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Luo H, Moss ME, Webb MD, Winterbauer NL, Tucker-McLaughlin M, Yockey RA, Smith AW, Wright WG. The most common types of nontraumatic dental conditions among emergency department visits in North Carolina before and during the COVID-19 pandemic. J Am Dent Assoc 2024; 155:149-157. [PMID: 38069961 PMCID: PMC11044986 DOI: 10.1016/j.adaj.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/09/2023] [Accepted: 10/14/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND This study aimed to identify the most common types of nontraumatic dental conditions (NTDCs) before and during the COVID-19 pandemic and assess the variations in the most common NTDCs by patient age groups and rural or urban locations and the impact of COVID-19 on emergency department (ED) visits for NTDCs in North Carolina. METHODS The authors conducted a retrospective data analysis of ED data from the North Carolina Disease Event Tracking and Epidemiology Collection Tool. The authors estimated the proportions of NTDCs of all ED visits in 2019 and 2021 and ranked the proportions of the major categories of NTDCs by age groups and rural or urban locations. They used a multiple logistic regression model to assess the impact of COVID-19 on NTDCs. RESULTS By the first diagnosis, the proportion of NTDCs dropped from 1.1% in 2019 to 0.99% in 2021 (P < .001). Caries was specified as the third most common NTDC. Oral infection was the top NTDC among young (≤ 17 years) and older patients (≥ 65 years). No significant differences were found in NTDCs between rural and urban areas (P = .68). Children younger than 2 years (adjusted odds ratio, 4.36) and adults aged 18 through 44 years (adjusted odds ratio, 4.54) were more likely to visit the ED for NTDCs than those 75 years and older. CONCLUSIONS The proportion of NTDCs seen at the ED was lower during the COVID-19 pandemic in 2021 than in 2019. The common NTDCs varied by age group but were similar in rural and urban areas. The most common NTDCs were related to toothache, oral infection, and caries. PRACTICAL IMPLICATIONS More efforts are needed to reduce ED visits for NTDCs.
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Synthesizing 30-years of adult medicaid dental policy research: A scoping review to identify gaps and opportunities. Heliyon 2023; 9:e13703. [PMID: 36873142 PMCID: PMC9975108 DOI: 10.1016/j.heliyon.2023.e13703] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
Objective Despite the importance of Medicaid for the oral health of low-income adults, the extent to which Medicaid dental policy variation influences outcomes is unknown. This study aims to review the evidence evaluating adult Medicaid dental policies to synthesize conclusions and motivate future research. Data sources A comprehensive search of academic literature published in English between 1991 and 2020 was conducted to identify studies which evaluated an adult Medicaid dental policy for its effect on outcomes. Studies strictly involving children, policies not related to adult Medicaid dental coverage, and non-evaluation studies were excluded. The data analysis identified the policies, outcomes, methods, populations, and conclusions of the included studies. Results Among the 2731 unique articles extracted, 53 met the inclusion criteria. 36 studies evaluated the effect of expanding Medicaid dental coverage, which was found to consistently increase dental service visits (21 studies) and reduce unmet dental needs (4 studies). Provider density, reimbursement rates, and level of benefits appear to influence the effect of expanding Medicaid dental coverage. The evidence for changing Medicaid benefits and reimbursement rates were mixed for its impact on provider participation and emergency dental services. Few studies examined how adult Medicaid dental policies impact health outcomes. Conclusions Most of the recent research has focused on evaluating the effect of expanding or reducing Medicaid dental coverage on dental service utilization. Future research investigating the impact of adult Medicaid dental policies on clinical, health, and wellness outcomes remains warranted. Clinical significance Low-income adults are responsive to Medicaid dental policy changes and utilize more care with more generous coverage. Less is known about how these policies influence health.
