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Examining Continuity of Care for Medicaid-Enrolled Children Receiving Oral Health Services in Medical Offices

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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.

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Acknowledgments

This study was supported by grant numbers R01 DE013949 and R03 DE017350 from the National Institute of Dental and Craniofacial Research (NIDCR). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIDCR or the National Institutes of Health (NIH). AMK was partially supported by a National Research Service Award Pre-Doctoral Traineeship from the Agency for Health Care Research and Quality sponsored by the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Grant No. T32-HS000032. MW was supported by an HSR&D Senior Career Scientist Award from the Department of Veterans Affairs.

Conflict of interest

The authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. 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

    Ashley M. Kranz

  2. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    R. Gary Rozier, Sally C. Stearns, Morris Weinberger & Jessica Y. Lee

  3. Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    John S. Preisser

  4. Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA

    Morris Weinberger

  5. Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Jessica Y. Lee

Authors
  1. Ashley M. Kranz
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  2. R. Gary Rozier
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  4. Sally C. Stearns
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Correspondence to Ashley M. Kranz.

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Kranz, A.M., Rozier, R.G., Preisser, J.S. et al. Examining Continuity of Care for Medicaid-Enrolled Children Receiving Oral Health Services in Medical Offices. Matern Child Health J 19, 196–203 (2015). https://doi.org/10.1007/s10995-014-1510-3

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  • DOI: https://doi.org/10.1007/s10995-014-1510-3

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