AHRQ Oral Health Resources
1. Introduction/Agency-level Executive Summary
AHRQ's mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. Information from AHRQ's research helps people make more informed decisions and improve the quality of health care services.
AHRQ's overall focus is—
- Safety and quality: Reduce the risk of harm by promoting delivery of the best possible health care.
- Effectiveness: Improve health care outcomes by encouraging the use of evidence to make informed health care decisions.
- Efficiency: Transform research into practice to facilitate wider access to effective health care services and reduce unnecessary costs.
AHRQ supports TeamSTEPPS® which is a teamwork system designed for health care professionals that is—
- A powerful solution to improving patient safety.
- An evidence-based teamwork system to improve communication and teamwork skills among health care professionals.
- A source for ready-to-use materials and a training curriculum to successfully integrate teamwork principles into all areas of health care systems.
- A solution that is scientifically rooted in more than 20 years of research and lessons from the application of teamwork principles.
- A solution that has been developed by the Department of Defense's Patient Safety Program in collaboration AHRQ.
|Agency-Supported Dental TeamSTEPPS||http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/dental/index.html|
|Dental Office Module: Lost Opportunity||(Flash video, 4 min., 43 sec.; 18.9 MB)|
|Dental Office Module: Opportunity Won||(Flash video, 4 min., 21 sec.; 17.3 MB)|
|Oral Surgery Module: Lost Opportunity||(Flash video, 4 min., 9 sec.; 16.8 MB)|
|Oral Surgery Module: Opportunity Won||(Flash video, 5 min., 38 sec.; 22.5 MB)|
3. Patients and Systems of Care
Health IT To Advance Excellence in Health Care
AHRQ's health information technology (IT) initiative is part of the Nation's strategy to put information technology to work in health care. By developing secure and private electronic health records for most Americans and making health information available electronically when and where it is needed, health IT can improve the quality of care, even as it makes health care more cost-effective. The broad mission of AHRQ's health IT initiative is to improve the quality of health care including dental care for all Americans. The Agency has focused its health IT activities on the following three goals:
- Improve health care decisionmaking.
- Support patient-centered care.
- Improve the quality and safety of medication management.
Supported by AHRQ, NORC at the University of Chicago, with the Children's Dental Health Project (CDHP), provided a report on the use of health IT and the Medicaid EHR incentive program as a tool to improve access to quality oral health care for children enrolled in Medicaid and the Children's Health Insurance Program (CHIP). This report provided recommendations regarding—
- Whether or not the Meaningful Use Incentive Payments could serve as an incentive for dentists to serve additional Medicaid and CHIP enrollees.
- Ways in which the functionalities of health IT can increase access to quality oral health care for Medicaid and CHIP enrollees.
The Medical Expenditure Panel Survey (MEPS) is a set of large-scale surveys of families and individuals, their medical providers, and employers across the United States. MEPS is the most complete source of data on the cost and use of health care and health insurance coverage. MEPS currently has two major components: the Household Component and the Insurance Component. The Household Component provides data from individual households and their members, which is supplemented by data from their medical providers. The Insurance Component is a separate survey of employers that provides data on employer-based health insurance.
The Household Component (HC) collects data from a sample of families and individuals in selected communities across the United States, drawn from a nationally representative subsample of households that participated in the prior year's National Health Interview Survey (conducted by the National Center for Health Statistics). During the household interviews, MEPS collects detailed information for each person in the household on the following: demographic characteristics, health conditions, health status, use of medical and dental services, charges and source of payments, access to care, satisfaction with care, health insurance coverage, income, and employment. The dental visit data file is one in a series of event-level public use data files drawn from the MEPS-HC. Released as an ASCII file with SAS and SPSS programming statements and in SAS transport format, the Dental Visits File provides detailed information on dental events for a nationally representative sample of the civilian, noninstitutionalized population of the United States. This file contains variables pertaining to household reported dental visits including the date of the dental event, type of provider seen, if the visit was due to an accident, reason for the dental event, and whether medicines were prescribed.