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Akinlotan MA, Ferdinand AO. Emergency department visits for nontraumatic dental conditions: a systematic literature review. J Public Health Dent 2020; 80:313-326. [DOI: 10.1111/jphd.12386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 04/24/2020] [Accepted: 06/26/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Marvellous A. Akinlotan
- Department of Health Policy and Management Texas A&M School of Public Health College Station TX USA
| | - Alva O. Ferdinand
- Department of Health Policy and Management Texas A&M School of Public Health College Station TX USA
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Violence as the Most Frequent Cause of Oral and Maxillofacial Injuries among the Patients from Low- and Middle-Income Countries-A Retrospective Study at a Level I Trauma University Emergency Department in Switzerland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134906. [PMID: 32646020 PMCID: PMC7369963 DOI: 10.3390/ijerph17134906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 01/10/2023]
Abstract
Preventive strategies can be developed by gathering more information about oral and maxillofacial injuries and oral pathologies in immigrants from low- to middle-income countries (LMIC). Additional information on the quality of care can also improve the allocation of clinical resources for the management of these patients. We studied immigrants from LMIC who presented in the emergency department (ED) at Berne University Hospital with dental problems or oral or maxillofacial injuries. The patient data included age, gender, nationality, the etiology and type of trauma and infection in the oral-maxillofacial area, and overall costs. The greatest incidence of maxillofacial injuries was observed in the age group of 16-35 years (n = 128, 63.6%, p = 0.009), with males outnumbering females in all age groups. Trauma cases were most frequent in the late evening and were mostly associated with violence (n = 82, 55.4%, p = 0.001). The most common fracture was fracture of the nose (n = 31). The mean costs were approximately the same for men (mean = 2466.02 Swiss francs) and women (mean = 2117.95 Swiss francs) with maxillofacial injuries but were greater than for isolated dental problems. In conclusion, the etiology of dental and maxillofacial injuries in immigrants in Switzerland requires better support in the prevention of violence and continued promotion of oral health education.
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Chalmers NI. Racial Disparities in Emergency Department Utilization for Dental/Oral Health-Related Conditions in Maryland. Front Public Health 2017; 5:164. [PMID: 28770189 PMCID: PMC5515044 DOI: 10.3389/fpubh.2017.00164] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 06/22/2017] [Indexed: 11/17/2022] Open
Abstract
Objectives Hospital emergency departments (EDs) are a place where many Americans seek treatment of dental conditions. Racial and ethnic minorities consistently have higher rates of ED utilization than whites for dental conditions. The reasons for these disparities and significant public health concerns are investigated less often. In this paper, we measure trends in racial disparities in ED discharges for dental conditions in Maryland from 2010 to 2013. To understand these disparities, we also describe differences between racial groups in age, gender, income, location, payer, comorbidities, and the availability of dental care. Methods 2010–2013 State Emergency Department Data for Maryland were used in the analysis. Rates per 100,000 of the population are calculated using information from census population estimates. Cost-to-charge ratios are used to estimate the costs of ED discharges. Dental/oral health-related conditions (DOHRC) are defined as discharge diagnoses of ICD-9-CM codes 520.0 through 529.9. Descriptive statistics and fixed effects logistic regression models with a rare event correction are used to analyze the data. Results Blacks, especially females aged 25–34, have larger proportions of total ED discharges due to DOHRC, and higher population rates of DOHRC, than any other racial or ethnic group. In 2013, Blacks represented 30% of Maryland’s population and accounted for 52% of ED costs for DOHRC. Hispanics and those of other races have much lower rates of DOHRC discharges. The regression results show that the high proportion of DOHRC discharges among Blacks may be explained by the concentration of Blacks in low-income central cities with less access to dental care. Conclusion There are significant racial disparities in the ED utilization for DOHRC in Maryland. These disparities reflect the lack of access to dental care due to both cost and geographic limitations. This results in high healthcare costs and ineffective solutions for patients. Addressing oral health disparities will require policy solutions that are targeted to the populations most at need, and action plans that combine community and state level efforts.
