PubMed Health⌕ Search

Biomedical subjects

J J Crall

Publications and source records attributed to J J Crall.

At least 19 recordsLinked to original sources
PubMed1999

Pediatric oral health performance measurement: current capabilities and future directions.

This paper offers an overview of performance measurement in health care, provides a synopsis of the findings and recommendations of an Oral Health Expert Panel organized by the National Committee for Quality Assurance (NCQA) under contract with the Health Care Financing Administration (HCFA), and discusses challenges and possible future directions for pediatric oral health care performance measures development. Existing performance measures for pediatric oral health care are extremely limited; however, several new measures have been proposed and are in various stages of development and testing. Measures capable of being implemented in the short-term focus on access and use of services, rely on administrative data sources, and represent refinements and enhancements of current measures. Measures proposed for future implementation focus more on the effectiveness of care, consumer assessments of care and plan performance, and the value of services provided to enrolled children. Recommendations are targeted toward high-risk children who, for the most part, are covered by public programs (e.g., Medicaid and the Children's Health Insurance Program). Nevertheless, the entire set of recommended measures is considered to be relevant to all pediatric populations and applicable to all forms of dental care coverage, including state-administered programs and commercial third party arrangements.

Adolescent↗
PubMed1998

Sociodemographic distribution of pediatric dental caries: NHANES III, 1988-1994.

This article examines the extent to which caries prevalence and untreated caries vary in children by ethnicity and household income level. Data from the Third National Health and Nutrition Examination Survey, 1988-1994, for 10,332 children 2 to 18 years of age indicate that lower-income children and Mexican-American and African-American children are more likely to have a higher prevalence of caries and more unmet treatment needs than their higher-income and non-Hispanic white counterparts.

Adolescent↗
PubMed1997

Variation in the use of crowns and their alternatives.

The use of crowns and their alternatives for the restoration of compromised posterior teeth is of interest to educators, purchasers, and patients. Considerable curricular time is devoted to learning these techniques, substantial amounts of money are spent on these procedures, and differences in the outcomes of these treatments may have consequences for tooth survival. To begin to understand more about the actual use of these procedures, the provision rates of these services in a sample of U.S. dental practices were examined. This study reports on the extent to which utilization patterns and subsequent costs of crowns and their alternatives were associated with certain patient and practice characteristics. Insurance claims for dental services submitted by general dental practices through an electronic claims clearinghouse were used. Crown ratios (crowns/crowns plus alternatives) were calculated for dental practices to evaluate relationships with available explanatory variables. Findings indicated that older patients were significantly more likely to receive crowns than those in younger groups, resulting in as much as a 33 percent increase in the mean per tooth cost of treatment in the oldest group. Regional variation existed in the provision of crowns and resulted in up to a 31 percent difference in the mean per tooth treatment cost between regions. Crown ratios exhibited variation beyond that accounted for by patient and practice factors, thus raising questions about the consistency of treatment recommendations among dentists. These findings support the need to examine further the consistency of crown use among general dentists and to modify current approaches for teaching treatment planning in predoctoral restorative curricula.

Adolescent↗
PubMed1997

Oral health component of child health services research.

The June 11 JAMA article outlines a rationale for developing a focus on child health services research and offers several strategies for facilitating the process. Developing a child health research agenda is essential to advancing dental care and professional education and, thus, is relevant to educators as well as researchers and policy makers. Oral health considerations are not likely to have high visibility or priority within that agenda unless dental health services researchers and dental schools become involved. An obvious question that is bound to be raised is "does it make sense to attempt to direct some portion of the already scarce resources available for dental health services research to children's issues?" Many individuals in leadership positions will probably think not; however, with an appropriate strategy, a small number of organized individuals and institutions can make a significant difference. Given the nature of dental diseases and the historical values of the profession, what better place to start?

Child↗
PubMed1995

Delivery systems for preschool children.

The United States dental care delivery system generally performs well for those who gain access and can afford necessary care; however, many segments of the population with significant levels of dental disease find it difficult or impossible to avail themselves of the potential benefits that the system has to offer. Preschool children are no exception, and they often receive little or no consideration in epidemiologic studies or policy development. Increasing awareness and improving preschooler's access to needed services will require fundamental changes in attitudes, policies, and behaviors on the part of the public, public officials, and health care professionals, including those within the dental profession.

