A Decade in Dental Care Utilization among Adults and Children (2001–2010)

Objective

To decompose the change in pediatric and adult dental care utilization over the last decade.

Data

2001 through 2010 Medical Expenditure Panel Survey.

Study Design

The Blinder-Oaxaca decomposition was used to explain the change in dental care utilization among adults and children. Changes in dental care utilization were attributed to changes in explained covariates and changes due to movements in estimated coefficients. Controlling for demographics, overall health status, and dental benefits variables, we estimated year-specific logistic regression models. Outputs from these models were used to compute the Blinder-Oaxaca decomposition.

Principal Findings

Dental care utilization decreased from 40.5 percent in 2001 to 37.0 percent in 2010 for adults and increased from 43.2 percent in 2001 to 46.3 percent in 2010 for children (p < .05). Among adults, changes in insurance status, race, and income contributed to a decline in adult dental care utilization (−0.018, p < .01). Among children, changes in controlled factors did not substantially change dental care utilization, which instead may be explained by changes in policy, oral health status, or preferences.

Conclusions

Dental care utilization for adults has declined, especially among the poor and uninsured. Without further policy intervention, disadvantaged adults face increasing barriers to dental care.     

保健地段儿童医疗服务需要与利用的描述性研究

对北京市东城区朝阳门医院保健地段1307名0～14岁儿童进行了为期1年的连续性家庭健康询问调查。研究发现该地段儿童人口占全人群的18.7％,属于典型老龄化地区的儿童人群,儿童人口的医疗服务需要量低于全人群,门、急诊医疗服务利用水平高于全人群,住院利用水平低于全人群,儿童所患疾病以呼吸系统疾病为主,且冬季高发。     

上海市贫困居民的卫生服务需要和利用

与上海市平均水平相比，贫困居民门诊服务的需要和利用偏低，但住院需要和利用较高。而且，贫困居民的卫生服务实际需要被低估。妇女和儿童的卫生服务利用在贫困家庭影响较大。从疾病构成看，贫困居民大重病患病率明显高于一般人群，这些大病患者应该得到关注。     

山东省五莲县16 782名儿童少年龋患状况分析

目的 了解五莲县中小学生口腔疾病现状，为中小学生口腔疾病防治工作提供科学依据。方法 根据WHO口腔健康调查方法，分层整群抽取36所学校共16782名学生进行口腔检查，按照《全国学生龋病、牙周病流行病学抽样调查》的标准进行。结果 混合牙列龋患率为48．59％，其中乳牙龋患率为36．49％，充填率为18．32％；恒牙龋患率为21．21％，充填率72．3l％。结论 五莲县中小学生龋患率较高，应加强学生的龋齿防治工作。     

山东省儿童保健服务利用及影响因素分析

目的 调查儿童保健服务利用情况,并对其影响因素进行分析.方法 采取分层随机抽样的方法进行调查,运用x2检验、多元Logistic回归等统计方法进行影响因素分析.结果 儿童健康体检和“五苗”接种率利用率较高,新生儿疾病筛查、新生儿访视和儿童保健指导利用率较低;居住地、家庭收入、母亲文化程度和儿童出生方式等是影响儿童保健服务利用的重要因素.结论 提高对儿童保健服务的关注程度,通过健康教育等措施不断提升儿童保健服务利用率.     

Children's Access to Dental Care in Connecticut's Medicaid Managed Care Program

Objective: To describe dental care utilization and access problems in Connecticut's Medicaid managed care program, using quantitative and qualitative research methods. Methods: Using Medicaid managed care enrollment and encounter data from Connecticut, utilization rates for preventive care and treatment services are determined for 87,181 children who were continuously enrolled in Medicaid managed care for 1 year in 1996–97. Sociodemographic and enrollment factors associated with utilization are identified using bivariate and multivariate methods. Dental providers and practices where children received services are described. Qualitative methods are used to characterize problems experienced by families seeking dental care during the study period. Results: Only 30.5% of children continuously enrolled in Medicaid managed care for 1 year received any preventive dental services; 17.8% received any treatment services. Children who received preventive care were eight times more likely to have received treatment services. Utilization was higher among (a) younger children, (b) children who lived in Hartford and in other counties served by public dental clinics, and (c) children enrolled in health plans that did not subcontract for administration of dental services. Just 5% of providers, primarily those in public dental clinics, performed 50% of the services. Families whose children needed care encountered significant administrative and logistical problems when trying to find willing providers and obtain appointments. Conclusions: Access to dental care is a problem for children in Connecticut's Medicaid managed care program. Several features of managed care have negatively affected access. Public dental clinics served many children across the state and contributed to higher utilization of preventive care and treatment services among children living in Hartford.     