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Affiliation(s)
- Natalia I Chalmers
- Analytics and Publication, DentaQuest Institute, Columbia, MD, United States
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Emergency Department Utilization related to dental conditions and distribution of Dentists, Nebraska 2011-2013. J Evid Based Dent Pract 2017; 17:83-91. [DOI: 10.1016/j.jebdp.2016.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 11/27/2016] [Accepted: 11/29/2016] [Indexed: 11/19/2022]
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Laniado N, Badner VM, Silver EJ. Expanded Medicaid dental coverage under the Affordable Care Act: an analysis of Minnesota emergency department visits. J Public Health Dent 2017; 77:344-349. [DOI: 10.1111/jphd.12214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 02/04/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Nadia Laniado
- Department of Dentistry, Jacobi Medical Center; Albert Einstein College of Medicine, Bronx; NY USA
| | - Victor M. Badner
- Department of Dentistry, Jacobi Medical Center; Albert Einstein College of Medicine, Bronx; NY USA
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Rowland S, Leider JP, Davidson C, Brady J, Knudson A. Impact of a Community Dental Access Program on Emergency Dental Admissions in Rural Maryland. Am J Public Health 2016; 106:2165-2170. [PMID: 27736218 PMCID: PMC5105007 DOI: 10.2105/ajph.2016.303467] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To characterize the expansion of a community dental access program (CDP) in rural Maryland providing urgent dental care to low-income individuals, as well as the CDP's impact on dental-related visits to a regional emergency department (ED). METHODS We used de-identified CDP and ED claims data to construct a data set of weekly counts of CDP visits and dental-related ED visits among Maryland adults. A time series model examined the association over time between visits to the CDP and ED visits for fiscal years (FYs) 2011 through 2015. RESULTS The CDP served approximately 1600 unique clients across 2700 visits during FYs 2011 through 2015. The model suggested that if the CDP had not provided services during that time period, about 670 more dental-related visits to the ED would have occurred, resulting in $215 000 more in charges. CONCLUSIONS Effective ED dental diversion programs can result in substantial cost savings to taxpayers, and more appropriate and cost-effective care for the patient. POLICY IMPLICATIONS Community dental access programs may be a viable way to patch the dental safety net in rural communities while holistic solutions are developed.
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Affiliation(s)
- Sandi Rowland
- Sandi Rowland is with Allegany Health Right, Cumberland, MD. Jonathon P. Leider is with the Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD. Clare Davidson, Joanne Brady, and Alana Knudson are with NORC, Bethesda, MD
| | - Jonathon P Leider
- Sandi Rowland is with Allegany Health Right, Cumberland, MD. Jonathon P. Leider is with the Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD. Clare Davidson, Joanne Brady, and Alana Knudson are with NORC, Bethesda, MD
| | - Clare Davidson
- Sandi Rowland is with Allegany Health Right, Cumberland, MD. Jonathon P. Leider is with the Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD. Clare Davidson, Joanne Brady, and Alana Knudson are with NORC, Bethesda, MD
| | - Joanne Brady
- Sandi Rowland is with Allegany Health Right, Cumberland, MD. Jonathon P. Leider is with the Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD. Clare Davidson, Joanne Brady, and Alana Knudson are with NORC, Bethesda, MD
| | - Alana Knudson
- Sandi Rowland is with Allegany Health Right, Cumberland, MD. Jonathon P. Leider is with the Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD. Clare Davidson, Joanne Brady, and Alana Knudson are with NORC, Bethesda, MD
