A scoping review of the economic impact of family oral health: Implications for public health, research, and policy.

Objectives: To summarize evidence on the impact of oral health on individual and family economic outcomes, describe trends in the literature, and identify areas for additional research to inform public health research and practice.

Methods: Searches were conducted within PubMed, CINAHL, EconLit, Cochrane Library, PsycInfo, and Web of Science databases. Article review, selection, abstraction, and reporting processes were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews.

Measuring quality of dental care during pregnancy.

Background: The authors aimed to develop and validate 2 Dental Quality Alliance measures of dental care access during pregnancy (Utilization of Services During Pregnancy, Oral Evaluation During Pregnancy) using claims and enrollment data and to report performance on these measures for a sample of Medicaid and Children's Health Insurance Program beneficiaries.

Methods: The authors used Transformed Medicaid Statistical Information System enrollment and claims data for 7,767,806 people enrolled in 5 state Medicaid programs and Children's Health Insurance Programs during 2018. The authors used split-half reliability testing to assess measure reliability.

Testing dental quality measures: Emergency department visits for nontraumatic dental conditions and subsequent follow-up dental visits.

Background: The goal of this study was to test the feasibility, reliability, and validity of the Dental Quality Alliance's adult dental quality measures for system-level implementation for ambulatory care sensitive (ACS) emergency department (ED) visits for nontraumatic dental conditions (NTDCs) in adults and follow-up after ED visits for NTDCs in adults.

Methods: Medicaid enrollment and claims data from Oregon and Iowa were used for measure testing. Testing included validation of diagnosis codes in claims data through patient record reviews of ED visits and calculations of κ statistic, sensitivity, and specificity.

Project ECHO Diabetes Cost Modeling to Support the Replication and Expansion of Tele-mentoring Programs in Non-research Settings.

Introduction: Project ECHO Diabetes is a tele-education learning model for primary care providers (PCPs) seeking to improve care for patients with diabetes from marginalized communities. Project ECHO Diabetes utilized expert "hub" teams comprising endocrinologists, dieticians, nurses, psychologists, and social workers and "spokes" consisting of PCPs and their patients with diabetes. This Project ECHO Diabetes model provided diabetes support coaches to provide additional support to patients.

Racial and ethnic disparities in oral healthcare quality among children enrolled in Medicaid and CHIP.

Objectives: Addressing inequities in oral health care requires identification of which populations are experiencing performance gaps and the extent of those gaps. This study used Dental Quality Alliance (DQA) measures to examine variations in quality by race and ethnicity.

Methods: We used eligibility and claims data for 2018 for children aged <21 years for state Medicaid/CHIP programs available through the Transformed Medicaid Statistical Information System.

Patient centered dental home: Building a framework for dental quality measurement and improvement.

Introduction: This article presents results of the second phase of a project to develop a patient-centered dental home (PCDH) model. Aims of PCDH model development include broadening the scope of prior dental home definitions to include populations across the lifespan, developing a quality measurement framework to facilitate quality assessment and improvement, and promoting opportunities for medical-dental integration through alignment with existing PCMH models. This phase determined the components, or conceptual subdivisions, associated with a previously developed PCDH definition and characteristics.

Findings from a caries risk assessment registry quality improvement initiative in an oral health partnership model.

Objectives: This quality improvement study evaluates the impact of a caries risk assessment (CRA) registry on the following: percentage of children with a documented CRA, receipt of preventive and restorative services, and costs of care.

Methods: We used 2014-2019 data for patients aged 0-17 years from 22 locations in a group practice in Wisconsin. Paired t-tests and Wilcoxon signed-rank tests were used to evaluate changes over time in the following practice-level outcomes: CRA documentation, fluoride receipt, continuing care procedures, restorative procedures, total procedures, and inflation-adjusted costs of care.

Advancing value in oral health through meaningful measurement.

Central to all value-based purchasing (VBP) approaches are value metrics, the measurements used to drive improvement, facilitate payment, and evaluate results of VBP programs. This article outlines approaches for adopting meaningful measurement systems that can be used to support VBP in the near term and identifies systemic changes critical to developing more robust measurement systems to advance VBP in the future.

The patient-centered dental home: A standardized definition for quality assessment, improvement, and integration.

