Racial and ethnic disparities in oral healthcare quality among children enrolled in Medicaid and CHIP

Measuring quality of dental care during pregnancy

BACKGROUND

The authors aimed to develop and validate 2 Dental Quality Alliance measures of dental care access during pregnancy (Utilization of Services During Pregnancy, Oral Evaluation During Pregnancy) using claims and enrollment data and to report performance on these measures for a sample of Medicaid and Children's Health Insurance Program beneficiaries.

METHODS

The authors used Transformed Medicaid Statistical Information System enrollment and claims data for 7,767,806 people enrolled in 5 state Medicaid programs and Children's Health Insurance Programs during 2018. The authors used split-half reliability testing to assess measure reliability. The authors calculated 95% CIs to assess statistically significant variation in performance between programs.

RESULTS

The intraclass correlation coefficient used to assess agreement between the split samples was 0.992 (95% CI, 0.941 to 0.999; P < .0001) for Utilization of Services During Pregnancy and 0.983 (95% CI, 0.879 to 0.998; P < .0001) for Oral Evaluation During Pregnancy. Performance scores ranged from 20% through 34% of beneficiaries receiving any dental service during pregnancy (Utilization of Services During Pregnancy) and from 14% through 23% of beneficiaries receiving a periodic or comprehensive oral evaluation during pregnancy (Oral Evaluation During Pregnancy), with statistically significant differences between programs.

CONCLUSIONS

The measures reliably assessed access to dental services and can distinguish performance between programs.

PRACTICAL IMPLICATIONS

These measures can be used to advance population health by means of supporting national efforts to improve access to dental care during pregnancy.

Testing dental quality measures: Emergency department visits for nontraumatic dental conditions and subsequent follow-up dental visits

BACKGROUND

The goal of this study was to test the feasibility, reliability, and validity of the Dental Quality Alliance's adult dental quality measures for system-level implementation for ambulatory care sensitive (ACS) emergency department (ED) visits for nontraumatic dental conditions (NTDCs) in adults and follow-up after ED visits for NTDCs in adults.

METHODS

Medicaid enrollment and claims data from Oregon and Iowa were used for measure testing. Testing included validation of diagnosis codes in claims data through patient record reviews of ED visits and calculations of κ statistic, sensitivity, and specificity.

RESULTS

Adult Medicaid enrollees' ACS NTDC ED visits ranged from 209 through 310 per 100,000 member-months. In both states, patients in the age category 25 through 34 years and non-Hispanic Black patients had the highest rates of ACS ED visits for NTDCs. Only one-third of all ED visits were associated with a follow-up dental visit within 30 days, decreasing to approximately one-fifth with a 7-day follow-up. The agreement between the claims data and patient records for identification of ACS ED visits for NTDCs was 93%, κ statistic was 0.85, sensitivity was 92%, and specificity was 94%.

CONCLUSIONS

Testing revealed the feasibility, reliability, and validity of 2 DQA quality measures. Most beneficiaries did not have a follow-up with a dentist within 30 days of an ED visit.

PRACTICAL IMPLICATIONS

Adoption of quality measures by state Medicaid programs and other integrated care systems will enable active tracking of beneficiaries with ED visits for NTDCs and develop strategies to connect them to dental homes.