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Salomon D, Heidel RE, Kolokythas A, Miloro M, Schlieve T. Does Restriction of Public Health Care Dental Benefits Affect the Volume, Severity, or Cost of Dental-Related Hospital Visits? J Oral Maxillofac Surg 2016; 75:467-474. [PMID: 27875708 DOI: 10.1016/j.joms.2016.10.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 10/05/2016] [Accepted: 10/09/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE On July 1, 2012, the Illinois legislature passed the Save Medicaid Access and Resources Together (SMART) Act, which restricts adult public dental insurance coverage to emergency-only treatment. The purpose of this study was to measure the effect of this restriction on the volume, severity, and treatment costs of odontogenic infections in an urban hospital. MATERIALS AND METHODS A retrospective cohort study of patients presenting for odontogenic pain or infection at the University of Illinois Hospital was performed. Data were collected using related International Classification of Diseases, Ninth Revision codes from January 1, 2011 through December 31, 2013 and divided into 2 cohorts over consecutive 18-month periods. Outcome variables included age, gender, insurance status, oral and maxillofacial surgery (OMS) consultation, imaging, treatment, treatment location, number of hospital admission days, and inpatient care level. Severity was determined by the presence of OMS consultation, incision and drainage, hospital admission, and cost per encounter. Hospital charges were used to compare the cost of care between cohorts. Between-patients statistics were used to compare risk factors and outcomes between cohorts. RESULTS Of 5,192 encounters identified, 1,405 met the inclusion criteria. There were no significant differences between cohorts for age (P = .28) or gender (P = .43). After passage of the SMART Act, emergency department visits increased 48%, surgical intervention increased 100%, and hospital admission days increased 128%. Patients were more likely to have an OMS consult (odds ratio [OR] = 1.42; 95% confidence interval [CI], 1.11-1.81), an incision and drainage (OR = 1.48; 95% CI, 1.13-1.94), and a longer hospital admission (P = .04). The average cost per encounter increased by 20% and the total cost of care increased by $1.6 million. CONCLUSION After limitation of dental benefits, there was an increase in the volume and severity of odontogenic infections. In addition, there was an escalated health care cost. The negative public health effects and increased economic impact of eliminating basic dental care show the importance of affordable and accessible preventative oral health care.
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Affiliation(s)
- David Salomon
- Resident, Department of Oral and Maxillofacial Surgery, University of Illinois, Chicago, IL
| | - R Eric Heidel
- Assistant Professor of Biostatistics, Department of Surgery, Office of Medical Education, Research, and Development, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Antonia Kolokythas
- Department Chair, Department of Oral and Maxillofacial Surgery, University of Rochester Medical Center, Rochester, NY
| | - Michael Miloro
- Department Head and Professor, Department of Oral and Maxillofacial Surgery, University of Illinois, Chicago, IL
| | - Thomas Schlieve
- Assistant Professor, Department of Oral and Maxillofacial Surgery, UT Southwestern Medical Center, Dallas, TX.
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Singhal A, Momany ET, Jones MP, Caplan DJ, Kuthy RA, Buresh CT, Damiano PC. Dental care after an emergency department visit for dental problems among adults enrolled in Medicaid. J Am Dent Assoc 2016; 147:111-9. [DOI: 10.1016/j.adaj.2015.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 08/07/2015] [Accepted: 08/14/2015] [Indexed: 11/25/2022]
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Figueiredo R, Dempster L, Quiñonez C, Hwang SW. Emergency Department Use for Dental Problems among Homeless Individuals: A Population-Based Cohort Study. J Health Care Poor Underserved 2016; 27:860-8. [PMID: 27180713 PMCID: PMC4889437 DOI: 10.1353/hpu.2016.0081] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate emergency department (ED) visits for dental problems among Toronto's homeless population (Ontario, Canada). METHODS A random sample of 1,189 homeless was recruited from shelters and meal programs. Emergency department visits for non-traumatic dental problems (ICD-10-CA codes K00-K14) were identified using participants' health insurance number, during 2005-2009. Age- and sex-matched controls were selected from low-income neighborhoods. RESULTS Homeless and matched controls had 182 and 10 ED visits for dental problems, respectively. Homeless people were more significantly more likely (OR=2.27, p=.007) to make ED visit for dental problems compared with controls. Over 80% of the ED visits by homeless people were for odontogenic infections, and 46% of homeless people had more than one such visit. CONCLUSION The high rate of ED visits for dental problems by people who are homeless suggests that access to dental care is inadequate. The large number of repeat visits indicates that ED settings are ineffective for treatment of dental problems.
