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Biomedical subjects

Howard Bailit

Publications and source records attributed to Howard Bailit.

9 recordsLinked to original sources
PubMed2006

Dental safety net: current capacity and potential for expansion.

OBJECTIVES: The authors' objectives were to determine the size and characteristics of the dentally underserved U.S. population, describe the capacity of the safety net system to treat the underserved, explore policy options for expanding the system and discuss the policy implications of these findings. METHODS: The data came from published reports from health care organizations and researchers, as well as from public officials, dental educators and clinic directors. The values presented are estimates from available data. RESULTS: The underserved population consists of 82 million people from low-income families. Only 27.8 percent of this population visits a dentist each year. The primary components of the safety net are dental clinics in community health centers, hospitals, public schools and dental schools. This system has the capacity to care for about 7 to 8 million people annually. The politically feasible options for expanding the system include increasing the number of community clinics and their efficiency, requiring dental school graduates to receive one year of residency training, and requiring senior dental students and residents to work 60 days in community clinics and practices. This could increase the capacity of the system to treat about 10 million people annually. CONCLUSIONS AND CLINICAL IMPLICATIONS: The safety net system has limited capacity but could be improved to care for another 2.5 million people. Even if it is expanded, however, the majority of low-income patients would need to obtain care in private practices to reduce access disparities. The biggest challenge is convincing the American people to provide the funds needed to care for the poor in safety net clinics and private practices.

Community Health Centers↗
PubMed2005

Use of asthma guidelines by primary care providers to reduce hospitalizations and emergency department visits in poor, minority, urban children.

OBJECTIVES: To determine whether an organized, citywide asthma management program delivered by primary care providers (PCPs) increases adherence to the National Asthma Education and Prevention Program (NAEPP) Asthma Guidelines and whether adherence to the guidelines by PCPs decreases medical services utilization in low-income, minority children. STUDY DESIGN: Analysis of the utilization of medical services for a cohort of 3748 children with asthma who presented for care at one of six primary care urban clinics in Hartford, Connecticut, and who were enrolled in a disease management program (Easy Breathing) between June 1, 1998 and August 31, 2002. RESULTS: Of the 3748 children with physician-confirmed asthma, 48% had persistent disease. Paid claims for inhaled corticosteroids increased 25% ( P <.0001) after enrollment in Easy Breathing. Provider adherence to the NAEPP guidelines for anti-inflammatory therapy increased from 38% to 96%. Easy Breathing children with asthma experienced a 35% decrease in overall hospitalization rates ( P <.006), a 27% decrease in asthma emergency department (ED) visits ( P <.01), and a 19% decrease in outpatient visits ( P <.0001). CONCLUSIONS: An organized, disease management program increased adherence to the NAEPP guidelines for anti-inflammatory use by PCPs in urban clinics. Adherence to this element of the guidelines by PCPs reduced hospitalizations, ED visits, and outpatient visits for children with asthma.

Adolescent↗
PubMed2005

The dental safety net in Connecticut.

BACKGROUND: Many poor, medically disabled and geographically isolated populations have difficulty accessing private-sector dental care and are considered underserved. To address this problem, public- and voluntary-sector organizations have established clinics and provide care to the underserved. Collectively, these clinics are known as "the dental safety net." The authors describe the dental safety net in Connecticut and examine the capacity and efficiency of this system to provide care to the noninstitutionalized underserved population of the state. METHODS: The authors describe Connecticut's dental safety net in terms of dentists, allied health staff members, operatories, patient visits and patients treated per dentist per year. The authors compare the productivity of safety-net dentists with that of private practitioners. They also estimate the capacity of the safety net to treat people enrolled in Medicaid and the State Children's Health Insurance Program. RESULTS: The safety net is made up of dental clinics in community health centers, hospitals, the dental school and public schools. One hundred eleven dentists, 38 hygienists and 95 dental assistants staff the clinics. Safety-net dentists have fewer patient visits and patients than do private practitioners. The Connecticut safety-net system has the capacity to treat about 28.2 percent of publicly insured patients. CONCLUSIONS: The dental safety net is an important community resource, and greater use of allied dental personnel could substantially improve the capacity of the system to care for the poor and other underserved populations.

Child↗
PubMed2003

Dental education summits: the challenges ahead.