Child, Preschool↗
PubMed1991

Informatics futures in dental education and research: quality assurance.

Traditional methods for quality assurance are increasingly being questioned on the grounds of costs and effectiveness. Quality assurance in dentistry has suffered from many of the same problems that have impeded development of the field outside the hospital sector: inadequate data sources, a paucity of broad-based research demonstrating the effects of various treatment approaches on patient outcomes, and a lack of cost-effective methods by which to monitor and evaluate care. Informatics holds considerable promise for dealing with those problems in a comprehensive, reliable and efficient manner. Although a considerable shared commitment on the art of academic dentistry will be needed, the anticipated advantages to be gained in terms of advancing the quality of dental education, research and patient care are substantial. The initiatives being undertaken by the AADS Special Committee on Information Technology are most timely. Parallel informatics efforts are being mounted at the national and international level in numerous health care disciplines. The dental academic community should be prepared to take advantage of the opportunities that the field of informatics is expected to yield in the near future so that it can provide leadership in promoting positive changes within the profession.

Accreditation↗
PubMed1989

Relationships between price and two components of quality of dental services.

Failure to account for differences in service attributes can lead to biased estimates and erroneous inferences regarding relationships between price and quality in studies of the dental care delivery system. This study examined relationships between prices of several common dental procedures and two components of the structure and process dimensions used in quality of care assessments. Results from ordinary least squares regression analysis demonstrated a significant positive relationship between price and an index of technical quality for two restorative services provided by general practitioners, even when controlling for market area characteristics. Additional analyses revealed that prices charged by general practitioners for specific services typically were lower on average and demonstrated greater variation than those charged by specialists for the same procedures. These findings highlight the need to consider service differentiation, including quality variation, in empirical studies involving the pricing of dental services.

Crowns↗
PubMed1989

Evaluations of effectiveness and quality of care.

Although technical competency continues to be viewed as an essential prerequisite for practicing dentistry, it is no longer felt to be a sufficient indicator of the effectiveness or quality of care that will be or is provided by a practitioner. Consistent with a broader definition of quality that includes timeliness and appropriateness of treatment, continuity of care, emphasis on prevention, and adequate documentation of services provided, initiatives are being mounted to develop improved methods for evaluating the effectiveness of treatment approaches and quality of care provided for patients. Fundamental to these evaluations are hypotheses relating aspects of the structure, process, and outcome dimensions of dental practice. Evidence for interrelationships among elements of these dimensions generally is weak or lacking entirely. If dentistry is to keep apace with other segments of the health care community, efficient methods must be developed to collect valid and reliable data from practice settings that will facilitate the evaluation of the impact of treatments, providers, and organizational arrangements on the oral health status and general welfare of patients.

Dental Care↗
PubMed1988

Relationships among structure, process, and outcome scores derived from evaluations of 300 general dental practices.

Analyses were undertaken to examine relationships among measures of structure, process, and outcome using data obtained during field testing of the Development of Evaluation Methods and Computer Applications in Dentistry (DEMCAD) office assessment instrument in 300 general dental practices. Correlation coefficients between scores for the structure dimension and scores for the process/outcome dimensions were 0.50 and 0.40, respectively, while process and outcome dimension scores were correlated at an even higher level (r = 0.79). Thus the DEMCAD instrument demonstrated a relatively high degree of interrelationship among these three major dimensions compared to other reports in the health care evaluation literature. Additional analyses were conducted to compare relationships between structure and process measures and various components of outcome, and to compare results across different types of practices (urban group, rural and urban nongroup). Correlations between the patient satisfaction component of outcome and scores for the structure/process dimensions were considerably lower than the corresponding correlations involving outcome components other than patient satisfaction. Ordinary least squares regression models demonstrated that structure scores were not significantly related to outcomes when controlling for process and that relationships were quite consistent across practice types.

Consumer Behavior↗
PubMed1987

Effects of DCPD/APF application and prolonged exposure to fluoride on caries-like lesion formation in vitro.