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Darling BG, Singhal A, Kanellis MJ. Emergency department visits and revisits for nontraumatic dental conditions in Iowa. J Public Health Dent 2015; 76:122-8. [DOI: 10.1111/jphd.12120] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 07/31/2015] [Indexed: 11/26/2022]
Affiliation(s)
| | - Astha Singhal
- Henry M. Goldman School of Dentistry; Boston University; Boston MA USA
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Walker A, Probst JC, Martin AB, Bellinger JD, Merchant A. Analysis of hospital-based emergency department visits for dental caries in the United States in 2008. J Public Health Dent 2013; 74:188-94. [DOI: 10.1111/jphd.12045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 10/18/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Andre Walker
- Institute for Partnerships to Eliminate Health Disparities; Arnold School of Public Health; University of South Carolina; Columbia SC USA
| | - Janice C. Probst
- Department of Health Services Policy and Management; Arnold School of Public Health; University of South Carolina; Columbia SC USA
- South Carolina Rural Health Research Center; Columbia SC USA
| | - Amy B. Martin
- Department of Health Services Policy and Management; Arnold School of Public Health; University of South Carolina; Columbia SC USA
- South Carolina Rural Health Research Center; Columbia SC USA
| | - Jessica D. Bellinger
- Department of Health Services Policy and Management; Arnold School of Public Health; University of South Carolina; Columbia SC USA
- South Carolina Rural Health Research Center; Columbia SC USA
| | - Anwar Merchant
- Department of Epidemiology and Biostatistics; Arnold School of Public Health; University of South Carolina; Columbia SC USA
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Karaca Z, Wong HS. Racial Disparity in Duration of Patient Visits to the Emergency Department: Teaching Versus Non-teaching Hospitals. West J Emerg Med 2013; 14:529-41. [PMID: 24106554 PMCID: PMC3789920 DOI: 10.5811/westjem.2013.3.12671] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 11/30/2012] [Accepted: 03/25/2013] [Indexed: 12/02/2022] Open
Abstract
Introduction: The sources of racial disparity in duration of patients’ visits to emergency departments (EDs) have not been documented well enough for policymakers to distinguish patient-related factors from hospital- or area-related factors. This study explores the racial disparity in duration of routine visits to EDs at teaching and non-teaching hospitals. Methods: We performed retrospective data analyses and multivariate regression analyses to investigate the racial disparity in duration of routine ED visits at teaching and non-teaching hospitals. The Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) were used in the analyses. The data include 4.3 million routine ED visits encountered in Arizona, Massachusetts, and Utah during 2008. We computed duration for each visit by taking the difference between admission and discharge times. Results: The mean duration for a routine ED visit was 238 minutes at teaching hospitals and 175 minutes at non-teaching hospitals. There were significant variations in duration of routine ED visits across race groups at teaching and non-teaching hospitals. The risk-adjusted results show that the mean duration of routine ED visits for Black/African American and Asian patients when compared to visits for white patients was shorter by 10.0 and 3.4%, respectively, at teaching hospitals; and longer by 3.6 and 13.8%, respectively, at non-teaching hospitals. Hispanic patients, on average, experienced 8.7% longer ED stays when compared to white patients at non-teaching hospitals. Conclusion: There is significant racial disparity in the duration of routine ED visits, especially in non-teaching hospitals where non-White patients experience longer ED stays compared to white patients. The variation in duration of routine ED visits at teaching hospitals when compared to non-teaching hospitals was smaller across race groups.