Objective: To develop the first standardized definition of the patient-centered dental home (PCDH).

Data Sources/study Setting: Primary data from a 55-member national expert panel and public comments.

Study Design: We used a modified Delphi process with three rounds of surveys to collect panelists' ratings of PCDH characteristics and open-ended comments.

Mission of Mercy patient characteristics and dental-related emergency department use.

Background: Although dental Mission of Mercy (MOM) events have existed for more than 2 decades and are held in more than 30 states, systematic data collection and reporting on patient characteristics, oral health care use patterns, and oral health care needs are lacking.

Methods: The authors surveyed patients attending the 2016 Florida MOM, asking about their reasons for seeking oral health care, oral health care use, and dental-related emergency department (ED) use. The authors conducted descriptive and multivariable analyses of survey and patient registration data to describe patient characteristics and examine associations between patient characteristics, time to last dental visit, and ED use.

Developing a caries risk registry to support caries risk assessment and management for children: A quality improvement initiative.

Objectives: Health registries are commonly used in medicine to support public health activities and are increasingly used in quality improvement (QI) initiatives. Illustrations of dental registries and their QI applications are lacking. Within dentistry, caries risk assessment implementation and documentation are vital to optimal patient care.

The Association of Health Literacy With Preventable Emergency Department Visits: A Cross-sectional Study.

Background: Policymakers argue that emergency department (ED) visits for conditions preventable with high-quality outpatient care contribute to waste in the healthcare system. However, access to ambulatory care is uneven, especially for vulnerable populations like minorities, the poor, and those with limited health literacy. The impact of limited health literacy on ED visits that are preventable with timely, high-quality ambulatory care is unknown.

Measuring quality: caries-related emergency department visits and follow-up among children.

Objective: This study validated two Dental Quality Alliance system-level measures of oral healthcare quality for children - caries-related emergency department (ED) visits and timely follow-up of those visits with a dentist - including formal validation of diagnosis codes used to identify caries-related ED visits and measurement of follow-up care.

Methods: The measures were specified for implementation with administrative claims data and validated using data from the Florida and Texas Medicaid and Children's Health Insurance Programs. Measure specification testing and measure score validation used administrative data for 7,007,765 children.

Trends in dental-related use of hospital emergency departments in Florida.

Objectives: The inability to access regular dental care may lead to care seeking at hospital emergency departments (EDs). However, EDs generally are not equipped or staffed to provide definitive dental services. This study examined trends and patterns of hospital ED use for dental-related reasons in Florida, a large, diverse state with serious barriers to accessing dental care.

Using a stakeholder-engaged approach to develop and validate electronic clinical quality measures.

Objective: To describe the stakeholder-engaged processes used to develop, specify, and validate 2 oral health care electronic clinical quality measures.

Materials And Methods: A broad range of stakeholders were engaged from conception through testing to develop measures and test feasibility, reliability, and validity following National Quality Forum guidance. We assessed data element feasibility through semistructured interviews with key stakeholders using a National Quality Forum-recommended scorecard.

Measuring quality of dental care: Caries prevention services for children.

Background: The authors conducted a study to validate the following 3 evidence-based, process-of-care quality measures focused on dental caries prevention for children with an elevated risk of experiencing caries: sealants for 6- to 9-year-olds, sealants for 10- to 14-year-olds, and topical fluoride.

Methods: Using evidence-based guidelines, the Dental Quality Alliance developed measures for implementation with administrative data at the plan and program levels. To validate the measures, the authors used data from the Florida and Texas Medicaid programs and Children's Health Insurance Programs and from national commercial dental benefit plans.

Quality of Care for Chronic Conditions Among Disabled Medicaid Enrollees: An Evaluation of a 1915 (b) and (c) Waiver Program.

Importance: Examining the impact of Medicaid-managed care home-based and community-based service (HCBS) alternatives to institutional care is critical given the recent rapid expansion of these models nationally.

Objective: We analyzed the effects of STAR+PLUS, a Texas Medicaid-managed care HCBS waiver program for adults with disabilities on the quality of chronic disease care.

Design, Setting, And Participants: We compared quality before and after a mandatory transition of disabled Medicaid enrollees older than 21 years from fee-for-service (FFS) or primary care case management (PCCM) to STAR+PLUS in 28 counties, relative to enrollees in counties remaining in the FFS or PCCM models.

