Department of Family Medicine, Bowen Center for Health Workforce Research & Policy, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Biostatistics, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA.
J Public Health Dent. 2018 Jun;78(3):266-274. doi: 10.1111/jphd.12272. Epub 2018 Jul 13.
The demand for dentists available for state Medicaid populations has long outpaced the supply of such providers. To help understand the workforce dynamics, this study sought to develop a novel approach to measuring dentists' relative contribution to the dental safety net and, using this new measurement, identify demographic and practice characteristics predictive of dentists' willingness to participate in Indiana's Medicaid program.
We examined Medicaid claims data for 1,023 Indiana dentists. We fit generalized ordered logistic regression models to measure dentists' level of clinical engagement with Medicaid. Using a partial proportional odds specification model, we estimated proportional adjusted odds ratios for covariates and separate estimates for each contrast of nonproportional covariates.
Though 75% of Medicaid-enrolled dentists were active providers, only 27% of them had 800 or more claims during fiscal year 2015. As has been shown in previous studies, our findings from the proportional odds model reinforced certain demographic and practice characteristics to be predictive of dentists' participation in state Medicaid programs.
In addition to confirming predictive factors for Medicaid enrollment, this study validated the clinical engagement measure as a reliable method to assess the level of Medicaid participation. Prior studies have been limited by self-reported data and variations in Medicaid claims reporting.
Our findings have implications for state Medicaid policymakers by enabling access to data regarding dental providers' level of participation in Medicaid in addition to identifying factors predictive of such participation. This information will inform Medicaid program plans and provider recruitment efforts.
对州医疗补助计划（Medicaid）覆盖人群的牙医的需求长期以来一直超过此类提供者的供应。为了帮助了解劳动力动态，本研究旨在开发一种衡量牙医对牙科保障网相对贡献的新方法，并使用这种新的衡量方法，确定对参与印第安纳州医疗补助计划有意愿的牙医的人口统计学和实践特征。
我们检查了印第安纳州 1023 名牙医的医疗补助索赔数据。我们拟合了广义有序逻辑回归模型来衡量牙医与医疗补助的临床参与程度。使用部分比例优势指定模型，我们为协变量估计了比例调整后的优势比，并为每个非比例协变量的对比分别进行了估计。
尽管 75%的参加医疗补助计划的牙医是活跃的提供者，但在 2015 财年，只有 27%的牙医有 800 次或以上的索赔。正如之前的研究所示，我们从比例优势模型中得出的发现加强了某些人口统计学和实践特征，以预测牙医参与州医疗补助计划。
除了确认参与医疗补助计划的预测因素外，本研究还验证了临床参与度衡量标准作为评估医疗补助参与程度的可靠方法。先前的研究受到自我报告数据和医疗补助索赔报告差异的限制。
我们的研究结果为州医疗补助政策制定者提供了信息，除了确定参与医疗补助计划的因素外，还可以获得有关牙科提供者参与医疗补助计划程度的数据。这些信息将为医疗补助计划规划和提供者招聘工作提供依据。