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Affiliation(s)
- Zeynal Karaca
- Social and Scientific Systems, Inc., Silver Spring, Maryland ; Agency for Healthcare Research and Quality, Rockville, Maryland ; George Washington University, Health Policy Department, Washington, DC
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Needleman HL, Stucenski K, Forbes PW, Chen Q, Stack AM. Massachusetts emergency departments' resources and physicians' knowledge of management of traumatic dental injuries. Dent Traumatol 2013; 29:272-9. [PMID: 22804874 PMCID: PMC3955057 DOI: 10.1111/j.1600-9657.2012.01170.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hospital emergency departments (ED) are confronted with triaging and managing dental emergencies of both traumatic and non-traumatic origin. However, the literature suggests that there exists inadequate knowledge of the management of traumatic dental injuries (TDI) among medical professionals who must be knowledgeable and have the appropriate resources needed to triage or treat patients presenting with TDI. AIM The aims of this study were to (i) evaluate the resources of Massachusetts emergency departments (MEDs) for TDI, (ii) determine the knowledge of management of TDI among MED physicians, and (iii) investigate potential factors that affect their knowledge. MATERIALS AND METHODS Surveys were mailed to MED directors and their physicians. The director survey contained questions regarding institutional information for each emergency department (ED). The physician survey contained questions about physician characteristics and tested their knowledge of managing dental trauma. RESULTS A total of 72 surveys (16 MED directors and 56 physicians) were returned and included in the analysis. Only 50% of the MEDs had on-site dental coverage, 43.8% had 24-h off-site dental coverage, and none had a formal written dental trauma protocol. MED physician's knowledge of the appropriate management of luxations and avulsions was generally good, but poor for dental fractures. The MED physician's knowledge for the emergent nature of the various injuries was generally good with that of avulsions being the best. Physicians were more likely to have a better knowledge of managing dental trauma if they were specialists in pediatric emergency medicine (P = 0.001) or their hospitals had an academic affiliation (P = 0.05). CONCLUSIONS Based on the findings from this study, educational campaigns must be undertaken to improve both the resources available to the ED, and the knowledge of physicians regarding emergency management of TDI. In addition, efforts should be made by local dental organizations to provide ED with lists of dentists who are knowledgeable and willing to be available 24 h day⁻¹ to consult with and, if necessary, treat TDI. These efforts would enhance the long-term outcomes for patients sustaining dental trauma who present to hospital ED.
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Edelstein BL. Engaging the U.S. Congress in the oral health of special-needs adults: lessons from pediatric oral health policy. SPECIAL CARE IN DENTISTRY 2013; 33:198-203. [DOI: 10.1111/scd.12007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Burton L. Edelstein
- Senior Fellow in Public Policy; Children's Dental Health Project Washington DC and Professor, Dentistry and Health Policy and Management; Columbia University, New York; New York
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Karaca Z, Wong HS, Mutter RL. Duration of patients' visits to the hospital emergency department. BMC Emerg Med 2012; 12:15. [PMID: 23126473 PMCID: PMC3549896 DOI: 10.1186/1471-227x-12-15] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 10/19/2012] [Indexed: 12/03/2022] Open
Abstract
Background Length of stay is an important indicator of quality of care in Emergency Departments (ED). This study explores the duration of patients’ visits to the ED for which they are treated and released (T&R). Methods Retrospective data analysis and multivariate regression analysis were conducted to investigate the duration of T&R ED visits. Duration for each visit was computed by taking the difference between admission and discharge times. The Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) for 2008 were used in the analysis. Results The mean duration of T&R ED visit was 195.7 minutes. The average duration of ED visits increased from 8 a.m. until noon, then decreased until midnight at which we observed an approximately 70-minute spike in average duration. We found a substantial difference in mean duration of ED visits (over 90 minutes) between Mondays and other weekdays during the transition time from the evening of the day before to the early morning hours. Black / African American patients had a 21.4-minute longer mean duration of visits compared to white patients. The mean duration of visits at teaching hospitals was substantially longer than at non-teaching hospitals (243.8 versus 175.6 minutes). Hospitals with large bed size were associated with longer duration of visits (222.2 minutes) when compared to hospitals with small bed size (172.4 minutes) or those with medium bed size (166.5 minutes). The risk-adjusted results show that mean duration of visits on Mondays are longer by about 4 and 9 percents when compared to mean duration of visits on non-Monday workdays and weekends, respectively. Conclusions The duration of T&R ED visits varied significantly by admission hour, day of the week, patient volume, patient characteristics, hospital characteristics and area characteristics.