Developing and testing pediatric oral healthcare quality measures.

Objective: This study describes processes used to develop and test pediatric oral healthcare quality measures and provides recommendations for implementation.

Methods: At the request of the Centers for Medicare and Medicaid Services, the Dental Quality Alliance (DQA) was formed in 2008 as a multi-stakeholder group to develop oral healthcare quality measures. For its initial focus on pediatric care, measure development processes included a literature review and environmental scan to identify relevant measure concepts, which were rated on importance, feasibility, and validity using the RAND/UCLA modified Delphi approach.

Effect of training pediatricians and family physicians in early childhood caries prevention.

Objectives: To analyze the effect of postresidency early childhood caries prevention training on physicians' oral health knowledge, confidence, and practice patterns and to identify variations by type of training.

Study Design: We conducted pre- and post-training surveys of pediatricians and family physicians in Florida. Paired t test and repeated-measures ANOVA analyses were used to compare physicians with no oral health training, those with applied in-office training, and those with another type of training on 5 composite measures: fluoride knowledge, nonfluoride oral health knowledge, confidence in advising parents, confidence in conducting oral health screening and caries risk assessment, and frequency in performing recommended oral health practices.

The effect of Medicaid primary care provider reimbursement on access to early childhood caries preventive services.

Objective: To examine receipt of early childhood caries preventive services (ECCPS) in two states' Medicaid programs before and after the implementation of reimbursement to medical primary care providers (M-PCPs).

Data Sources: Enrollment and claims data from the Florida and Texas Medicaid programs for children ≤54 months of age during the period 2006-2010.

Study Design: We conducted time trend-adjusted, difference-in-differences analyses by using modified Poisson regressions combined with generalized estimating equations (GEEs) to analyze the effect of M-PCP reimbursement on the likelihood that an enrollee had an ECCPS visit after controlling for age, sex, health status, race/ethnicity, geographic location, and enrollment duration.

Emergency department crowding and time to antibiotic administration in febrile infants.

Introduction: Early antibiotic administration is recommended in newborns presenting with febrile illness to emergency departments (ED) to avert the sequelae of serious bacterial infection. Although ED crowding has been associated with delays in antibiotic administration in a dedicated pediatric ED, the majority of children that receive emergency medical care in the United States present to EDs that treat both adult and pediatric emergencies. The purpose of this study was to examine the relationship between time to antibiotic administration in febrile newborns and crowding in a general ED serving both an adult and pediatric population.

Anti-inflammatory medication adherence, healthcare utilization and expenditures among Medicaid and children's health insurance program enrollees with asthma.

Background: Underuse of controller therapy among Medicaid-enrolled children is common and leads to more emergency department (ED) visits and hospitalizations. However, there is little evidence about the relationship between medication adherence, outcomes and costs once controller therapy is initiated.

Objective: This study examined the relationship between adherence to two commonly prescribed anti-inflammatory medications, inhaled corticosteroids (ICS) and leukotriene inhibitors (LI), and healthcare utilization and expenditures among children enrolled in Medicaid and the Children's Health Insurance Program in Florida and Texas in the US.

Health literacy and emergency department outcomes: a systematic review.

Study Objective: We assess emergency department (ED) patients' health literacy, the readability of ED patient materials, and the relationship between health literacy and ED outcomes through a systematic literature review.

Methods: PubMed, PsychInfo, CINAHL, Web of Knowledge, and ERIC were searched for studies published January 1, 1980, to July 15, 2010, conducted in the United States, reporting original data, and measuring ED patients' health literacy, the readability of ED materials, or the association between health literacy and ED-related outcomes. Two reviewers evaluated each study and abstracted information from included studies into evidence tables.

Preventive oral health care in early childhood: knowledge, confidence, and practices of pediatricians and family physicians in Florida.

Objective: To examine the relationships among pediatricians' and family physicians' oral health training, knowledge, confidence, and practice patterns.

Study Design: A survey of physicians identified through the membership databases of the Florida Academy of Family Physicians and the Florida Pediatric Society was conducted in 2008. Responses of pediatricians and family physicians were compared through bivariate and multivariate analyses.