The ability of a topical fluoride regimen consisting of a 4-min application of a saturated dicalcium phosphate dihydrate (DCPD) solution followed by a 4-min application of 1.23% acidulated phosphate fluoride (APF) to inhibit caries-like lesion formation in sound enamel was compared to that of a 4-min application of APF. Following the applications, specimens were washed for 24 h in an inorganic wash solution or for 28 days in a wash solution containing 1 ppm fluoride. The mean overall lesion depth for specimens treated with APF and washed for 28 days was significantly greater than that for the group treated with DCPD/APF and washed for 28 days, and for the group treated with APF and washed for 24 h (p less than 0.05). For those specimens washed for 24 h, the mean width of the surface zone was greater (p less than 0.05) for the DCPD/APF group compared to the APF group.

Acidulated Phosphate Fluoride↗
PubMed1986

Promotion of oral health and prevention of common pediatric dental problems.

Many effective methods currently are available for preventing oral diseases and promoting oral health. The responsibility for ensuring the optimal use of these approaches is shared by members of the dental profession and other primary care providers in the present health care delivery system. Recognition of each provider's role and greater collaborative efforts could enhance the gains that already have been made with respect to improving the oral health status of children and adolescents.

Child↗
PubMed1986

Enamel fluoride retention after DCPD and APF application and prolonged exposure to fluoride in vitro.

The effect of a topical fluoride regimen consisting of a four-minute pre-treatment with a saturated dicalcium phosphate dihydrate (DCPD) solution followed by a four-minute application of APF was compared with that of a four-minute application of APF alone with respect to the deposition of fluoride in enamel in an apatitic form in vitro. Following the topical applications, specimens were washed in either (1) an inorganic wash solution for 24 hrs or (2) an inorganic wash solution with 1 ppm F added for 28 days; specimens were then subjected to KOH extraction for 24 hrs. Fluoride-by-depth profiles revealed that the DCPD/APF treatment resulted in a significant increase in the apatitic F concentration of enamel to a depth of 20 microns, while APF application alone did not. All groups exposed to the 1 ppm F wash acquired significant amounts of apatitic F, with the differences between groups remaining relatively constant.

Acidulated Phosphate Fluoride↗
PubMed1986

Preferences for treatment by dental specialists.

A group of employees was surveyed regarding factors related to selection of dental insurance coverage, including preference for obtaining various types of dental services from specialists. More than one-third of the 885 respondents preferred to see a specialist for services other than routine examinations, cleanings, and restorations. Preference varied according to the type of service, being lowest for prosthodontic care (31 percent) and highest for treatment of periodontal conditions (44 percent). Respondents who perceived a need for a particular category of services within the next year were more likely to prefer treatment by a specialist compared to those who perceived no need for that type of service. No significant differences with regard to preference for specialty care were noted among groups having different ages, income levels, or patterns of seeking dental care.

Adolescent↗
PubMed1985

Prevention of oral disease in children: concepts and practices.

Many of the dental traits exhibit continuous variation due to the multifactorial nature of dental development. Genetic and environmental disorders can result in further variation in specific dental traits. Identification of a dental anomaly can, at times, lead to the initial diagnosis of an underlying disorder and portend the patient's future health risks. Examples include the specific pattern of hypodontia seen before the development of iris dysplasia in Rieger syndrome, and the presence of supernumerary teeth and facial osteomas preceding malignant transformation of intestinal polyps in Gardner syndrome. In addition, dental anomalies can be useful in evaluating a patient's past medical history. A horizontal line of structural alteration in teeth can be used as a kymographic record of the causative metabolic disturbance and help pinpoint the active period of the disturbance. Normal eruption times of primary and permanent teeth also show a broad range of individual variation. Many disorders can cause extreme alterations in the eruption times of primary and permanent teeth or act to cause their premature exfoliation through disruption of their supporting tissues. The disruption of the eruption and integrity of the dentition can function as an indicator of the existent disease state. For example, the early exfoliation of primary teeth may be the presenting symptom of a patient with leukemia. Recognition of dental anomalies, distinct from normal variation can, therefore, be useful to the physician in the diagnosis of a patient's underlying condition and lead to a more thorough understanding of the mechanism of these disorders.

Child↗