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Affiliation(s)
- Zeynal Karaca
- Social & Scientific Systems, Inc, Rockville, MD 20850, USA.
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Elangovan S, Srinivasan S, Allareddy V. Hospital-based emergency department visits with oral candidiasis in the USA. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:e26-31. [PMID: 22769417 DOI: 10.1016/j.oooo.2012.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 02/02/2012] [Accepted: 02/07/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to determine the number of hospital Emergency Department (ED) visits with a diagnosis of oral candidiasis for the year 2007 in the USA and to identify the comorbid conditions associated with it. STUDY DESIGN The Nationwide Emergency Department Sample (NEDS) for 2007 was employed in this study. Patients who visited the ED with a diagnosis of oral candidiasis were selected, and the estimates were projected to the national levels using the discharge weights. Presence of comorbid conditions in these patients was also determined. RESULTS A total of 249,092 ED visits had oral candidiasis. Most of the patients belonged to the lower socioeconomic strata. Patients presented with a wide range of comorbid conditions and a large percentage of the patients were subsequently hospitalized after ED visits. CONCLUSIONS A significant number of patients in the US visited the ED with oral candidiasis in the year 2007.
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Affiliation(s)
- Satheesh Elangovan
- Department of Periodontics, University of Iowa, Iowa City, Iowa 52242, USA.
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Skapetis T, Gerzina T, Hu W. Can a four-hour interactive workshop on the management of dental emergencies be effective in improving self reported levels of clinician proficiency? ACTA ACUST UNITED AC 2012; 15:14-22. [DOI: 10.1016/j.aenj.2011.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 12/13/2011] [Accepted: 12/13/2011] [Indexed: 11/29/2022]
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Anderson L, Cherala S, Traore E, Martin NR. Utilization of Hospital Emergency Departments for non-traumatic dental care in New Hampshire, 2001-2008. J Community Health 2011; 36:513-6. [PMID: 21104429 DOI: 10.1007/s10900-010-9335-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Hospital Emergency Departments (ED) provide a variety of medical care, some of which is for non-urgent, chronic conditions. We describe the statewide use of hospital ED for selected non-traumatic dental conditions that occurred during 2001-2008 in New Hampshire. Using the administrative hospital discharge dataset for 2001-2007, and provisional 2008 data, we identified all visits for selected dental conditions and calculated age-adjusted rates per 10,000 New Hampshire residents by several socio-demographic characteristics. The Spearman correlation coefficient was used to assess the statistical significance for trend over time. Emergency department visits for non-traumatic dental conditions increased significantly from 11,067 in 2001 to 16,238 visits in 2007 (P < 0.007). There were persistent differences in ED visits by age, county and primary payor, and varying difference by gender. Self-paying individuals and those 15-44 years old were the most frequent ED dental care users. The most frequent dental complains (46%) were diseases of the teeth and supporting structures, diagnostic code ICD-9-CM-525. Dental care associated ED visits have increased in New Hampshire. Individuals seeking dental treatment in ED are not receiving definitive treatment, and they misuse limited resources. Future studies need to determine the specific barriers to timely and effective dental care in dental offices. Ongoing consistent monitoring of ED use for non-traumatic dental conditions is essential.
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Affiliation(s)
- Ludmila Anderson
- Division of Public Health Services, New Hampshire Department of Health and Human Services, Concord, NH 03301-6504, USA.