Associations between neighborhood characteristics and sexual risk behaviors among HIV-infected and HIV-uninfected women in the southern United States

PurposeNeighborhood characteristics shape sexual risk in HIV-uninfected adults in the United States (US). We assess relationships between census tract characteristics and sexual risk behaviors in a predominantly HIV-infected cohort of women living in the Southern US.MethodsThis cross-sectional multilevel analysis included data from 737 HIV-infected and HIV-uninfected women enrolled in the Women's Interagency HIV Study. Administrative data captured characteristics of census tracts where women lived; participant-level data were gathered via survey. We used principal components analysis to condense tract-level variables into components: social disorder (e.g., violent crime rate), and social disadvantage (e.g., alcohol outlet density). We used hierarchical generalized linear models to assess relationships between tract-level characteristics and condomless vaginal intercourse, anal intercourse, and condomless anal intercourse.ResultsGreater social disorder was associated with less anal intercourse (OR = 0.63, 95% CI = 0.43–0.94) and condomless anal intercourse (OR = 0.49, 95% CI = 0.30–0.80), regardless of HIV status. There were no statistically significant additive or multiplicative interactions between tract characteristics and HIV status.ConclusionsNeighborhood characteristics are associated with sexual risk behaviors among women living in the Southern US, these relationships do not vary by HIV status. Future studies should establish temporality and explore the causal pathways through which neighborhoods influence sexual risk.     

口腔综合保健在预防儿童龋齿中应用

目的：探讨口腔综合保健在预防儿童龋齿过程中的应用,用以指导临床预防措施。方法将治疗组78例应用口腔综合保健的效果与对照组78例仅进行常规口腔保健的效果进行比较观察。结果治疗组在刷牙方法正确率、刷牙次数、定期检查次数等方面均明显优于对照组,差异有统计学意义(P<0.05),同时其龋齿发生率也明显低于对照组,差异有统计学意义(P<0.05)。结论口腔综合保健预对防儿童龋齿具有重要意义,可帮助儿童养成良好的口腔保健习惯,帮助儿童家属及其监护人树立正确的口腔保健观念,能有效预防儿童龋齿发生,值得临床推广应用。     

The Relationship between Commercial Health Care Prices and Medicare Spending and Utilization

ObjectiveTo explore the relationship between commercial health care prices and Medicare spending/utilization across U.S. regions.ConclusionsCommercial health care prices are negatively associated with Medicare spending across regions. Providers may respond to low commercial prices by shifting service volume into Medicare. Further investigation is needed to establish causality.     

刷牙方法与牙线的使用对牙菌斑控制的研究

目的 了解习惯刷牙法(hahitual method)、水平颤动法(Bass method)、旋转法(Rolling stroke method)等3种不同刷牙方法与牙线的使用对牙菌斑的清除效果，以便有效地加强学生口腔卫生健康教育。方法 抽取安徽医科大学79名口腔专业四年级学生，按班级不同分别采用Bass刷牙法、Rolling刷牙法和习惯法分为3个组，比较3种刷牙方法对菌斑清除情况，同时比较同一种方法对A、B、C、D4个象限及前后牙区域的菌斑清除情况；检查牙线对牙菌斑清除情况。结果 Rolling刷牙组的菌斑清除率明显优于其他2种刷牙组的菌斑清除率；A、B、c、D4个象限的菌斑清除率差异无显性，前牙区的菌斑清除率明显优于后牙区；牙线对清除邻面菌斑效果较佳。结论 Rolling刷牙法有利于对牙面牙菌斑的清除，刷牙时应注意加强后牙区的菌斑清除，积极推广使用牙线。     

Dental Care in Programs of All-Inclusive Care for the Elderly: Organizational Structures and Protocols

