Kaakko Tarja, Skaret Erik, Getz Tracy, Hujoel Philippe, Grembowski David, Moore Carree S, Milgrom Peter
Department of Dental Public Health Sciences, School of Dentistry, University of Washington, Seattle 98195, USA.
J Public Health Dent. 2002 Winter;62(1):45-50. doi: 10.1111/j.1752-7325.2002.tb03420.x.
The Access to Baby and Child Dentistry (ABCD) Program addresses the needs of families in obtaining dental care. In this study, the program was evaluated in rural Stevens County, Washington. Aims were to assess utilization of dental services, average dental expenditures per child, and oral health status.
Medicaid-enrolled children aged 1-4 years were randomly assigned to the ABCD program (n=216) or to regular benefits (n=221). An outreach worker contacted each ABCD family and provided an orientation. Dental care utilization and expenditures were calculated from claims. A posttest-only design was used to evaluate oral health status.
An enrollment effect was seen in ABCD, but the difference between groups was not sustained. There was a doubling of utilization between groups for the youngest cohort, while the others showed no differences. In the first year the rate was higher for the entire ABCD group than for the children not in ABCD (34.0% vs 24.7%). Thirty-three percent of ABCD children (70/212) who had visited the dentist had >1 appointment compared to 21.5 percent (47/219) for the children not in ABCD who had visited the dentist. There was no overall difference in expenditures, while expenditures for preventive services were greater for ABCD. ABCD children had fewer teeth with initial caries. The average incremental cost per child per initial lesion prevented was 31.44 dollars.
ABCD most benefited the youngest cohort of children and improved health.
“儿童牙科就诊机会”（ABCD）项目旨在满足家庭获得牙科护理的需求。本研究在华盛顿州史蒂文斯县农村地区对该项目进行了评估。目的是评估牙科服务的利用率、每个儿童的平均牙科支出以及口腔健康状况。
将参加医疗补助计划的1至4岁儿童随机分为ABCD项目组（n = 216）或常规福利组（n = 221）。一名外展工作人员联系了每个ABCD家庭并提供了指导。根据索赔数据计算牙科护理的利用率和支出。采用仅后测设计来评估口腔健康状况。
在ABCD项目中观察到了登记效应，但两组之间的差异没有持续。最年幼队列的两组之间利用率翻倍，而其他队列则没有差异。第一年，整个ABCD组的就诊率高于未参加ABCD项目的儿童（34.0%对24.7%）。在看过牙医的ABCD儿童中，33%（70/212）有超过1次就诊预约，而在看过牙医的未参加ABCD项目的儿童中这一比例为21.5%（47/219）。支出方面没有总体差异，而ABCD项目的预防性服务支出更高。ABCD项目组儿童的初期龋齿牙齿更少。预防每颗初期龋齿病变的每个儿童平均增量成本为31.44美元。
ABCD项目使最年幼的儿童队列受益最大，并改善了健康状况。
