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Objectives: The Coronavirus Aid, Relief, and Economic Security (CARES) Act appropriated $100 billion to the Provider Relief Fund, allowing for direct payments to health care providers due to COVID‐19. Few studies have evaluated participation in the Provider Relief Fund (PRF), and none have specifically looked at dental providers in the safety net. Methods: We conducted a retrospective, secondary data analysis using a quasi‐experimental cohort design of South Carolina dentists who received PRF payments, comparing those who did and did not participate in the safety net. Safety net practice was operationalized as those participating in Medicaid, and whether they provided care in dental health professional shortage areas, or rural communities. Results: Of the 628 dental providers in South Carolina who received PRF payments, 34% were identified as Medicaid providers while 66% did not participate in Medicaid; we found no statistical difference between payments to Medicaid versus non‐Medicaid dental providers. Of PRF payments to dental providers participating in South Carolina's Medicaid program, we found no difference between payments to rural and urban providers but did find that practices offering services in dental care shortage areas received less than providers practicing in counties not designated as a shortage area. Conclusions: The PRF achieved its goal of distributing financial support to providers affected by the COVID‐19 pandemic. But without policy imperatives linked to need‐based allocations or incentives for PRF recipients to serve safety net populations, we may later learn this was a missed opportunity for PRF. [ABSTRACT FROM AUTHOR]

Objectives: Early childhood caries (ECC) negatively impacts many child health outcomes and can lead to greater costs for medical and dental care as well as negatively impact future oral health wellness. ECC risk factors are rooted in many social determinants of health. Addressing ECC at the population-level is a national public health priority. The purpose of this study was to identify the South Carolina counties with the greatest risk for ECC. As policy-makers seek to address inequities stemming from early childhood caries, documenting its prevalence is essential.Methods: Since no county level ECC rates were published for South Carolina, we identified an opportunity to strengthen ECC surveillance through public use data, so as to properly equip policy-makers and pediatric providers with an evidence based understanding of the scope of the problem. As a result we sought to develop an overall county level prevalence measure for ECC risk through an ecological analysis of public use data.Results: Ten counties with the greatest overall risk for ECC were all rural as hypothesized. Additionally, seven of the 10 highest risk counties fell into what is often referred to as the "Corridor of Shame."Conclusions: We have found an affordable way of measuring county level risk for ECC that allows pediatric advocates and policy-makers to develop population level interventions to reduce and measure risk with public-use data. [ABSTRACT FROM AUTHOR]

Objective: We estimated the effect of South Carolina's (SC) Medicaid fluoride varnish (FV) reimbursement policy on children's receipt of fluoride varnish in medical (MFV) and dental (DFV) settings.Methods: We obtained data from SC Medicaid enrollment and claims files for children ≤ 47 months of age across State Fiscal Years (SFY) 2008-2013 and created a panel dataset of 52,841 children representing 126,464 child-years of observation. Pooled multivariate logistic regression models were estimated to identify factors associated with a higher likelihood of a child receiving one or more MFV or DFV treatments.Results: The FV rates per child-year were 1 percent for physicians and 23 percent for dentists, respectively. The child-year rate for receipt of FV from both a physician and a dentist was less than one-third of one percent.Conclusions: A policy designed to increase access to FV treatments from physicians and dentists for children up to forty-seven months of age was not successful for physicians; however, the positive findings for dentists were promising. [ABSTRACT FROM AUTHOR]

Objectives. We examined geographic differences in Early Periodic Screening, Diagnosis, and Treatment (EPSDT) visits as the South Carolina Department of Health and Environmental Control (SCDHEC) transitioned from direct service provision (DSP) to assuring delivery within the larger health care system. Methods. We examined infant cohorts with continuous Medicaid coverage and normal birth weights from 1995 to 2010. Outcome variables included any EPSDT visit and the ratio of observed to expected visits. Change in SCDHEC market share over time by residence was the primary variable of interest. We used growth curve models to examine changes in EPSDT visits by rural areas and levels of DSP over time. Results. A small proportion of the study population (10%) resided in rural counties that were more dependent on SCDHEC for DSP. The trajectory of not having visits among counties with high DSPs was steeper in rural areas (0.208; P = .001) compared with urban areas (0.145; P = .002). In counties with high DSPs, the slope of the predicted ratio in rural areas (-0.033; P < .001) was steeper than that of urban areas (-0.013; P < .001). Conclusions. Health departments operations continue to transition from DSP, which might decrease access to well-child care in rural communities. Health care reform provides opportunities for health departments to work with community partners to facilitate DSP from public to private sectors. [ABSTRACT FROM AUTHOR]

