title: Population-centered Risk- and Evidence-based Dental Interprofessional Care Team (PREDICT): study protocol for a randomized controlled trial.
abstract: BACKGROUND
  To improve the oral health of low-income children, innovations in dental delivery systems are needed, including community-based care, the use of expanded duty auxiliary dental personnel, capitation payments, and global budgets. This paper describes the protocol for PREDICT (Population-centered Risk- and Evidence-based Dental Interprofessional Care Team), an evaluation project to test the effectiveness of new delivery and payment systems for improving dental care and oral health.
  
  
  METHODS
  This is a parallel-group cluster randomized controlled trial. Fourteen rural Oregon counties with a publicly insured (Medicaid) population of 82,000 children (0 to 21 years old) and pregnant women served by a managed dental care organization are randomized into test and control counties. In the test intervention (PREDICT), allied dental personnel provide screening and preventive services in community settings and case managers serve as patient navigators to arrange referrals of children who need dentist services. The delivery system intervention is paired with a compensation system for high performance (pay-for-performance) with efficient performance monitoring. PREDICT focuses on the following: 1) identifying eligible children and gaining caregiver consent for services in community settings (for example, schools); 2) providing risk-based preventive and caries stabilization services efficiently at these settings; 3) providing curative care in dental clinics; and 4) incentivizing local delivery teams to meet performance benchmarks. In the control intervention, care is delivered in dental offices without performance incentives. The primary outcome is the prevalence of untreated dental caries. Other outcomes are related to process, structure and cost. Data are collected through patient and staff surveys, clinical examinations, and the review of health and administrative records.
  
  
  CONCLUSIONS
  If effective, PREDICT is expected to substantially reduce disparities in dental care and oral health. PREDICT can be disseminated to other care organizations as publicly insured clients are increasingly served by large practice organizations.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02312921 6 December 2014. The Robert Wood Johnson Foundation and Advantage Dental Services, LLC, are supporting the evaluation.
authors.affiliation: Department of Oral Health Sciences, Northwest Center to Reduce Oral Health Disparities, University of Washington, Box 357475, Seattle, WA, 98195-7475, USA. silvajcc@uw.edu.
authors.forename: Joana
authors.initials: J
authors.lastname: Cunha-Cruz
authors.affiliation: Department of Oral Health Sciences, Northwest Center to Reduce Oral Health Disparities, University of Washington, Box 357475, Seattle, WA, 98195-7475, USA. dfrc@uw.edu.
authors.forename: Peter
authors.initials: P
authors.lastname: Milgrom
authors.affiliation: Advantage Dental Services, LLC, 442 SW Umatilla Ave, Suite 200, Redmond, OR, 97756, USA. mikes@advantagedental.com.
authors.forename: R Michael
authors.initials: RM
authors.lastname: Shirtcliff
authors.affiliation: Department of Community Medicine and Health Care, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA. bailit@uchc.edu.
authors.forename: Howard L
authors.initials: HL
authors.lastname: Bailit
authors.affiliation: Department of Health Services, University of Washington, Box 357230, Seattle, WA, 98195-7230, USA. colleenh@uw.edu.
authors.forename: Colleen E
authors.initials: CE
authors.lastname: Huebner
authors.affiliation: Department of Health Services, University of Washington, Box 357230, Seattle, WA, 98195-7230, USA. dconrad@uw.edu.
authors.forename: Douglas
authors.initials: D
authors.lastname: Conrad
authors.affiliation: Advantage Dental Services, LLC, 442 SW Umatilla Ave, Suite 200, Redmond, OR, 97756, USA. SharityL@advantagedental.com.
authors.forename: Sharity
authors.initials: S
authors.lastname: Ludwig
authors.affiliation: Advantage Dental Services, LLC, 442 SW Umatilla Ave, Suite 200, Redmond, OR, 97756, USA. missym@advantagedental.com.
authors.forename: Melissa
authors.initials: M
authors.lastname: Mitchell
authors.affiliation: Advantage Dental Services, LLC, 442 SW Umatilla Ave, Suite 200, Redmond, OR, 97756, USA. jeanned@advantagedental.com.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Dysert
authors.affiliation: Advantage Dental Services, LLC, 442 SW Umatilla Ave, Suite 200, Redmond, OR, 97756, USA. garya@advantagedental.com.
authors.forename: Gary
authors.initials: G
authors.lastname: Allen
authors.affiliation: Department of Pediatric Dentistry, University of Washington, Box 354915, Seattle, WA, 98195-4915, USA. elorra@uw.edu.
authors.forename: JoAnna
authors.initials: J
authors.lastname: Scott
authors.affiliation: Department of Oral Health Sciences, Northwest Center to Reduce Oral Health Disparities, University of Washington, Box 357475, Seattle, WA, 98195-7475, USA. llman@uw.edu.
authors.forename: Lloyd
authors.initials: L
authors.lastname: Mancl
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003299:Cooperative Behavior; D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000458:organization & administration*; D003731:Dental Caries / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D003752:Dental Health Services / Q000191:economics / Q000458:organization & administration*; D005260:Female; D017048:Health Care Costs; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration*; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D033183:Interdisciplinary Communication; D008297:Male; D008484:Medicaid; D009909:Oral Health; D009922:Oregon / Q000453:epidemiology; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration*; D011203:Poverty; D011247:Pregnancy; D015995:Prevalence; D012017:Referral and Consultation; D012052:Reimbursement, Incentive; D012107:Research Design; D012423:Rural Health; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult