Abstract
BackgroundTo 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/DesignThis 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.DiscussionIf 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.Trial registrationClinicalTrials.gov NCT02312921 6 December 2014. The Robert Wood Johnson Foundation and Advantage Dental Services, LLC, are supporting the evaluation.
Highlights
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
PREDICT can be disseminated to other care organizations as publicly insured clients are increasingly served by large practice organizations
In most states, children enrolled in the Medicaid program have low utilization of dental care and a high prevalence of untreated decayed teeth
Summary
Children enrolled in the Medicaid program have low utilization of dental care and a high prevalence of untreated decayed teeth. Children at high risk can be identified and intensive evidence-based effective preventive and curative services provided To our knowledge, this intervention will be the first large scale, “real world” test of an alternative delivery and payment model that has the potential to reduce dental care and oral health disparities nationally. The major challenges for PREDICT are obtaining the permission of community organizations and schools to implement the new dental care system, gaining the cooperation of community leaders, educators, principals and teachers, and getting parents to sign-up for the program Another challenge is providing the screening, risk assessment and risk-based services to children at community settings cost-effectively. Children with dental diseases or other oral health needs that require treatment in dental offices need to receive it in a timely fashion through well-organized pathways Both the evaluation and effective management of this intervention depend on the availability of operational data.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