The Insurance Component (IC) collects data from a sample of private and public sector employers on the health insurance plans they offer their employees. The collected data include the number and types of private insurance plans including dental insurance plans offered (if any), premiums, contributions by employers and employees, eligibility requirements, benefits associated with these plans, and employer characteristics.
The following relevant dental reports, publications, and manuscripts have been published using MEPS data.
|Selected MEPS Dental Relevant Journal Articles:|
Manski, R.J. and Brown, E. Dental Coverage of Adults Ages 21-64, United States, 1997 and 2007. Statistical Brief 295. October 2010. Agency for Healthcare Research and Quality, Rockville, MD.
Manski, R.J. and Cooper, P.F. "Characteristics of Employers Providing Dental Coverage in the U.S., Journal of the American Dental Association 141(6):700-711 June 2010.
Manski, R.J. and Brown, E. Dental Coverage of Children and Young Adults under Age 21, United States, 1996 and 2006. Statistical Brief 221. September 2008. Agency for Health Care Research and Quality, Rockville. MD.
Manski, R.J. and Cooper, P.F. "Dental Care Use: Does Dental Insurance Truly Make a Difference in the Us?" Community Dental Health 24(4):205-212 December 2007.
Wall, T.P., Brown, L.B., Zentz, R.R. and Manski, R.J. "Dentist Prescribed Drugs and the Patients Receiving Them," Journal of the American College of Dentists 74(3):32-41 Fall 2007.
Chu, M., Sweis, L.E., Guay, A.H. and Manski, R.J. "Children's Dental Care: Visits and Checkups, 2003," Journal of the American Dental Association 138(10):1324-1331 October 2007.
Manski, R.J. and Brown, E. Dental Use, Expenses, Private Dental Coverage, and Changes, 1996 and 2004. Rockville (MD): Agency for Healthcare Research and Quality; 2007. MEPS Chartbook No.17.
Cohen L.A. and Manski, R.J. "Visits to Non-Dentists Health Care Providers for Dental, Problems: A National Perspective," Family Medicine 38(8):556-564 September 2006.
Drilea, S.K., Reid, B.C., Li, C.H., Hyman, J.J. and Manski, R. J. "Dental Visits Among Smoking and Nonsmoking U.S. Adults in 2000," American Journal of Health Behavior 29(5):462-471. September/October 2005.
Goodman, H.S., Manski, M.C., Williams J.N. and Manski, R.J. "An Analysis of Preventive Dental Visits by Provider Type: 1996," Journal of the American Dental Association 136(2):221-228 February 2005.
Brown E, Manski R. Dental services: Use, expenses, and sources of payment, 1996-2000. Rockville (MD): Agency for Healthcare Research and Quality; 2004. MEPS Research Findings Research and Quality; 2004. MEPS Research Findings No. 20. AHRQ Pub. No. 04-0018.
Manski, R.J., Goodman, H.S., Reid, B.C., and Macek, M.D., "Dental Insurance Visits And Expenditures Among Older Adults" American Journal of Public Health 94(5):759-764, May 2004.
Manski, R.J., Moeller, J.F. and Hupp J.R. "An Analysis of Oral Surgical Dental Visits By Provider Type, 1996," Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics 94(6):687-691, December 2002.
Manski, R.J., Macek, M.D., and Moeller, J.F. "Private Dental Coverage: Who Has it and How Does it Influence Dental Visits and Expenditures?" Journal of the American Dental Association 133(11):1551-1559, November 2002.
Brown, L.J., Wall, T.P. and Manski, R.J. "Recent Trends in the Funding of Dental Services and Sources of Funding Among U.S. Adults," Journal of the American Dental Association 133(5):627-635, May 2002.
