrollees in states that did not provide coverage, enrollees in states that provided coverage of nonemergency dental services were approximately 9 percentage points more likely to have a dental visit, approximately 7 percentage points more likely to have any preventive dental service, and more likely to have all other types of dental services except oral surgery services. Among enrollees with any visit, out-of-pocket share of dental expenditures was approximately 19 percentage points lower among those in covered states than those in uncovered states.Conclusions
Medicaid adult nonemergency dental benefits were associated with higher use of preventive and other types of dental services and lower out-of-pocket share of dental costs.Practical Implications
Our results may help inform policy makers as they consider ways of improving dental health of adults through Medicaid. 相似文献14.
Natalia S. Rozas June M. Sadowsky Cameron B. Jeter 《Journal of the American Dental Association (1939)》2017,148(4):236-245.e3
Background
Cognitive impairment is the gradual loss of one’s ability to learn, remember, pay attention, and make decisions. Cognitively impaired elderly people are a challenging patient population for dental health care professionals and may be at higher risk of developing oral health diseases. The authors systematically reviewed interventions effective at improving dental health in patients with cognitive impairment and described research gaps remaining.Types of Studies Reviewed
In a comprehensive search of multiple databases, the authors identified 2,255 studies published in the English language from 1995 through March 2016. The authors included studies if the investigators evaluated oral health measures after an intervention in patients 65 years or older with cognitive impairment or dementia. Nine full-text articles met the criteria for inclusion.Results
Only 1 study was a randomized control trial, whereas all others lacked appropriate controls. Investigators studied the effects of dental treatments, battery-powered devices for oral hygiene, and training of care staff members. Most interventions improved some aspect of the oral health of patients with dementia, and results were more pronounced when patients required assistance while performing oral hygiene tasks or had poor oral health at baseline.Conclusions and Practical Implications
A basic care plan for patients with dementia should, at the minimum, match prevention strategies recommended for healthy elderly patients. Dental health care professionals should promote oral hygiene education for caregivers for elderly patients with cognitive impairment. There is a wide gap in knowledge regarding effective methods specifically to improve oral health in patients with dementia. 相似文献15.
Background
This study was undertaken to quantify how the Great Recession impacted the demand for general oral health care and orthodontic care in the United States. The authors conducted an analysis to help dentists anticipate changes in demand for care during future economic downturns.Methods
The authors analyzed Medical Expenditure Panel Survey data for the period 2003 through 2015. Data plotting for the various factors considered showed patient demand before, during, and after the Great Recession, including an indication of postrecession recovery. Statistical significance across time was determined using a χ2 test. The point estimates and statistical inferences took into account the complex survey design of the Medical Expenditure Panel Survey.Results
General dentist visits declined slowly and steadily during the Great Recession, reaching a low of 38.4% in 2010, and have not shown significant signs of recovery. Orthodontic visits also declined to an all-time low of 2.5% in 2010, although they have somewhat recovered. Out-of-pocket expenditures were lower in 2015 than in 2003 for general dental and orthodontic care.Conclusion
The effects of the Great Recession resulted in a decrease in the demand for oral health care, differing for general oral health care and orthodontic care.Practical Implications
These findings, especially in combination with leading indicators for economic downturns, will allow dentists to better plan and use strategies for maintaining practice stability during periods of reduced demand for care. 相似文献16.