BACKGROUND: The authors present the major findings from ADA-sponsored education summit meetings in 2001 and 2002 that addressed the issues of dental education costs, dental student debt levels at graduation and budgeted unfilled dental school faculty positions. OVERVIEW: The meetings included representation from the ADA, the American Dental Education Association, the American Student Dental Association, the National Institute of Dental and Craniofacial Research and ADA-recognized dental specialty organizations. National experts on the three issue areas made formal presentations. State funds for dental education declined 22 percent from 1991 to 1998, after adjusting for inflation. Reductions in state budgets for 2002 and 2003 suggest further declines in state support. To cope with declining revenues, schools increased student tuition and fees 10 percent annually from 1991 to 1998, contributing to increasing levels of student educational debt, which in 2000 averaged dollar 87,600. Dental schools also have decreased their investment in physical plant and faculty numbers. Annual faculty salaries have increased 3 percent, while practitioner income has increased 7 percent. Academic income disparities with private practice have contributed to dental schools having almost 400 unfilled faculty positions. CONCLUSIONS AND PRACTICE IMPLICATIONS: Dental education is facing severe financial challenges that likely will increase. While there are no easy solutions, schools must make greater efforts to reduce operating expenses and seek more state and federal support for dental education. The ADA approved the summit reports, and the ADA House of Delegates adopted six resolutions that support the summits' recommendations.

American Dental Association↗
PubMed2003

Improving the oral health status of all Americans: roles and responsibilities of academic dental institutions: the report of the ADEA President's Commission.

Academic dental institutions are the fundamental underpinning of the nation's oral health. Education, research, and patient care are the cornerstones of academic dentistry that form the foundation upon which the dental profession rises to provide care to the public. The oral health status of Americans has improved dramatically over the past twenty-five to thirty years. In his 2000 report on oral health, the Surgeon General acknowledges the success of the dental profession in improving the oral health status of Americans over the past twenty-five years, but he also juxtaposes this success to profound and consequential disparities in the oral health of Americans. In 2002, the American Dental Education Association brought together an ADEA President's Commission of national experts to explore the roles and responsibilities of academic dental institutions in improving the oral health status of all Americans. They have issued this report and made a variety of policy recommendations, including a Statement of Position, to the 2003 ADEA House of Delegates. The commission's work will help guide ADEA in such areas as: identifying barriers to oral health care, providing guiding principles for academic dental institutions, anticipating workforce needs, and improving access through a diverse workforce and the types of oral health providers, including full utilization of allied dental professionals and collaborations with colleagues from medicine.

Dental Auxiliaries↗
PubMed2002

The importance of productivity in estimating need for dentists.

BACKGROUND: Although the number of dentists is an important determinant of supply, other factors also contribute. Technological advancements and well-trained and managed auxiliary personnel affect supply by allowing dentists to produce more dental services per unit of time. METHODS: This article examines trends in dental output, productivity, number of dentists and dental care utilization from 1960 through 1998. The authors estimated growth rates for the entire period and selected subperiods using regression analysis. Growth rates for dentist productivity and per capita utilization are important to estimate the number of active dentists needed in the year 2020. RESULTS: Based on ADA practice survey data, the annual growth rate in dentists' productivity was 1.41 percent from 1960 through 1998. However, productivity grew at different rates during this period. It increased 3.95 percent per year from 1960 to 1974. There was a decline in productivity of 0.13 percent annually from 1974 to 1991. From 1991 to 1998, productivity grew 1.05 percent annually. CONCLUSIONS: Accurate estimates of changes in dentist productivity are important in evaluating the adequacy of the number of dentists to meet the demand for dental services. PRACTICE IMPLICATIONS. Since productivity generally increases over time, failure to account for changes in productivity can lead to an overestimation of the number of dentists required for any given level of demand for dental services.

Dental Auxiliaries↗
PubMed2002

The dental work force in Wisconsin: ten-year projections.

BACKGROUND: The national dentist-to-population ratio is expected to decline during the next decade. The Wisconsin Dental Association undertook a study to determine the impact of this decline on the future supply of and demand for dental care in Wisconsin. METHODS: Using state and national data, the researchers estimated the number of dentists leaving and entering the state for the years 2001 through 2010. Then, using multivariate regression equations, the researchers estimated expected changes in dentists' productivity, the growth of the Wisconsin population and increases in utilization of dental services for the next 10 years. From these data, they determined the number of dentists needed in 2010 to maintain the current level of access. They assessed several strategies for increasing the number of dentists in the state. RESULTS: Wisconsin will have 297 fewer dentists in 2010 than it did in 2000. However, with increases in dentists' productivity of 1.8 percent per year, a slowly growing Wisconsin population (0.42 percent per year) and modest increases in utilization (0.82 percent per year), Wisconsin will need only 194 additional dentists to maintain current levels of access to care. The authors examined several options for increasing the number of dentists and their productivity, including increasing the number of Wisconsin (vs. out-of-state) students enrolled at Marquette University School of Dentistry, Milwaukee, employing more auxiliaries and using risk-based scheduling for recall patients. CONCLUSIONS: Wisconsin will have fewer dentists in 2010 than in 2000, but current levels of access can be maintained by implementing modest changes in the selection of dental students at Marquette, in the use of dental auxiliaries and in patient scheduling. CLINICAL IMPLICATIONS: With the national dentist-to-population ratio declining, each state should assess how its supply and demand for dental care will change in the next 10 years. If substantial supply-and-demand imbalances exist, options for correcting the imbalances need to be considered.

Dental Auxiliaries↗