Dental caries is a chronic condition and the most common preventable dental disease affecting children's oral health-related quality of life and well-being. Adequate access to preventive dental procedures remains a challenge for Medicaid-enrolled children. Placement of dental sealants is an evidence-based preventive procedure where a thin plastic coating is bonded into the deep grooves, pits and fissure surfaces of premolar and molar teeth to prevent dental caries (tooth decay). Despite documented evidence of the efficacy, cost-effectiveness and benefits of dental sealant placement, they still remain underutilized. In 2006, the Wisconsin Medicaid program changed its policy to allow dental hygienists in school based settings, to become Medicaid certified providers for dental sealant placement. It is unclear whether this policy change has resulted in an appreciable increase in access and utilization of dental sealants as well as reduced restorative care on first molars for Medicaid- enrolled children in Wisconsin. The goal of this project is to assess whether this policy change in a public health program and system has influenced access, oral health disparities and rates of dental sealant utilization in children considered to be at high risk for dental caries. Ths study will use Medicaid claims data for 2004 to 2013 from the Electronic Data Systems of Medicaid Evaluation and Decision Support (MEDS) database for the state of Wisconsin. Using the Wisconsin Medicaid Claims data we will: 1) assess the overall utilization rates of dental sealant placement among Medicaid- enrolled children pre- and post-policy period; 2) examine the association of patients' socio- demographics, provider characteristics, designation of Dental Health Professional Area (DHPSA) and county level characteristics using Urban Influence Codes on the utilization of dental sealants; and 3) test the association between sealants placed on first molars and restorative treatment for first molars over time. Descriptive statistics and multivariate regression models will be used to estimate the effect of the policy change on the rate at which Medicaid-eligible children receive dental sealants and restorative treatment on first molars. We will control for all available covariates including child's county of residence, age and year. The study will document relevant variables associated with the policy change and the effect on public health service systems and the benefit of collaborative practice of health professionals aimed at eliminating health disparities. This secondary data analysis project is innovative, addresses oral health care disparities and provides documentation that is supportive of community-grounded efforts aimed at improving oral health. Findings from this project may influence future expansion of the policy to other states yet to adopt it, increase awareness about the benefits of sealants as a preventive measure and promote public health program development.
This project will provide documentation regarding the influence of policy change as a driving force for improving access to care, reducing oral health disparities and increasing the utilization of preventive dental services. In addition, it provides information that could have an impact on transforming health improvement efforts through capacity building in public health programs and systems.
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