title: Examining continuity of care for Medicaid-enrolled children receiving oral health services in medical offices.
abstract: Children living in poverty encounter barriers to dentist visits and disproportionally experience dental caries. To improve access, most state Medicaid programs reimburse pediatric primary care providers for delivering preventive oral health services. To understand continuity of oral health services for children utilizing the North Carolina (NC) Into the Mouths of Babes (IMB) preventive oral health program, we examined the time to a dentist visit after a child's third birthday. This retrospective cohort study used NC Medicaid claims from 2000 to 2006 for 95,578 Medicaid-enrolled children who received oral health services before age 3. We compared children having only dentist visits before age 3 to those with: (1) only IMB visits and (2) both IMB and dentist visits. Cox proportional hazards regression was used to estimate the time to a dentist visit following a child's third birthday. Propensity scores with inverse-probability-of-treatment-weights were used to address confounding. Children with only IMB visits compared to only dentist visits before age 3 had lower rates of dentist visits after their third birthday [adjusted hazard ratio (AHR) = 0.41, 95 % confidence interval (CI) 0.39-0.43]. No difference was observed for children having both IMB and dentist visits and only dentist visits (AHR = 0.99, 95 % CI 0.96-1.03). Barriers to dental care remain as children age, hindering continuity of care for children receiving oral health services in medical offices.
authors.affiliation: Department of Dental Research, School of Dentistry, University of North Carolina at Chapel Hill, Koury Oral Health Sciences Building, Room 4505, Campus Box 7455, Chapel Hill, NC, 27599-7455, USA, akranz@unc.edu.
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Kranz
authors.forename: R Gary
authors.initials: RG
authors.lastname: Rozier
authors.forename: John S
authors.initials: JS
authors.lastname: Preisser
authors.forename: Sally C
authors.initials: SC
authors.lastname: Stearns
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
authors.forename: Jessica Y
authors.initials: JY
authors.lastname: Lee
mesh_terms: D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003153:Community Health Services / Q000706:statistics & numerical data; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D019140:Dental Care for Children / Q000379:methods / Q000706:statistics & numerical data*; D003740:Dental Clinics / Q000706:statistics & numerical data*; D005260:Female; D006293:Health Promotion / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D008297:Male; D008484:Medicaid; D009657:North Carolina; D009909:Oral Health; D010372:Pediatrics; D011313:Preventive Dentistry / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014481:United States