Dental caries, and its resulting cavities, is the most common disease of childhood, causing significant costs to individuals and society. This project will provide the empirical foundation for the development of strategies to reduce health disparities through evidence-based dental system redesign in the era of health care reform and accountability. This project directly addresses one of NIDCR's 2014-2019 Strategic Plan's four goals, by "applying rigorous multidisciplinary research approaches to overcome disparities and inequalities in dental, oral and craniofacial health" in the area of dental caries in children.

Our long-term goal is to improve dental care quality through evidence-based prevention and treatment, as a key component in the overall strategy to reduce disparities in children's oral health. Children from lower-income households in Oregon have a substantially higher dental caries rate than children from higher-income households, nearly twice the untreated decay rate, and more than twice the rate of rampant decay. Universal pediatric dental coverage is within reach under the Affordable Care Act (ACA), yet the dental delivery system is challenged by the Medicaid population's high dental care needs combined with expanded enrollment, heightening the need for sustainable, real-world preventive solutions. The Willamette Dental Group (WDG) provides a unique opportunity to examine the relationship between quality of care and health outcomes. The WDG caries prevention program consists of highly standardized, diagnosis-driven, risk-based, evidenced- based, clinical-decision-supported care exquisitely documented in an electronic health record (EHR). The objective of this study is to evaluate the WDG caries prevention program's capacity to reduce disparities in caries burden (untreated decay and caries incidence) between commercially- and Medicaid-insured children in a large multi-specialty group dental practice, and to evaluate organizational sustainability and Medicaid policy implications. The study's primary hypothesis is that the WDG caries prevention program will improve oral health and reduce disparities longitudinally between the Medicaid- and commercially-insured pediatric populations in untreated decay and caries incidence from baseline, during 2014-2018. The two-phase, multi- level, transdisciplinary program evaluation includes phase 1 (UH2) specific aims to evaluate and select appropriate metrics at the patient, organization, and policy levels. Baseline data, including utilization, risk status, diagnosis, and health behavior, will be documented, and patient acceptance of and compliance with the interventions and home care will be evaluated for the two groups. Phase 2 (UH3) patient-level specific aims will assess the oral health status of Medicaid- and commercially-insured pediatric patients enrolled in the WDG program from 2014- 2018 to determine program's ability to reduce disparities in caries burden and to identify the critical program components in reducing disparities. Organizational-level specific aims will analyze the program's cost-benefit by population group over time. Policy-level specific aims will compare quality and cost metrics across dental plans to evaluate programmatic impact on the Medicaid population as well as analysis of the broader system context. The expected outcome of this project will be the empirical foundation of a sustainable, scalable roadmap for delivery system and benefit design called for by policy makers to reduce disparities and meet the Triple Aim in dentistry: better population health, better care experience, and lower cost per capita.