School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA.
Columbia University College of Dental Medicine, New York, NY, USA.
J Dent Res. 2021 Aug;100(9):928-934. doi: 10.1177/00220345211007448. Epub 2021 Apr 21.
Previous reports suggest that periodontal treatment is associated with improved health care outcomes and reduced costs. Using data from the New York State Medicaid program, rates of emergency department (ED) use and inpatient admissions (IPs), as well as costs for ED, IPs, pharmacy, and total health care, were studied to determine the association of preventive dental care to health care outcomes. Utilization of dental services in the first 2 y (July 2012-June 2014) was compared to health care outcomes in the final year (July 2014-June 2015). Costs and utilization for members who did not receive dental services (No Dental) were compared to those who received any dental care (Any Dental), any preventive dental care (PDC), PDC without an extraction and/or endodontic treatment (PDC without Ext/Endo), PDC with an Ext/Endo (PDC with Ext/Endo), or Ext/Endo without PDC (Ext/Endo without PDC). Propensity scores were used to adjust for potential confounders. After adjustment, ED rate ratios were significantly lower for PDC and PDC without Ext/Endo but higher for the Any Dental and Ext/Endo without PDC. IP ratios were lower for all treatment groups except Ext/Endo without PDC. ED costs differed little compared to the No Dental group except for Ext/Endo without PDC. For IPs, costs per member were significantly lower for all groups (-$262.91 [95% confidence interval (CI), -325.40 to -200.42] to -$379.82 [95% CI, -451.27 to -308.37]) except for Ext/Endo without PDC. For total health care costs, Ext/Endo without PDC had a significantly greater total health care cost ($530.50 [95% CI, 156.99-904.01]). Each additional PDC visit was associated with a 3% reduction in the relative risk for ED and 9% reduction for IPs. Costs also decreased for total health care (-$235.64 [95% CI, -299.95 to -171.33]) and IP (-$181.39 [95% CI, -208.73 to -154.05]). In conclusion, an association between PDC and improved health care outcomes was observed, with the opposite association for Ext/Endo without PDC.
先前的报告表明，牙周治疗与改善医疗保健结果和降低成本有关。本研究使用来自纽约州医疗补助计划的数据，研究了急诊部（ED）使用率和住院率（IP）以及 ED、IP、药房和总医疗保健费用，以确定预防性牙科护理与医疗保健结果之间的关系。比较了前 2 年（2012 年 7 月至 2014 年 6 月）的牙科服务利用率与最后一年（2014 年 7 月至 2015 年 6 月）的医疗保健结果。将未接受牙科服务（无牙科）的成员的费用和利用率与接受任何牙科护理（任何牙科）、任何预防性牙科护理（PDC）、无拔牙和/或牙髓治疗的 PDC（无拔牙和/或牙髓治疗的 PDC）、有拔牙和/或牙髓治疗的 PDC（有拔牙和/或牙髓治疗的 PDC）以及无 PDC 的拔牙和/或牙髓治疗（无 PDC 的拔牙和/或牙髓治疗）进行比较。使用倾向评分调整潜在混杂因素。调整后，PDC 和无拔牙和/或牙髓治疗的 PDC 的 ED 率比值显著降低，但任何牙科和无 PDC 的拔牙和/或牙髓治疗的 ED 率比值升高。除了无 PDC 的拔牙和/或牙髓治疗外，所有治疗组的 IP 比值均较低。与无牙科组相比，ED 费用差异不大，除了无 PDC 的拔牙和/或牙髓治疗。对于 IP，除了无 PDC 的拔牙和/或牙髓治疗外，所有组的每位成员的费用都显著降低（-$262.91 [95%置信区间（CI），-325.40 至-200.42]至-$379.82 [95% CI，-451.27 至-308.37]）。对于总医疗保健费用，无 PDC 的拔牙和/或牙髓治疗的总医疗保健费用显著增加（$530.50 [95% CI，156.99-904.01]）。每次额外的 PDC 就诊与 ED 的相对风险降低 3%和 IP 的相对风险降低 9%相关。总医疗保健费用（-$235.64 [95% CI，-299.95 至-171.33]）和 IP（-$181.39 [95% CI，-208.73 至-154.05]）也有所下降。总之，观察到 PDC 与改善医疗保健结果之间存在关联，而无 PDC 的拔牙和/或牙髓治疗则存在相反的关联。
