The primary goal of this project is to improve oral health care delivery and reduce health inequities by conducting robust program evaluations to support decision-making during the pandemic by policymakers and stakeholders. To achieve this goal, the proposed study?s primary objective is to assess how pre-pandemic access to school-based caries prevention programs (SCPPs) affect children?s dental and dental-related care utilization and exposure to environments with high or very high COVID-19 exposure risk levels during the pandemic. This will be done by leveraging (1) a unique data linkage introduced in the original K-25 grant in tandem with (2) a natural experiment caused by unexpected SCPP service schedule interruptions from the pandemic that approximates randomization to pre-pandemic SCPP access and no pre-pandemic access across participating schools. This overcomes site selection bias concerns faced by prior evaluations of school- based programs more generally, whereby schools choosing to participate in school-based programs may be different from those choosing to opt out in ways affecting the observed outcomes of school-based programs. In support of this research, Dr. Shulamite S. Huang is applying for an administrative supplement to her funded K-25 award. Dr. Huang, a health economist specializing in the study of the dental market at New York University?s College of Dentistry (NYU COD), is establishing herself as a young investigator in oral health services research. This award will allow Dr. Huang to further work towards reducing health disparities and improving health care delivery and quality by integrating her background and experience in health economics and policy evaluation with clinical research methods and evaluation of clinical interventions.
In Aim 1, Dr. Huang will determine how trends in dental and dental-related medical utilization have changed among vulnerable children, before and during the pandemic. In particular, she will assess whether any changes in dental-related emergency department visits are indicative of increasing numbers and increasing severity of unmet dental needs during the pandemic.
In Aim 2, Dr. Huang will quantify the impact of pre-pandemic SCPP access on dental and dental-related medical utilization during the pandemic relative to no pre-pandemic SCPP access. This research will serve to further establish Dr. Huang as a oral health services researcher that brings causal inference methods from the field of economics, as well as novel large dataset linkages, to study the impact of changes in dental care delivery on large populations. As in the original K-25 award, Dr. Huang continues to be supported by a mentoring team comprised of a primary mentor, Dr. Heather Gold, an expert in population health research and economic evaluations of clinical & behavioral interventions and Professor at NYU Langone Health and School of Medicine; and one co- mentor, Dr. Richard Niederman, a dentist and Professor and Chair of the Department of Epidemiology and Health Promotion at NYU COD, who conducts the SCPP pragmatic clinical trial providing data for this study.
This project addresses the need to assess the impact of (1) the widespread dental clinic closures during the pandemic and (2) pre-pandemic access to school-based caries prevention programs (SCPPs) on care related to dental conditions among children enrolled in Medicaid/CHIP during the pandemic. This study will use a natural experiment caused by the staggered timing of SCPP care provision among schools, in combination with the unexpected pandemic closures, to assess the impact of SCPPs on care related to dental conditions. This study will inform decision-making by public health officials, policymakers, and other stakeholders about whether pandemic closures exacerbate oral health disparities and whether SCPPs can be used to improve oral health equity during the pandemic.