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Kathleen M. Ross Jason S. Mehr Rebecca D. Greeley Lindsay A. Montoya Prathit A. Kulkarni Sonya Frontin Trevor J. Weigle Helen Giles Barbara E. Montana 《Journal of the American Dental Association (1939)》2018,149(3):191-201
Background
In October and November 2014, the New Jersey Department of Health received reports of 3 patients who developed Enterococcus faecalis endocarditis after undergoing surgical procedures at the same oral surgery practice in New Jersey. Bacterial endocarditis is an uncommon but life-threatening condition; 3 patients with enterococcal endocarditis associated with a single oral surgery practice is unusual. An investigation was initiated because of the potential ongoing public health risk.Methods
Public health officials conducted retrospective surveillance to identify additional patients with endocarditis associated with the practice. They interviewed patients using a standardized questionnaire. An investigative public health team inspected the office environment, interviewed staff, and reviewed medical records.Results
Public health officials identified 15 confirmed patients with enterococcal endocarditis of those patients who underwent procedures from December 2012 through August 2014. Among these patients, 12 (80%) underwent cardiac surgery. One (7%) patient died from complications of endocarditis and subsequent cardiac surgery. Breaches of recommended infection prevention practices were identified that might have resulted in transmission of enterococci during the administration of intravenous sedation, including failure to perform hand hygiene and failure to maintain aseptic technique when performing procedures and handling medications.Conclusions
This investigation highlights the importance of adhering to infection prevention recommendations in dental care settings. No additional patients with endocarditis were identified after infection prevention and control recommendations were implemented.Practical Implications
Infection prevention training should be emphasized at all levels of professional dental training. All dental health care personnel establishing intravenous treatment and administering intravenous medications should be trained in safe injection practices. 相似文献18.
Ana Neumann Elsbeth Kalenderian Rachel Ramoni Alfa Yansane Bunmi Tokede Jini Etolue Ram Vaderhobli Kristen Simmons Joshua Even Joanna Mullins Shwetha Kumar Suhasini Bangar Krishna Kookal Joel White Muhammad Walji 《Journal of the American Dental Association (1939)》2017,148(9):634-643.e1
Background
Patients with diabetes are at increased risk of developing oral complications, and annual dental examinations are an endorsed preventive strategy. The authors evaluated the feasibility and validity of implementing an automated electronic health record (EHR)–based dental quality measure to determine whether patients with diabetes received such evaluations.Methods
The authors selected a Dental Quality Alliance measure developed for claims data and adapted the specifications for EHRs. Automated queries identified patients with diabetes across 4 dental institutions, and the authors manually reviewed a subsample of charts to evaluate query performance. After assessing the initial EHR measure, the authors defined and tested a revised EHR measure to capture better the oral care received by patients with diabetes.Results
In the initial and revised measures, the authors used EHR automated queries to identify 12,960 and 13,221 patients with diabetes, respectively, in the reporting year. Variations in the measure scores across sites were greater with the initial measure (range, 36.4-71.3%) than with the revised measure (range, 78.8-88.1%). The automated query performed well (93% or higher) for sensitivity, specificity, and positive and negative predictive values for both measures.Conclusions
The results suggest that an automated EHR-based query can be used successfully to measure the quality of oral health care delivered to patients with diabetes. The authors also found that using the rich data available in EHRs may help estimate the quality of care better than can relying on claims data.Practical Implications
Detailed clinical patient-level data in dental EHRs may be useful to dentists in evaluating the quality of dental care provided to patients with diabetes. 相似文献19.
Shulamite S. Huang 《Journal of the American Dental Association (1939)》2018,149(12):1049-1056.e1
Background
Previous study results have indicated that the Patient Protection and Affordable Care Act (ACA) health insurance expansion for dependents (called the dependent coverage expansion) also led to a dental insurance expansion for dependents. In this study, the author examines whether this expansion is due to changes in employer-sponsored dental insurance.Methods
The author compared enrollment and oral health care use between 2 groups of young adults in employer-sponsored dental plans managed by Delta Dental of Michigan before and after the initial implementation of the ACA: adults aged 20 through 24 years (eligible for the expansion) and adults aged 30 through 34 years (ineligible).Results
The ACA dependent coverage expansion led to an increase in both dental plan enrollment rates (5.38%; P < .01) and oral health care use rates (3.57%; P < .1) among adults aged 20 through 24 years relative to adults aged 30 through 34 years.Conclusions
Although the ACA’s dependent coverage expansion led to an increase in dental plan enrollment and oral health care use in Michigan, the effects seen by other insurers and states are yet to be determined, although the direction likely is similar.Practical Implications
This study’s results suggest that employers responded to the ACA dependent coverage expansion by expanding dependent oral health care coverage. 相似文献20.
Isis Henriques de Almeida Bastos Erivaldo S. Alves Cláudia Daltro de Sousa Gabriela B. Martins Elisângela de Jesus Campos Carla Daltro 《Journal of the American Dental Association (1939)》2018,149(12):1032-1037