Macek, M.D., Manski, R.J., Vargas, C.M. and Moeller, J. "Comparing Oral Health Care Utilization Estimates in the U.S. Across Three Nationally Representative Surveys," Health Services Research 37(2):499-521, April 2002.
|Wall, T.P., Brown, L.J., and Manski, R.J. "Recent Trends in the Funding of Dental Services and Sources of Funding Among U.S. Children 2 to 17 Years Old," Journal of the American Dental Association 133(4):477-482, April 2002.|
|Edelstein B.L., Manski R.J. and Moeller J.F. "Child Dental Expenditures, 1996," Pediatric Dentistry 24(1):11-17, February 2002.|
|Manski, R.J. and Moeller, J.F. "Dental Services: An Analysis of Visits, Procedures and Providers, 1996," Journal of the American Dental Association 133(2):167-175, February 2002.|
|Watson, M.R., Manski, R.J. and Macek, M.D. "The Impact of Income at the 'Poor' and 'Near Poor' Poverty Levels on Child and Adolescent Preventive Dental Visits," Journal of the American Dental Association 132(11):1580-1588, November 2001.|
|Macek M.D., Edelstein B.L., Manski R.J. "An Analysis of Dental Visits in U.S. Children, By Category of Service and Sociodemographic Factors, 1996," Pediatric Dentistry 23(5):383-389, September/October 2001.|
|Manski, R.J., Edelstein, B.L. and Moeller, J.F. "Child Dental Coverage: Visits and Expenditures, 1996," Journal of the American Dental Association, 132(8):1137-1145, August 2001.|
|Manski, R.J., Moeller, J.F., and Maas, W. "Dental Services: An Analysis of Utilization Over Twenty Years," Journal of the American Dental Association 132(5):655-664, May 2001.|
|Manski, R.J., Davidson W.M., and Moeller, J.F. "Orthodontic Dental Visits During 1987 and 1996," American Journal of Orthodontics and Dentofacial Orthodpedics 118(1):10-13, July 2000.|
|Edelstein, B.L., Manski, R.J., and Moeller, J.F. "Pediatric Dental Visits During 1996," Pediatric Dentistry 22(1):17-20, January/February 2000.|
|Vargas, C., and Manski, R.J. "Dental Expenditures and Source of Payment by Race/Ethnicity and other Sociodemographic Characteristics," Journal of Public Health Dentistry 59(1)33-38, Winter 1999.|
|Manski, R.J., Moeller, J.F., and Maas, W. "Health Expenditures: A Comparison Between Dental Expenditures and Office-Based Medical Expenditures, 1987," Journal of the American Dental Association 130(5):659-666, May 1999.|
|Manski, R.J., Moeller, J.F., and Maas, W. "Dental Services: Use, Expenditures and Sources of Payment, 1987," Journal of the American Dental Association 130(4):500-508, April 1999.|
The Healthcare Cost and Utilization Project (HCUP, pronounced "H-Cup") is a family of health care databases and related software tools and products developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ). HCUP databases bring together the data collection efforts of State data organizations, hospital associations, private data organizations, and the Federal government to create a national information resource of patient-level health care data (HCUP Partners). HCUP includes the largest collection of longitudinal hospital care data in the United States, with all-payer, encounter-level information beginning in 1988. These databases enable research on a broad range of health policy issues, including cost and quality of health services, medical practice patterns, access to health care programs, and outcomes of treatments at the national, State, and local market levels.
National and regional HCUP data include dental related care. The following dental relevant manuscripts have been published using HCUP data.
|Selected HCUP Dental Relevant Reports and Publications|
|Nalliah, R.P., Allareddy, V., Elangovan, S., Karimbux, N. Hospital based emergency department visits attributed to dental caries in the United States in 2006, Journal of Evidence Based Dental Practice 2010;10(4):212-22.|
|Shortridge, E.F., Moore, J.R. Use of emergency departments for conditions related to poor oral healthcare: implications for rural and low-resource urban areas for three states, J Public Health Management Practice 2009 May-Jun;15(3):238-45.|
|Simpson, L., Owens, P.L., Zodet, M.W., Chevarley, F.M., Dougherty, D., Elixhauser, A., McCormick, M C. Health care for children and youth in the United States: annual report on patterns of coverage, utilization, quality, and expenditures by income, Ambulatory Pediatrics 2005 Jan-Feb;5(1):6-44.|
|Chevarley, F.M., Owens, P.L., Zodet, M.W., Simpson, L.A., McCormick, M.C., Dougherty, D. Health care for children and youth in the United States: annual report on patterns of coverage, utilization, quality, and expenditures by a county level of urban influence, Ambulatory Pediatrics 2006 Sep-Oct;6(5):241-264.|
The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) program is a public-private initiative to develop standardized surveys of patients' experiences with ambulatory and facility-level care. The CAHPS program is funded and administered by AHRQ, which works closely with a consortium of public and private organizations. Health care organizations, public and private purchasers, consumers, and researchers use CAHPS results to—
- Assess the patient-centeredness of care.