ObjectivesThis study uses a national model of community-based long-term services and supports, the Program of All-inclusive Care for the Elderly (PACE), to identify organizational structures and protocols that can facilitate the delivery of dental examinations.DesignWe developed an online survey instrument and conceptual model for this study representing 10 domains believed to characterize a quality PACE dental program.Setting and ParticipantsThe Qualtrics survey was distributed nationally to all 124 PACE programs in the 31 states PACE was available. Respondents in this study represented 35 programs (program response rate = 28.2%) in 23 states (state response rate = 74.2%).MethodsSelected independent variables from each of the 10 domains were tested against the reported delivery of dental examinations variable using the Kendall τ and χ². Twenty-nine programs were included in the final analysis.ResultsMost programs mandated a dental examination within 31–60 days of enrollment (63.6%). Few programs had a dental manual (15.6%) or any quality assurance for dental care (32.3%). A majority of programs (58.8%) stated that they had a protocol for enrollees to receive a cleaning every 6–12 months. Having a system for quality assurance for dental care, protocol for a cleaning every 6–12 months, mandating a comprehensive dental examination and providing preventive dental services onsite with built-in equipment, were all statistically associated with a higher reported delivery of dental examinations.Conclusion and ImplicationsOrganizations providing long-term services and supports, including PACE, can use these identified domains to develop minimal standards to ensure dental care is part of innovative models of community-based long-term services and supports. Implementing these domains can facilitate effective delivery of dental examinations that have the potential to support positive oral health and general health outcomes.     

基层医疗保健机构孕产妇保健服务利用现状与相关因素分析

目的 探究影响孕产妇利用保健服务的相关因素,并结合地区实际,提出了相关建议和措施.方法 对在我院进行保健服务的1558名孕产妇进行调查分析,结合实际情况用SPSS 18.0统计学软件进行系统分析.结果 文化程度、家庭年收入水平、居住地距离、职业和医保等因素对孕产妇保健服务利用影响较大;同时,在1 558名受访者中,接受孕前保健指导的比率相对较低,早孕检查、5次以上产检率和住院分娩率结果相对较高,说明近几年来孕产妇对保健服务利用的意识有所提高,但产后访视比例仅为21.76％,比例较低.结论 针对当前现状,研究认为,个人、基层医疗保健机构及卫生管理部门等各方应当分别在提高认识水平、提高服务水平及加强基层系统建设等方面进行改善,以提高孕产妇保健服务的利用,提高优生优育水平.     

Changes in Regional Variation of Medicare Home Health Care Utilization and Service Mix for Patients Undergoing Major Orthopedic Procedures in Response to Changes in Reimbursement Policy

Background. Significant variation in regional utilization of home health (HH) services has been documented. Under Medicare's Home Health Interim and Prospective Payment Systems, reimbursement policies designed to curb expenditure growth and reduce regional variation were instituted.
Objective. To examine the impact of Medicare reimbursement policy on regional variation in HH care utilization and type of HH services delivered.
Research Design. We postulated that the reimbursement changes would reduce regional variation in HH services and that HH agencies would respond by reducing less skilled HH aide visits disproportionately compared with physical therapy or nursing visits. An interrupted time-series analysis was conducted to examine regional variation in the month-to-month probability of HH selection, and the number of and type of visits among HH users.
Subjects. A 100 percent sample of all Medicare recipients undergoing either elective joint replacement (1.6 million hospital discharges) or surgical management of hip fracture (1.2 million hospital discharges) between January 1996 and December 2001 was selected.
Results. Before the reimbursement changes, there was great variability in the probability of HH selection and the number of HH visits provided across regions. In response to the reimbursement changes, though there was little change in the variation of probability of HH utilization, there were marked reductions in the number and variation of HH visits, with greatest reductions in regions with highest baseline utilization. HH aide visits were the source of the baseline variation and accounted for the majority of the reductions in utilization after implementation.
Conclusions. The HH interim and prospective payment policies were effective in reducing regional variation in HH utilization.     

Insurance Disruption due to Spousal Medicare Transitions: Implications for Access to Care and Health Care Utilization for Women Approaching Age 65

Objective. To assess whether a husband's Medicare transition leads to insurance disruptions for his wife that impact her perceived access to care, health care utilization, or health status.
Data Sources/Study Setting. Respondents were married women under age 65 from the 2003–2005 round of the Wisconsin Longitudinal Study ( N =655).
Study Design. Instrumental variable (IV) linear and IV-probit analyses provided unbiased estimates of the effect of an insurance disruption on study outcomes. The instrument was the husband's age: (1) women with husbands who transitioned to Medicare within the previous year (age 65–66); (2) women with husbands who did not transition (60 Data Collection/Extraction Methods. Respondents were surveyed via telephone and mail.
Principal Findings. After adjustment, women who experienced an insurance disruption due to their husband's Medicare transition had a greater probability of experiencing a change in usual clinic/provider (71 percent), delaying filling or taking fewer medications than prescribed because of cost (75 percent), going to the emergency room (52 percent), and had lower average mental health scores than women who did not experience an insurance disruption.
Conclusions. Despite consistent insurance coverage, the insurance disruption that accompanies a spouse's Medicare transition has adverse access and health care utilization consequences for women.