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Introduction: Project ECHO Diabetes is a tele-education learning model for primary care providers (PCPs) seeking to improve care for patients with diabetes from marginalized communities. Project ECHO Diabetes utilized expert "hub" teams comprising endocrinologists, dieticians, nurses, psychologists, and social workers and "spokes" consisting of PCPs and their patients with diabetes. This Project ECHO Diabetes model provided diabetes support coaches to provide additional support to patients. We sought to estimate the costs of operating a Project ECHO Diabetes hub, inclusive of diabetes support coach costs. Methods: Data from Project ECHO Diabetes from June 2021 to June 2022 and wages from national databases were used to estimate hub and diabetes support coach costs to operate a 6-month, 24-session Project ECHO Diabetes program at hubs (University of Florida and Stanford University) and spokes (PCP clinic sites in Florida and California). Results: Hub costs for delivering a 6-month Project ECHO Diabetes program to five spoke clinics were $96,873. Personnel costs were the principal driver. Mean cost was $19,673 per spoke clinic and $11.37 per spoke clinic patient. Diabetes support coach costs were estimated per spoke clinic and considered scalable in that they would increase proportionately with the number of spoke clinics in a Project ECHO Diabetes cohort. Mean diabetes support coach costs were $6,506 per spoke clinic and $3.72 per patient. Total program costs per hub were $129,404. Mean cost per clinic was $25,881. Mean cost per patient was $15.03. Conclusion: Herein, we document real-world costs to operate a Project ECHO Diabetes hub and diabetes support coaches. Future analysis of Project ECHO Diabetes will include estimates of spoke participation costs and changes in health care costs and savings. As state agencies, insurers, and philanthropies consider the replication of Project ECHO Diabetes, this analysis provides important initial information regarding primary operating costs. [ABSTRACT FROM AUTHOR]

Background. Although dental Mission of Mercy (MOM) events have existed for more than 2 decades and are held in more than 30 states, systematic data collection and reporting on patient characteristics, oral health care use patterns, and oral health care needs are lacking. Methods. The authors surveyed patients attending the 2016 Florida MOM, asking about their reasons for seeking oral health care, oral health care use, and dental-related emergency department (ED) use. The authors conducted descriptive and multivariable analyses of survey and patient registration data to describe patient characteristics and examine associations between patient characteristics, time to last dental visit, and ED use. Results. Sixty-six percent of 1,462 study participants reported having orofacial pain; one-third of those were in pain for more than 1 year. Only 18% reported fair or poor overall health, whereas 75% reported fair or poor oral health. Florida MOM attendees who were younger adults, were of non-Hispanic ethnicity, had less than a college education, lived below federal poverty guidelines, and reported poorer oral health were at increased risk of having dental-related ED visits. Conclusions. Incorporating systematic data collection into dental MOM events provides important information about the characteristics and oral health care needs of clinic attendees that can be used to develop programs to address oral health care access on the basis of community-specific needs. Practical Implications. Community partners are using study data to develop strategies to address unmet oral health care needs. By systematically collecting information about patients who attend dental MOM events, we can obtain valuable information to create awareness about local community oral health care needs and promote efforts to develop sustainable strategies to improve oral health care access and outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study validated two Dental Quality Alliance system-level measures of oral healthcare quality for children - caries-related emergency department (ED) visits and timely follow-up of those visits with a dentist - including formal validation of diagnosis codes used to identify caries-related ED visits and measurement of follow-up care.Methods: The measures were specified for implementation with administrative claims data and validated using data from the Florida and Texas Medicaid and Children's Health Insurance Programs. Measure specification testing and measure score validation used administrative data for 7,007,765 children. We validated the diagnosis codes in claims data by comparisons with manual reviews of 300 records from a Florida hospital ED and calculation of the kappa statistic, sensitivity, and specificity.Results: Overall agreement in caries-related ED visit classifications between the claims data and record reviews was 87.7 percent with kappa = 0.71, sensitivity = 82 percent, and specificity = 90 percent. The calculated measure scores using administrative data found more than four-fold variation between programs with the lowest and highest caries-related ED visit rates (6.90/100,000 member months and 30.68/100,000 member months). The percentage of follow-up visits within 7 days and 30 days ranged from 22-39 percent and 34-49 percent, respectively.Conclusions: These National Quality Forum endorsed measures provide valid methodologies for assessing the rate of caries-related ED visits, an important system-level outcome indicator of outpatient prevention and disease management, and the timeliness of follow-up with a dentist. There is significant variation in caries-related ED visits among state Medicaid programs, and most ED visits do not have follow-up with a dentist within 30 days. [ABSTRACT FROM AUTHOR]

Objectives: The inability to access regular dental care may lead to care seeking at hospital emergency departments (EDs). However, EDs generally are not equipped or staffed to provide definitive dental services. This study examined trends and patterns of hospital ED use for dental-related reasons in Florida, a large, diverse state with serious barriers to accessing dental care.Methods: Data for this study were drawn from ambulatory ED discharge records compiled by Florida's Agency for Health Care Administration for 2005-2014. Visits for dental-related reasons in Florida were defined by the patient's reported reason for seeking care or the ED physician's primary diagnosis using ICD-9-CM codes. We calculated frequencies, age-specific and age-adjusted rates per 100,000 population, and secular trends in dental-related ED visits and their associated charges.Results: The number of dental-related visits to Florida EDs increased each year, from 104,642 in 2005 to 163,900 in 2014; the age-adjusted rate increased by 43.6 percent. Total charges for dental-related ED visits in Florida increased more than threefold during this time period, from $47.7 million in 2005 to $193.4 million in 2014 (adjusted for inflation). The primary payers for dental-related ED visits in 2014 were Medicaid (38 percent), self-pay (38 percent), commercial insurance (11 percent), Medicare (8 percent), and other (5 percent).Conclusions: Dental-related visits to hospital EDs in Florida have increased substantially during the past decade, as have their associated charges. Most patients did not receive definitive oral health care in EDs, and this trend represents an increasingly inefficient use of health care system resources. [ABSTRACT FROM AUTHOR]

