Determination of the Appropriate Level of Preventive Dental Services for Children by Risk Status and Special Healthcare Needs

PI’s: Paul Griffin & Jack Thomas

Project Date: February 3, 2018

Current recommendations are for a 6-month recall interval for oral health services in all children, regardless of their risk status or special healthcare needs.  There is limited evidence, however, to support this policy.  We propose the following research aims to estimate the benefit of setting recall time by risk status as well as how to allocate limited resources to provide sufficient preventive care to highest-risk children.

Aim 1: Estimate the benefit of setting the dental visit recall interval by risk status/special healthcare needs.  To accomplish this aim we estimate the benefits of providing routine preventive care to high-risk versus low-risk children.

Step 1:  Classify children by baseline risk status and whether they received routine preventive care: The proposed approach will be to use NQF and AADP risk category guidelines to classify children at baseline, and then to follow the preventive services that they receive longitudinally along with their corresponding oral health outcomes (i.e. receipt of caries related procedures, receipt of dental care in OR). Based on receipt of preventive care, children will be classified as routinely receiving preventive care and not routinely receiving routine preventive care. A similar approach will be used for children with special healthcare needs (cancer, craniofacial, and cardiac conditions) using data from the Children’s Healthcare of Atlanta programs. 

Step 2:  Estimate oral health resources spent on children by whether they received routine preventive care and risk status/special healthcare needs: Total costs of oral health preventive and restorative care as well as receipt of caries related procedures will be estimated for children who received and did not receive routine preventive care for children classified as high- and low-risk.  The proposed approach is a difference in differences model controlling for dental provider. 

Aim 2:  Determine the net benefit of modifying the recall interval based on risk status/special healthcare needs: The proposed approach is an optimization model matching need and supply under specifications of system constraints including the recall intervals determined from Aim 1, a patient’s limits on willingness/ability to travel, a discounted preference for providers with high service congestion, access to a dental home, and Medicaid reimbursement.  Different targeted prevention intervention strategies such as school based sealant strategies and sending public health workers to the home will be considered.

Lee, I., Monahan, S., Serban, N., Griffin, P.M., Tomar, S.L., “Estimating the Cost Savings of Preventive Dental Services Delivered to Medicaid-Enrolled Children in Six Southeastern States”, Health Serv Res (2018), 53: 3592-3616. doi:10.1111/1475-6773.12811.