The candidate is currently a fellow in Pediatric Dentistry completing a Ph.D in Health Policy Analysis with additional advanced training in health services research. She has a long established history of commitment and interest in research and academic dentistry. This application proposes a comprehensive interdisciplinary program wherein the candidate would receive the necessary training and mentorship to develop into an independent investigator. Two phases are described. In the first phase (Scholarly Development) Dr. Lee will work under the mentorship of Dr. R. Gary Rozier and a research advisory committee to complete the first part of the study. In the second phase (Faculty Transition) the candidate will work more independently to complete the second part of the proposal and build upon this research to seek additional funding. This will assist in the transition towards becoming an independent investigator. The research component will examine disparities in access to oral health care for pre-school aged children enrolled in Medicaid. The current level of oral health service utilization in Medicaid has presented a major public policy challenge as evident by reports from the Office of Technology Assessment, the General Accounting Office and the Office of the Surgeon General. Medicaid is the country's largest investment in improving access and decreasing oral health problems of young low-income children. It has been established that low-income, minority, rural children have a disproportionately higher level of dental disease, but very little is known about their use of and access to oral health services. This research proposal will be the first to systematically study racial and geographic disparities and their interactions with each other and Medicaid enrollment on utilization, treatment outcomes and expenditures among pre-school aged children. Four large databases will be used: Composite birth records from 1992, Medicaid enrollment and claims files from 1992-97, and the Area Resource File. This longitudinal cohort study treats the child as the unit of analysis. The data set will contain multiple observations per child-that is one observation for each year until the fifth birthday. Panel data techniques, specifically random effects models, will be incorporated into the estimation equations. Complex and hierarchical modeling will be used in the analyses. While controlling for predisposing and enabling characteristics, we will examine disparities on different outcome measures; 1) any oral health utilization 2) extent of utilization 3) type of visit 4) avoidable hospitalizations and source of care 5) dental related Medicaid expenditures. We will also examine quality performance measures as established by the NCQA expert panel.
