Emergency department visits for nontraumatic dental problems: a mixed-methods study. 2015

Benjamin C Sun, and Donald L Chi, and Eli Schwarz, and Peter Milgrom, and Annick Yagapen, and Susan Malveau, and Zunqui Chen, and Ben Chan, and Sankirtana Danner, and Erin Owen, and Vickie Morton, and Robert A Lowe
Benjamin C. Sun, Annick Yagapen, Susan Malveau, and Ben Chan are with Department of Emergency Medicine, Oregon Health and Science University (OHSU), Portland. Robert A. Lowe is with the Department of Medical Informatics and Clinical Epidemiology, OHSU. Donald L. Chi and Peter Milgrom are with Department of Oral Health Sciences, University of Washington, Seattle. Eli Schwarz is with School of Dentistry, OHSU. Zunqui Chen is with Department of Public Health and Preventive Medicine, OHSU. Sankirtana Danner is with Oregon Rural Practice-Based Research Network, OHSU. Erin Owen is with Slocum Research and Education Foundation, Eugene, OR. Vickie Morton is with Financial Services, OHSU.

OBJECTIVE We documented emergency department (ED) visits for nontraumatic dental problems and identified strategies to reduce ED dental visits. METHODS We used mixed methods to analyze claims in 2010 from a purposive sample of 25 Oregon hospitals and Oregon's All Payer All Claims data set and interviewed 51 ED dental visitors and stakeholders from 6 communities. RESULTS Dental visits accounted for 2.5% of ED visits and represented the second-most-common discharge diagnosis in adults aged 20 to 39 years, were associated with being uninsured (odds ratio [OR] = 5.2 [reference: commercial insurance]; 95% confidence interval [CI] = 4.8, 5.5) or having Medicaid insurance (OR = 4.0; 95% CI = 3.7, 4.2), resulted in opioid (56%) and antibiotic (56%) prescriptions, and generated $402 (95% CI = $396, $408) in hospital costs per visit. Interviews revealed health system, community, provider, and patient contributors to ED dental visits. Potential solutions provided by interviewees included Medicaid benefit expansion, care coordination, water fluoridation, and patient education. CONCLUSIONS Emergency department dental visits are a significant and costly public health problem for vulnerable individuals. Future efforts should focus on implementing multilevel interventions to reduce ED dental visits.

UI MeSH Term Description Entries
D007223 Infant A child between 1 and 23 months of age. Infants
D007345 Insurance Claim Review Review of claims by insurance companies to determine liability and amount of payment for various services. The review may also include determination of eligibility of the claimant or beneficiary or of the provider of the benefit; determination that the benefit is covered or not payable under another policy; or determination that the service was necessary and of reasonable cost and quality. Claims Review,Insurance Audit,Insurance Claims Processing,Analysis, Claims,Claim Review, Insurance,Claims Analysis,Insurance Claims Analysis,Review, Claims,Review, Insurance Claim,Analyses, Claims,Analyses, Insurance Claims,Analysis, Insurance Claims,Audit, Insurance,Audits, Insurance,Claim Reviews, Insurance,Claims Analyses,Claims Analyses, Insurance,Claims Analysis, Insurance,Claims Processing, Insurance,Claims Reviews,Insurance Audits,Insurance Claim Reviews,Insurance Claims Analyses,Processing, Insurance Claims,Reviews, Claims,Reviews, Insurance Claim
D008297 Male Males
D008484 Medicaid Federal program, created by Public Law 89-97, Title XIX, a 1965 amendment to the Social Security Act, administered by the states, that provides health care benefits to indigent and medically indigent persons. Dental Medicaid Program,Medical Assistance, Title 19,Dental Medicaid Programs,Medicaid Program, Dental,Medicaid Programs, Dental,Program, Dental Medicaid,Programs, Dental Medicaid
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009922 Oregon State bounded on the north by Washington, on the east by Idaho, on the south by California and Nevada, and on the west by the Pacific Ocean.
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D002675 Child, Preschool A child between the ages of 2 and 5. Children, Preschool,Preschool Child,Preschool Children
D003729 Dental Care The total of dental diagnostic, preventive, and restorative services provided to meet the needs of a patient (from Illustrated Dictionary of Dentistry, 1982). Care, Dental
D004636 Emergency Service, Hospital Hospital department responsible for the administration and provision of immediate medical or surgical care to the emergency patient. Emergency Outpatient Unit,Emergency Services Utilization,Hospital Emergency Room,Hospital Emergency Service,Hospital Emergency Services Utilization,Accident and Emergency Department,Emergency Departments,Emergency Hospital Service,Emergency Room,Emergency Units,Emergency Ward,Hospital Service Emergency,Service, Hospital Emergency,Department, Emergency,Departments, Emergency,Emergencies, Hospital Service,Emergency Department,Emergency Hospital Services,Emergency Outpatient Units,Emergency Room, Hospital,Emergency Rooms,Emergency Rooms, Hospital,Emergency Services, Hospital,Emergency Unit,Emergency Wards,Emergency, Hospital Service,Hospital Emergency Rooms,Hospital Emergency Services,Hospital Service Emergencies,Hospital Service, Emergency,Hospital Services, Emergency,Outpatient Unit, Emergency,Outpatient Units, Emergency,Room, Emergency,Room, Hospital Emergency,Rooms, Emergency,Rooms, Hospital Emergency,Service Emergencies, Hospital,Service Emergency, Hospital,Service, Emergency Hospital,Services Utilization, Emergency,Services Utilizations, Emergency,Services, Emergency Hospital,Services, Hospital Emergency,Unit, Emergency,Unit, Emergency Outpatient,Units, Emergency,Units, Emergency Outpatient,Utilization, Emergency Services,Ward, Emergency,Wards, Emergency

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