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Biomedical subjects

James J Crall

Publications and source records attributed to James J Crall.

14 recordsLinked to original sources
PubMed2006

Classical test theory and item response theory analyses of multi-item scales assessing parents' perceptions of their children's dental care.

BACKGROUND: Classical test theory and item response theory methods can provide useful and potentially different insights into the performance of items in a survey designed to elicit parental perceptions of dental care delivered to children in publicly funded programs. OBJECTIVES: We sought to illustrate the use of both classical test theory and item response theory to evaluate survey instruments. METHODS: : Using 2 years of cross-sectional data collected from enrollees in dental plans in 2001 and 2002, we studied families with children between ages 4 to 18 who were enrolled in 1 of 5 dental plans for 12 months or longer. The 2001 survey yielded a total of 2536 usable surveys and the 2002 survey yielded 2232 useable surveys (50% and 46% response rate, respectively) for a total sample size of 4036 children who used the plan for most or all of their care. MEASURES: The beta version of the CAHPS(R) dental care survey instrument includes 2 global rating items (dental care, dental plan) and multi-item scales assessing getting needed care, getting care quickly, communication with dental providers, office staff, and customer service. RESULTS: Item missing data rates were low. Item-scale correlations for hypothesized scales (corrected for overlap) tended to exceed correlations of items with other scales. Classical test theory analyses identified 5 of 10 communication items that did not perform well. Internal consistency reliability estimates for the scales ranged from 0.73 to 0.86. Item response theory painted a more promising picture than classical test theory for the 2 communication items that assessed access to an interpreter when needed. CONCLUSIONS: The beta CAHPS(R) dental survey performed well and the revised instrument is recommended for future studies. Classical test theory and item response theory can provide complementary information about survey items.

Adolescent↗
PubMed2006

Determining dental utilization rates for children: an analysis of data from the Iowa Medicaid and SCHIP programs.

OBJECTIVE: Accessing dental care is a significant problem for children in Medicaid and SCHIP. Evaluating the extent of the access problem is affected by the differential dental utilization rates as calculated by unique approaches used by national organizations. The problem is related to the intermittent enrollment in Medicaid and SCHIP for many children during the year. The objective of this study is to evaluate the effect of four different approaches for calculating dental utilization rates for children in Medicaid and SCHIP programs. METHODS: All Iowa Medicaid and S-SCHIP dental claims and enrollment files for CY 2001 were used to characterize the populations, calculate dental utilization rates and evaluate the types of services received by dental utilizers. Dental utilization rates were calculated four ways using the following different rate denominators: 1) any child enrolled during the year (Center for Medicare and Medicaid Services method), 2) children enrolled for 11-12 months (National Committee for Quality Assurance method), 3) a full-time equivalents (FTE) method, 4) only newly enrolled children. RESULTS: The methodology employed greatly affected the dental utilization rates. Rates varied from 18% for newly enrolled children in Medicaid to 58% for S-SCHIP-enrolled children using the FTE method. Methods that included children who were more likely to be in for more months during the year, such as the NCQA approach, produced the highest rates. CONCLUSIONS: The method used to determine the dental utilization rates for Medicaid and SCHIP enrollees should be clearly stated when these rates are being presented. This will allow the reader to be able to make a careful and appropriate interpretation of the results.

Adolescent↗
PubMed2006

Oral health status of mississippi delta 3- to 5-year-olds in child care: an exploratory study of dental health status and risk factors for dental disease and treatment needs.

OBJECTIVES: For poor and minority young children, disparities exist in dental health and treatment. In rural impoverished areas, institutions that reach young children and potentially offer access to care are limited. In the current Mississippi Delta study, child care centers were examined as potential venues for oral health intervention and research, and potential risk factors for dental caries and treatment urgency in high-risk preschool children were explored. METHODS: Child care centers were selected and attending children recruited. Data on oral health practices were collected from surveys of center directors and parents/caregivers. Children were examined for caries and treatment urgency at centers by dentists. Bivariate and multivariate analyses with a 0. 05 alpha were used to examine data. RESULTS: A total of 346 preschool children at 15 participating centers were examined: 46% were female, 68% minority. Minority children and those with public insurance were more than twice as likely to have caries and urgent treatment needs as non-minorities or those with private insurance. The odds of children having caries were half as great if parents reported using floss and nearly twice as great if the parent had experienced a dental abscess. For every soft drink the parent consumed daily, the odds of dental caries for children increased by 44%. CONCLUSIONS: Conducting oral health exams and research in child care venues was possible, yet presented challenges. The combined use of two parental variables, reported soft drink consumption and abscess history, appears promising for caries prediction. Implementation of oral health programs and research in child care venues merits further exploration.

Carbonated Beverages↗
PubMed2006

Access to oral health care: Professional and societal considerations.

