Population-centered Risk- and Evidence-based Dental Interprofessional Care Team (PREDICT): study protocol for a randomized controlled trial

Abstract

BackgroundTo improve the oral health of low-income children, innovations in dental delivery systems are needed, including community-based care, the use of expanded duty auxiliary dental personnel, capitation payments, and global budgets. This paper describes the protocol for PREDICT (Population-centered Risk- and Evidence-based Dental Interprofessional Care Team), an evaluation project to test the effectiveness of new delivery and payment systems for improving dental care and oral health.Methods/DesignThis is a parallel-group cluster randomized controlled trial. Fourteen rural Oregon counties with a publicly insured (Medicaid) population of 82,000 children (0 to 21 years old) and pregnant women served by a managed dental care organization are randomized into test and control counties. In the test intervention (PREDICT), allied dental personnel provide screening and preventive services in community settings and case managers serve as patient navigators to arrange referrals of children who need dentist services. The delivery system intervention is paired with a compensation system for high performance (pay-for-performance) with efficient performance monitoring. PREDICT focuses on the following: 1) identifying eligible children and gaining caregiver consent for services in community settings (for example, schools); 2) providing risk-based preventive and caries stabilization services efficiently at these settings; 3) providing curative care in dental clinics; and 4) incentivizing local delivery teams to meet performance benchmarks. In the control intervention, care is delivered in dental offices without performance incentives. The primary outcome is the prevalence of untreated dental caries. Other outcomes are related to process, structure and cost. Data are collected through patient and staff surveys, clinical examinations, and the review of health and administrative records.DiscussionIf effective, PREDICT is expected to substantially reduce disparities in dental care and oral health. PREDICT can be disseminated to other care organizations as publicly insured clients are increasingly served by large practice organizations.Trial registrationClinicalTrials.gov NCT02312921 6 December 2014. The Robert Wood Johnson Foundation and Advantage Dental Services, LLC, are supporting the evaluation.

Care delivery and compensation system changes: a case study of organizational readiness within a large dental care practice organization in the United States

“…The setting of this case study is a quality improvement project (PREDICT [ 21 ]) conducted in 14 rural counties in Oregon, USA. The project is being implemented by a dental care organization, Advantage Dental Plans, LLC, Redmond, Oregon USA, The organization is a privately-owned for-profit company and one of the largest providers of dental care in Orgaon State for low income families insured by the United States’ joint federal-state program, Medicaid.…”

“…PREDICT involves changes at the system, community, provider and staff and patient levels [ 21 ]. The delivery system changes are intended to increase, substantially, community-based mobile care.…”

Survival of silver diamine fluoride among patients treated in community dental clinics: A naturalistic study

“…In 2016, Advantage incorporated twice-annual 38% SDF into its clinical guidelines as a risk-based treatment option, following an established protocol [7,[31][32][33]. The goal of increased adoption and utilization of SDF was to bolster efforts to reduce oral health disparities by optimizing community-based approaches with multi-disciplinary teams to arrest or prevent early stage caries disease [32]. Clinicians determined patients' caries risk category by completing a four item chairside examination [33].…”

Survival of Silver Diamine Fluoride Among Patients Treated in Community Dental Clinics: A Naturalistic Study

“…Operating in a value-based care design, it prioritizes community care delivered by remote supervision dental hygienists, many working in rural and other outreach-focused settings, with an emphasis on disease prevention and management vis a vis assessment, preventive services, and referral to interprofessional oral healthcare. In 2016, Advantage incorporated twice-annual 38% Silver Diamine Fluoride into the clinical guidelines as a treatment option as determined by risk assessment, following an established protocol [7,31,32]. SDF was made available for caries prevention and arrest in addition to placement of temporary restoration without excavation where appropriate, as well as for hypersensitivity.…”

“…SDF was made available for caries prevention and arrest in addition to placement of temporary restoration without excavation where appropriate, as well as for hypersensitivity. The goal of increased adoption and utilization of SDF was to bolster efforts to reduce oral health disparities by optimizing community-based approaches with multi-disciplinary teams to arrest or prevent early stage caries disease [32]. Utilizing a retrospective claims analysis, this study examines the survival of SDF as applied in practice settings, over the course of one year.…”