- Compare and report on performance.
- Improve quality of care.
In 2006, the CAHPS Consortium voted to adopt a Dental Plan Survey developed by the American Institutes for Research (AIR) in collaboration with TRICARE as an official CAHPS survey. (TRICARE is the Department of Defense's health plan for military personnel and their dependents.) AIR and TRICARE had been working since October 2004 to develop this survey for measuring patients' experiences with their dental plan and its services. The CAHPS Dental Plan Survey is currently being used to evaluate dental programs that cover over 2.8 million lives and soon will expand to over 3.5 million covered lives. It is available for use by States, purchasers, and other organizations interested in assessing, improving, and reporting on the quality and value offered by dental plans.
4. Health Promotion/Disease Prevention
AHRQ has supported the following projects to promote oral health through education, events, or other activities.
Q-SPAN: Expanding and Improving Quality of Care Measures
Expansion of Quality of Care Measures (Q-SPAN) is a project of AHRQ (formerly the Agency for Health Care Policy and Research) designed to strengthen the science base of quality measurement while expanding the scope and availability of validated, ready-to-use measures. Q-SPAN builds on past work in quality measurement by public and private organizations through eight cooperative agreements to develop and test additional clinical performance measures for specific conditions, patient populations, and health care settings.
Once the new measures are ready for use, they will be added to the more than 1,200 performance measures included in AHCPR's Computerized Needs-Oriented Quality Measurement Evaluation System (CONQUEST), a unique software tool for helping health plans, providers, and others identify, understand, evaluate, and select clinical measures to assess and improve the quality of the health care they provide.
Clinical Performance Measures for Dental Care Plans (HS-9453)
James Bader, D.D.S. University of North Carolina at Chapel Hill
Project Dates: September 30, 1996 - September 29, 1998
Performance measures are being developed and tested for two major dental diseases: dental caries and periodontal disease. They will be evaluated in various dental care sites in terms of outcomes, feasibility of implementation, and perceived utility among purchasers, administrators, and providers.
The purpose of this study is to develop and evaluate a set of clinical performance measures for dental care. The measures will be developed with guidance from Steering and Advisory Committees comprising representatives of dental health plans, purchasers, and providers. The measures will be pilot tested for reliability and validity. They will then be implemented in a large demonstration project involving two large managed care plans. A supplement was awarded in September 1997 to add up to six additional dental care sites, such as state and local public health delivery programs and national insurers. The final product will be a users' manual including information on the development of the measures, their reliability and validity, how their numerators and denominators are constructed, and how they may be used.
5. Oral Health Literacy
AHRQ supports research and other activities designed to encourage empirical research on health literacy concepts, theory and interventions as these relate to the U.S. Department of Health and Human Services public health priorities that are outlined in its HealthierUS and Healthy People 2010 initiatives.
AHRQ Health Literacy Funding Opportunities
Currently the following funding opportunities to support Health Literacy including oral health literacy are supported by AHRQ:
- Program Announcement (PA) Number: PAR-10-133 (R01).
- Program Announcement (PA) Number: PAR-10-134 (R03).
- Program Announcement (PA) Number: PAR-10-135 (R21).