Access to health care is a complex subject with vast personal, economic, political, and societal ramifications. Issues concerning the rights and responsibilities of health care professionals-collectively and as individual members of a profession-comprise an important topic within ongoing debates concerning access to care, and constituted the overarching focus of the deliberations that form the basis of this publication. This article provides definitions of key terms; data concerning demography, oral health status, and use of dental services for children and seniors; and a contextual framework for examining broad underlying professional and societal considerations. It concludes with reflections on joint responsibilities and guiding principles that apply to dental professionals and government agencies charged with administering public benefits programs and the consequences likely to ensue if these vital stakeholders fail to respect fundamental principles of professionalism and economics.

Aged↗
PubMed2003

California children and oral health: trends and challenges.

This paper highlights fundamental elements of the challenge of securing optimal oral health for California's children, now and in the future, and underscores the need for new strategies to reduce the risk of dental disease and expand access to effective services. Developing effective strategies to gain optimal oral health for California children, especially those that are most vulnerable to dental disease and its consequences, requires an appreciation of key dynamic factors that define this challenge and the degree to which these factors are modifiable in the near and long term. Particular attention is directed toward three principal elements: population demographics, levels of dental disease in California children, and factors affecting access to services for vulnerable groups of children. The concluding section addresses the need for strategic action.

California↗
PubMed2002

Comparison of children's medical and dental insurance coverage by sociodemographic characteristics, United States, 1995.

BACKGROUND: Insurance coverage can reduce financial barriers that constitute a significant deterrent to obtaining medical and dental care, especially for children who reside in low-income households. We present baseline information on the codistribution of medical and dental coverage among US children according to sociodemographic characteristics before the enactment of the State Children's Health Insurance Program (SCHIP). METHODS: Data for 27,059 children 0-17 years old from the 1995 National Health Interview Survey (NHIS) were analyzed to examine the distribution of medical and dental insurance coverage by sociodemographic characteristics. Prevalence estimates and adjusted odds ratios with 95 percent confidence intervals were calculated using SUDAAN. RESULTS: Overall, 14.1 percent children were uninsured for medical care and 36.4 were uninsured for dental care; thus, there were 2.6 times as many children uninsured for dental than for medical care. Near-poor and Hispanic children were most likely to be without medical or dental coverage. Near-poor children were more likely to be uninsured for dental care than for medical care (43.8% vs 22.5%). CONCLUSION: Our findings, coupled with previous reports, suggest that the most serious problem concerning lack of dental insurance is among near-poor children. SCHIP has the potential to address dental coverage among near-poor children.

Adolescent↗
PubMedDate not supplied

Children's oral health services: organization and financing considerations.

This article highlights prominent issues concerning children's oral health and provides an overview of the structure, organization, and financing of dental services for children in the United States. The size, composition, characteristics, and distribution of the dental workforce and the arrangements that facilitate the delivery and financing of dental services are discussed. Features of the current dental care delivery system are examined within the context of primary care. Suggestions for creating meaningful change to enhance access through expanded, integrated systems are presented as part of a concluding challenge.

Allied Health Occupations↗
PubMedDate not supplied

Behavior management conference panel II report--Third-party payer issues.

Panel II discussed key issues related to third-party payment for behavior management in pediatric dentistry and responded to a series of questions raised by the Conference Planning Committee. The panel was composed of individuals representing consumers (parents and caretakers), pediatric dentists, other health care providers, and a large dental insurance plan. They were charged with: (1) identifying problems related to third-party coverage and benefits for behavior management; (2) developing recommendations for the American Academy of Pediatric Dentistry; and (3) prioritizing the problems and recommendations.

Behavior Control↗
PubMedDate not supplied

Development and integration of oral health services for preschool-age children.

The purpose of this paper was to highlight 6 important considerations for developing a comprehensive strategy for optimizing the oral health of preschoolers. These considerations are based on the nature of Early Childhood Caries and the strengths and limitations of various components of the pediatric health care delivery system. Emphasized are 3 strategies for optimizing oral health care delivery for young children within the context of primary care: (1) early establishment of dental homes; (2) risk-based approaches; and (3) integration of dental and medical components of the primary care delivery system. Additional considerations are noted concerning: (1) scope of services provided by medical care personnel; (2) care coordination and referrals; (3) terminology; and (4) unresolved issues likely to have significant implications for future oral health care delivery for infants and young children.

Child, Preschool↗
PubMedDate not supplied

Rethinking prevention.

The purpose of this paper was to present information that underscores: (1) the need for understanding the fundamental nature of dental caries; and (2) efforts to minimize its consequences in light of available scientific evidence, recent population trends, and persistent pressures to extend improvements in oral health to all children in the most cost-effective manner. The primary emphasis was placed on the importance of appreciating caries as a common, complex, chronic disease whose deleterious effects can be mitigated best with ongoing use of appropriate, risk-based protective measures. Additional attention was given to current and emerging challenges along with considerations for aligning oral health promotion and delivery system capacity with children's oral health care needs.

Adolescent↗