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Wisconsin Medicaid enrollees' recurrent use of emergency departments and physicians' offices for treatment of nontraumatic dental conditions. J Am Dent Assoc 2011; 142:540-50. [PMID: 21531936 DOI: 10.14219/jada.archive.2011.0224] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Medicaid enrollees experience a number of barriers that prevent them from seeking care in dental offices, leading some to repeatedly seek treatment for nontraumatic dental conditions (NTDCs) in emergency departments (EDs) and physicians' offices (POs). The authors examined the rate of return visits to EDs and POs for treatment of NTDCs among Wisconsin Medicaid enrollees and sought to characterize frequent and typical users of such care in this population. METHODS The authors conducted a retrospective analysis of all Wisconsin Medicaid dental claims for NTDCs to EDs and POs from 2001 through 2003. They used finite mixture models, allowing for covariate dependence, to model separate rates of return for NTDC-related visits corresponding to typical and frequent users of EDs and POs. RESULTS Overall, 23,999 enrollees had made NTDC-related visits to EDs and POs, with 6.5 percent estimated to be frequent users of such care. Typical and frequent users had a mean (± standard error) rate of return visits of 0.2 ± 0.01 and 4.0 ± 0.08 per year, respectively. Male enrollees and people aged 19 to 42 years were more likely to be frequent users, with African American and Hispanic enrollees having lower odds of being frequent users than did white enrollees. The effect of living in an area with a shortage of dental health care professionals did not affect the likelihood of being a frequent user of EDs and POs for such care. CONCLUSIONS Male and middle-aged enrollees were significantly more likely to be frequent users of EDs and POs for treatment of NTDCs. Compared with white enrollees, African American and Hispanic enrollees were less likely to be frequent users and had lower rates of recurrent visits for NTDCs among typical users. CLINICAL IMPLICATIONS Improved access to dental care for Medicaid enrollees that is best managed by dental care providers should reduce the rates of recurrent NTDC-related visits to EDs and POs.
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Adhikari S, Blaivas M, Lander L. Comparison of bedside ultrasound and panorex radiography in the diagnosis of a dental abscess in the ED. Am J Emerg Med 2011; 29:790-5. [DOI: 10.1016/j.ajem.2010.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 02/07/2010] [Accepted: 03/07/2010] [Indexed: 01/04/2023] Open
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Ethical Issues in Emergency Care and Research. J Taibah Univ Med Sci 2011. [DOI: 10.1016/s1658-3612(11)70169-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Patel R, Miner JR, Miner SL. The need for dental care among adults presenting to an urban ED. Am J Emerg Med 2010; 30:18-25. [PMID: 21030190 DOI: 10.1016/j.ajem.2010.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 09/08/2010] [Accepted: 09/09/2010] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The study aimed to estimate the prevalence of need for dental care among patients in the ED and assess associated characteristics. METHODS This was a cross-sectional study conducted in the emergency department (ED) of a level I trauma center between June 1 and August 31, 2009. All ED patients were prospectively screened during randomly selected 8-hour blocks of time; consenting patients completed a survey on sociodemographics and health. The treating clinician completed an oral health examination to determine the patient's need for dental care as none (continue usual care), early (need to be seen soon), or urgent (need to be seen immediately). Data were analyzed using logistic regression. RESULTS There were 4670 patients who presented to the ED, 2787 (59.7%) were eligible, 1190 (63.2%) consented and enrolled, and 653 (54.9%) had a dental examination. Of these, 388 (59.4%; 95% confidence interval [CI], 56%-63%) had no need for dental care, 199 (30.5%; 95% CI, 27%-34%) had an "early need," and 66 (10.1%; 95% CI, 8%-12%) had an "urgent need." Logistic regression showed the need for dental care was associated with age, ethnicity, and having not had a routine checkup/cleaning in the last 3 years. CONCLUSIONS Of the patients presenting to the ED, 40.6% were in some need of dental care. This need was not associated with insurance or socioeconomic status as shown in previous studies. Age, ethnicity, and no routine oral care in the last 3 years were all associated with early/urgent need for oral health care.
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Affiliation(s)
- Roma Patel
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 55415, USA
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Edelstein B. The dental safety net, its workforce, and policy recommendations for its enhancement. J Public Health Dent 2010; 70 Suppl 1:S32-9. [DOI: 10.1111/j.1752-7325.2010.00176.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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