Research Objective. To examine the impact of premium changes in Florida's State Children's Health Insurance Program (SCHIP) on enrollment duration. Data Sources. Administrative records, containing enrollment and demographic data, were used to identify 173,330 enrollment spells for 153,768 children in Florida's SCHIP from July 2002 through June 2004. Health care claims data were used to classify the children's health status. Study Design. Accelerated failure time models were used to examine the immediate and longer term effects on enrollment length of a temporary premium increase of $15 to $20 per family per month (PFPM) for children in families with income between 101–150 percent of the federal poverty level (FPL) and a permanent premium increase of $15 to $20 PFPM for children in families with 151–200 percent FPL. Health status and sociodemographic variables were included as covariates. Transfers to other public health insurance programs were taken into account. Principal Findings. Enrollment lengths decreased significantly immediately following the premium increases, with a greater percentage decrease among lower income children (61 percent) than higher income children (55 percent). Enrollment lengths partially recovered in the longer term for both the temporary and permanent changes. Those with significant acute or chronic health conditions had longer enrollment lengths and were less sensitive to premium changes than healthy children. Conclusions. An increase in the PFPM premium amount had differential effects across income categories and health status levels. Enrollment lengths remained shortened after the premium increase was rescinded for lower income families, suggesting that it may be difficult to reverse the impacts of even a short-term premium increase. [ABSTRACT FROM AUTHOR]

Objectives: To analyze the effect of postresidency early childhood caries prevention training on physicians' oral health knowledge, confidence, and practice patterns and to identify variations by type of training., Study Design: We conducted pre- and post-training surveys of pediatricians and family physicians in Florida. Paired t test and repeated-measures ANOVA analyses were used to compare physicians with no oral health training, those with applied in-office training, and those with another type of training on 5 composite measures: fluoride knowledge, nonfluoride oral health knowledge, confidence in advising parents, confidence in conducting oral health screening and caries risk assessment, and frequency in performing recommended oral health practices., Results: The final sample included 229 physicians (162 pediatricians and 67 family physicians). The interaction in the repeated-measures ANOVA between group (training category) and time (pre- and post-training) was significant for the nonfluoride knowledge [F(2, 225) = 4.1, P = .02] and confidence in screening [F(2, 224) = 4.1, P = .02] composite measures, lending support for a positive treatment effect of training on these domains. Greater gains were observed among physicians with in-office training compared with those who received another type of training. A statistically significant treatment effect on oral health practices was not detected., Conclusions: Efforts to engage physicians in oral health training and to incorporate applied components in training curricula may improve physicians' oral health knowledge and increase their confidence in conducting oral health screenings and caries risk assessments. Additional research is needed to evaluate the relative costs and benefits of different training modalities on specific oral health practices., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: To examine the relationships among pediatricians' and family physicians' oral health training, knowledge, confidence, and practice patterns., Study Design: A survey of physicians identified through the membership databases of the Florida Academy of Family Physicians and the Florida Pediatric Society was conducted in 2008. Responses of pediatricians and family physicians were compared through bivariate and multivariate analyses., Results: Although training was not directly associated with performing recommended practices, there were positive associations between training and confidence and between confidence and performing recommended practices (P <.05). Pediatricians were more likely than family physicians to answer fluoride-related knowledge questions correctly and reported greater confidence (P <.05). Less than 20% of the respondents reported counseling parents about bringing their child to the dentist before age 1 year or inquiring about the parents' dental health., Conclusions: Oral health training appears to promote confidence in performing recommended oral health practices. Differences in fluoride knowledge by provider type suggest that fluoride guidance has been disseminated more effectively among pediatricians than among family physicians. Educational content of oral health training programs should place increased emphasis on current fluoride guidance, early dental visits, and assessing parents' oral health. Instructional methods should address physicians' confidence, particularly among family physicians., (Copyright © 2010 Mosby, Inc. All rights reserved.)

Objective: To examine the impact of changing from a passive renewal process to an active renewal process in Florida's State Children's Health Insurance Program (SCHIP) on disenrollment., Data Sources: Administrative records, containing enrollment and demographic data, were used to identify 414,396 enrollment spells from January 2004 through February 2006. Health care claims data were used to classify the children's health status., Study Design: A Cox proportional hazards model was used to analyze the impact of changing to an active renewal process on the children's risk of disenrolling, controlling for the children's sociodemographic characteristics. Differential effects of the policy change by the children's health status were examined, and transfers to other public health insurance programs were taken into account., Principal Findings: Children faced almost a 10-fold greater risk of disenrolling in their renewal month under active renewal than under passive renewal. We did not detect differential impacts of the policy change across children with different health status levels., Conclusions: The switch to an active renewal process in Florida's SCHIP significantly increased disenrollment rates, and the effect of this policy change does not appear to vary by health status.