AHRQ Health Literacy Programs (Healthcare 411)
Healthcare 411 is an audio podcast series produced by AHRQ. AHRQ's mission is to improve the quality, safety, efficiency and effectiveness of health care for all Americans. Using the latest technology, AHRQ shares news and information in the form of concise 60-second audio news programs that feature current research on important health care topics. Healthcare 411 gives consumers information they can use in their health care decisionmaking.
|Agency-Supported Podcasts on Health Literacy|
|Improving Your Health Literacy||Tuesday, September 7, 2010, 9:00 AM|
|Understanding Your Health: Healthfinder.gov||Wednesday, October 8, 2008, 9:00 AM|
|What's Your Health Literacy Score?||Tuesday, May 20, 2008, 9:00 AM|
|Health Literacy and Understanding Health Information||Wednesday, December 19, 2007, 5:00 PM|
|Health Literacy||Wednesday, December 26, 2007, 9:00 AM|
|Tools Designed to Help Pharmacists Communicate Better with Patients||Wednesday, December 26, 2007, 5:00 PM|
6. Reducing Disparities
AHRQ supports research and other activities designed to improve quality and address disparities in health care for racial and ethnic minorities. AHRQ has supported the following relevant projects, reports and activities.
In its reauthorization legislation, Congress mandated that the Agency for Healthcare Research and Quality (AHRQ) produce an annual report on health care disparities in the United States (Public Law 106-129). The National Healthcare Disparities Report (NHDR) includes a broad set of performance measures that can be used to monitor the Nation's progress toward improved health care quality for all Americans. The NHDR summarizes health care quality and access among various racial, ethnic, and income groups and other priority populations, such as residents of rural areas and people with disabilities. A measure of dental care utilization is also included in this report.
AHRQ-Supported Reports and Publications To Address Disparities in Health Care for Racial and Ethnic Minorities
|Selected Reports and Publications|
|Dental Use, Expenses, Dental Coverage, and Changes, 1996 and 2004||Chartbook #17|
|Children's Dental Care: Periodicity of Checkups and Access to Care, 2003||Statistical Brief #113|
|Children's Dental Visits and Expenses, United States, 2003||Statistical Brief #117|
|Dental Coverage of Children and Young Adults under Age 21, United States, 1996 and 2006||Statistical Brief #221|
|Percentage of Persons Unable to Get or Delayed in Getting Needed Medical Care, Dental Care, or Prescription Medicines: United States, 2007||Statistical Brief #282|
|Dental Services: Use, Expenses, and Sources of Payment, 1996-2000||Research Findings #20|
|Health Care Expenses in the United States, 2000||Research Findings #21|
|Agency-Supported Podcasts on Health Disparities for Racial and Ethnic Minorities|
|AHRQ News and Numbers: Dental Checkups||Wednesday, April 12, 2006, 12:00 PM|
|Many U.S. Children Lack Health Insurance||Wednesday, December 3, 2008, 9:00 AM|
|Health Insurance Gaps for America's Kids||Wednesday, November 5, 2008, 9:00 AM|
|Less Than Half of All Children in the U.S. Visited a Dentist in 2004||Wednesday, December 19, 2007, 5:00 PM|
AHRQ's mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. AHRQ fulfills its mission through establishing a broad base of scientific research to promote improvements in clinical and health system practices, such as incorporation of health IT and recommended screening tests in everyday care delivery. The goal of our research is measurable improvements in American health care, gauged in terms of improved quality of life and patient outcomes, lives saved, and value gained for what we spend.
Currently, AHRQ supports the following dental research projects:
eHealth Records To Improve Dental Care for Patients With Chronic Illnesses
Project Date: September 30, 2007 - September 29, 2011
The primary goal of this proposal is to conduct a randomized clinical trial to evaluate the effectiveness of an integrated electronic health record system that includes an eMedical Record (EMR), eDental Record (EDR), and a Personal eHealth Record (PHR) to improve the quality and safety of dental care for patients with chronic illnesses including diabetes, heart disease, pulmonary disease, and conditions that cause xerostomia (dry mouth). If these medical conditions are not identified and addressed in routine dental care, the quality and safety of the care is adversely affected.
