Population-centered Risk- and Evidence-based Dental Inter-professional Care Team (PREDICT)

Reducing Oral Health Disparity Through Outreach, Evidenced-Based Care, Global Budgeting and the Alternative Quality Contract

The main goal of the payment and delivery system reform is to reduce disparities in oral health and dental care access of low-income mothers and children living in rural Oregon counties. The target population is children, pregnant women and new mothers enrolled in Oregon Health Plan (OHP) in rural Oregon.

Study Overview

• Status: Unknown
• Conditions: Dental Caries
• Intervention / Treatment: Other: PREDICT

Detailed Description

To implement a payment plan model based on global budgeting and Alternative Quality Contract (pay-for-performance) for dental providers within Advantage Dental Services, LLC with the goal of incentivizing implementation of delivery system changes aimed at reducing disparities in access and oral health for low-income mothers and children living in rural Oregon counties.

To implement delivery system changes where a team of dental providers (dentists, dental hygienists, case managers, community outreach workers and others) within Advantage Dental Services, LLC provide evidence-based screening, risk assessment and primary preventive care in non-conventional community settings (WIC, Head Start and similar settings) and seamless, timely and appropriate evidence-based care in Advantage dental clinics.

To evaluate and document the payment and delivery system changes to assess whether the changes result in (1) reductions in disparities in access for low-income mothers and children; (2) efficiency in allocation of limited resources with the application of evidence-based screening; (3) seamless and appropriate care for mothers and their child at high risk of dental caries

• Study Type: Observational
• Enrollment (Anticipated): 14

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: No older than 19 years (Child, Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

80,000 children on Medicaid nested in 14 rural Oregon Counties.

Description

Inclusion Criteria:

• Children less than 21 years old and women who are pregnant or up to 2 months-post-partum.
• Enrollment in Medicaid and assigned by Oregon Health Authority to receive dental care from Advantage Dental Plan.
• Home address is located in the selected counties.

Exclusion Criteria:

• None

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Control; Usual care
PREDICT; Delivery system changes where a team of dental providers (dentists, dental hygienists, case managers, community outreach workers and others) within Advantage Dental Services, LLC provide evidence-based screening, risk assessment and primary and secondary preventive care in non-conventional community settings (WIC, Head Start and similar settings) and seamless, timely and appropriate evidence-based care in dental clinics. Payment plan model based on global budgeting and Alternative Quality Contract (pay-for-performance) for dental providers within Advantage Dental Services, LLC (Advantage) with the goal of incentivizing implementation of delivery system changes aimed at reducing disparities in dental care utilization and oral health for low-income mothers and children..	Other: 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 intervention is paired with a compensation system for high performance (pay-for-performance) with efficient performance monitoring. PREDICT focuses on: 1) identifying eligible children and gaining caregiver consent for services in community settings (e.g., 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Untreated dental caries	Percentage of participants with untreated dental caries	2 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Consumer Satisfaction	Scores on the Dental Satisfaction Questionnaire	2 years
Dental care utilization	Percentage of participants 0-21 years of age and pregnant women who received a dental service	2 years

Collaborators and Investigators

• Sponsor: Advantage Dental Services, LLC
• Collaborators: University of Chicago; University of Washington; Robert Wood Johnson Foundation
• Investigators: Study Director: Peter Milgrom, DDS, Advantage Dental Services, LLC

Publications and helpful links

General Publications

• Cunha-Cruz J, Milgrom P, Shirtcliff RM, Bailit HL, Huebner CE, Conrad D, Ludwig S, Mitchell M, Dysert J, Allen G, Scott J, Mancl L. Population-centered Risk- and Evidence-based Dental Interprofessional Care Team (PREDICT): study protocol for a randomized controlled trial. Trials. 2015 Jun 20;16:278. doi: 10.1186/s13063-015-0786-y.

Study record dates

Study Major Dates

• Study Start: January 1, 2016
• Primary Completion (Anticipated): June 1, 2019
• Study Completion (Anticipated): June 1, 2019

Study Registration Dates

• First Submitted: December 6, 2014
• First Submitted That Met QC Criteria: December 8, 2014
• First Posted (Estimate): December 9, 2014

Study Record Updates

• Last Update Posted (Estimate): August 9, 2016
• Last Update Submitted That Met QC Criteria: August 8, 2016
• Last Verified: August 1, 2016

More Information

Terms related to this study

• Keywords: child; dental care; managed healthcare
• Additional Relevant MeSH Terms: Stomatognathic Diseases; Tooth Demineralization; Tooth Diseases; Dental Caries
• Other Study ID Numbers: RWJF