title: Dental Care in an Equal Access System Valuing Equity: Are There Racial Disparities?
abstract: BACKGROUND
  Racial disparities in dental care have previously been shown in the Veterans Health Administration (VA)-a controlled access setting valuing equitable, high-quality care.
  
  
  OBJECTIVE
  The aim of this study is to examine current disparities in dental care by focusing on the receipt of root canal therapy (RCT) versus tooth extraction.
  
  
  METHODS
  This is a retrospective analysis of data contained in the VA's electronic health records. We performed logistic regressions on the independent measures along with a facility-specific random effect, using dependent binary variables that distinguished RCT from tooth extraction procedures.
  
  
  METHODS
  VA outpatients who had at least 1 tooth extraction or RCT visit in the VA in fiscal year 2011.
  
  
  METHODS
  A dependent binary measure of tooth extraction or RCT. Other measures are medical record data on medical comorbidities, dental morbidity, prior dental utilization, and demographic characteristics.
  
  
  RESULTS
  The overall rate of preferred tooth-preserving RCT was 18.1% during the study period. Black and Asian patients were most dissimilar with respect to dental morbidity, medical and psychological disorders, and black patients had the least amount of eligibility for comprehensive dental care. After adjustment for known confounding factors of RCT, black patients had the lowest RCT rates, whereas Asians had the highest.
  
  
  CONCLUSIONS
  Current quality improvement efforts and a value to improve the equity of care are not sufficient to address racial/ethnic disparities in VA dental care; rather more targeted efforts will be needed to achieve equity for all.
authors.affiliation: *Department of Community Health Sciences, Boston University School of Public Health, Boston †Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Hospital (152), Bedford ‡Department of Health Law, Policy and Management, Boston University School of Public Health, Boston §Department of Statistics, Harvard University, Cambridge ∥Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston ¶VA Center for Health Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford #Department of General Dentistry, Boston University Henry M. Goldman School of Dental Medicine **Department of Health Law, Policy and Management, Boston University ††Section of General Internal Medicine, Boston University School of Medicine ‡‡Veterans Affairs Boston Healthcare System, Boston, MA.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Boehmer
authors.forename: Mark
authors.initials: M
authors.lastname: Glickman
authors.forename: Judith A
authors.initials: JA
authors.lastname: Jones
authors.forename: Michelle B
authors.initials: MB
authors.lastname: Orner
authors.forename: Carolyn
authors.initials: C
authors.lastname: Wheler
authors.forename: Dan R
authors.initials: DR
authors.lastname: Berlowitz
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Kressin
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D003729:Dental Care / Q000458:organization & administration*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D054625:Healthcare Disparities / Q000208:ethnology / Q000458:organization & administration*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D044469:Racial Groups / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012390:Root Canal Therapy / Q000706:statistics & numerical data; D014081:Tooth Extraction / Q000706:statistics & numerical data; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data