Effects of Early and Regular Preventive Dental Care on Treatment Use, Costs
Heather Beil, R36HS18076-01 UNC
The purpose of this study is to determine the effects of initiating regular preventive dental care at a young age on dental treatment, dental costs and dental caries history. The first two study aims rely on a longitudinal cohort design in which Medicaid-enrolled children who had a preventive dental visit before the age of 5 and those who did not have any preventive dental care by that age are compared to determine the effect of initiating regular preventive care at a young age on dental treatment utilization and costs. Results of the study can inform practice guidelines and Medicaid policy on the recommended age of the first dental visit.
A Qualitative Description of a Pilot Project To Improve Access to Care in Residents of a Medically Underserved Area
Sarah Raskin R36HS19117-01A1 University of Arizona
This proposal aims to determine how the pilot project to expand access to dental care fared, a proposal also consistent with Healthy People 2010 goals and objectives related to Oral Health and Public Health Infrastructure. Residents of rural central Appalachia, an area characterized by poverty, low dental insurance coverage, and health professional shortages, bear a disproportionate burden of oral disease. In cooperation with grantee collaborators, a report will contain recommendations for improving interventions which use task-sharing to increase access to oral health care among low-income rural residents.
Fluoride Effectiveness in Prevention of Dental Caries in High Caries Risk Adults
Jones, Judith A R21 HS19527-01
Project Date: September 30, 2010 - September 29, 2012
The proposed work addresses several of the Institute of Medicine's (IOM's) national priorities in clinical effectiveness research: disparities in oral health and health care. Combining extant dental data with other components of the rich Veterans' Affairs patient databases, we will be able to examine the effectiveness of fluoride in preventing caries in patients with five of the 14 priority conditions specified by AHRQ: medically compromised veterans with dementia, depression and bipolar disorder, diabetes, HIV-AIDS and persons with alcohol dependence. Recent data suggest that dental caries is as much of a problem in adults as children (Dye, et al., 2007). However, significant knowledge gaps remain in our knowledge base regarding prevention of caries in adults (Griffin et al., 2007). Using an extant, rich electronic data base from a health care system providing dental treatment to over 342,000 veterans annually, this proposed retrospective, longitudinal study takes maximum advantage of a unique opportunity to examine the following specific aims in a population of medically complex veterans. Aim 1. Examine the effectiveness of prescription-strength, self-applied fluoride and professionally applied fluoride in the prevention of caries in medically compromised veterans who are at high risk for caries. Veterans will be defined as at risk for caries if they have had two or more restorations in the previous year. Aim 2. While recent evidence suggests that fluoride is effective in preventing caries in adults, and multiple exposures to fluoride reduces caries risk in children (Weintraub, 2006), limited data exist showing that multiple exposures or modalities are more effective than a single modality in adults. Thus, we have a unique opportunity to examine whether multiple exposures to fluoride will be more effective than a single exposure. Aim 3. Over the past year, the Department of Veterans Affairs introduced a quality measure (the fluoride monitor) that examines, on a quarterly basis, the percentage of veterans at high risk for caries who receive fluoride treatments. This project will examine the effectiveness of the introduction of this fluoride monitor in reducing the rate of restorations in medically compromised veterans at high risk for caries.
AHRQ, in close collaboration with CMS, supports research to develop an improved healthcare quality measure for dental treatment. The measure is being developed under the authority of the CHIPRA legislation (PL 111-03).
8. Policy and Finance
AHRQ, in close collaboration with CMS and AHRQ's National Advisory Council Subcommittee on Child and Adolescent Quality Measures for Medicaid and CHIP, under the authority of the CHIPRA legislation (PL 111-03), identified two dental measures to be included in the initial core set posted by the Secretary by December 2009; the measures are for voluntary use by State Medicaid and CHIP programs.
AHRQ supports collaborative relationships to advance oral health. Specifically, as noted above, AHRQ is partnering with CMS to develop and improve children's healthcare quality measures for voluntary use by Medicaid and CHIP programs, under the authority of the CHIPRA legislation (PL 111-3).