Purpose: An unhealthy prepregnancy weight and/or gaining an inappropriate amount of weight during pregnancy increase the risk for poor pregnancy and birth outcomes. To our knowledge, no studies to date have examined differences in prepregnancy body mass index (BMI) and gestational weight gain (GWG) patterns by rurality. Methods: The 2004-2006 South Carolina birth certificate data (n = 132,795) were used. Rurality of residence was determined using Rural-Urban Commuting Area (RUCA) codes. Mothers were categorized as underweight (<18.5 kg/m2), normal weight (18.5-24.9), overweight (25.0-29.9), and obese (≥30.0) using their prepregnancy BMI and as having inadequate, adequate, or excessive GWG according to the Institute of Medicine's 2009 GWG guidelines. Chi-square tests and adjusted multinomial logistic regression were used in analysis. Findings: Rural women had higher odds of being overweight and obese compared to urban women. This relationship was found to be partially explained by the higher proportion of minorities living in rural areas. The relationship between GWG and residence type varied by BMI category. Specifically, among normal weight women, rural women had increased odds of inadequate GWG. Among overweight women, rural women had decreased odds of excessive GWG. In obese women, rural women had decreased odds of both inadequate and excessive GWG. Conclusions: Rural women were more likely to have an unhealthy prepregnancy weight than urban women. However, rural residence was found to be protective against unhealthy GWG in overweight and obese women. Future research exploring reasons for these findings and confirmation of these results in other populations is necessary. [ABSTRACT FROM AUTHOR]

Our exploratory study examined rural-urban differences in dental care utilization during early childhood among Medicaid-enrolled children aged younger than 4 years in South Carolina. We conducted a secondary data analysis using Medicaid data. Dependent variables included preventive dental visits, use of medical settings (emergency room [ER] and primary care [PC] offices) for dental reasons, receipt of fluoride varnish, and dental home status. The primary independent variable was child's area of residence, rural or urban. The control variables were child's age, gender, race, and special healthcare need status. In adjusted analyses, rural children were found to have significantly higher odds of lacking preventive dental visits, fluoride varnishes, and dental homes as well as using medical settings for dental reasons compared to urban children. This difference, however, was not a simple function of rural residence. Other variables such as race and special healthcare need status interacted with rurality in explaining the differences in the outcomes of interest except visiting medical settings for dental reasons. Children under age of 2 years had higher odds of undesirable outcomes compared to those aged older than 2 years. Significant disparities in dental care utilization were evident among rural, Medicaid-enrolled preschool-aged children in South Carolina. While the state has addressed Medicaid reimbursement and related policies for nearly 10 years, their impact may be disproportionately effective. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To examine the rate of timely postpartum screening for diabetes among Medicaid-eligible women with gestational diabetes mellitus (GDM). Methods: We examined a retrospective cohort of Medicaid women with a live birth between 2004 and 2007. Women with singleton live births at greater than 28 weeks gestation were included in the cohort and their screening receipt tracked. Only the first qualifying pregnancy within the observation period was assessed. Birth certificate records were linked with hospital discharge data, outpatient prenatal care claims to identify women with GDM (n = 6,239). Medicaid postpartum claims for these women were examined to determine receipt of postpartum screening for diabetes within 5 to 13 weeks. Women with any indication of a dedicated plasma glucose test identified by CPT codes 82947, 82950, 82951, and 82952 during this time period were considered to meet the definition of screening. Results: Approximately 3.4% of women identified as having GDM were screened for diabetes postpartum. Adjusted analysis found women not attending the postpartum visit (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.37–0.91) and women receiving inadequate prenatal care (OR, 0.57; 95% CI, 0.34–0.95) were less likely to receive postpartum screening for diabetes. Conversely, women 20 to 34 years of age (OR, 1.79; 95% CI, 1.21–2.66) and women who were obese (OR, 2.28; 95% CI, 1.56–3.32) were more likely to be screened. Conclusions: Medicaid is a primary source of insurance for many women; however, for most coverage ends at 60 days postpartum, leaving a narrow window of opportunity for postpartum screening. Extended periods of coverage may be beneficial in ensuring the opportunity to receive adequate postpartum care, including screening for diabetes. [Copyright &y& Elsevier]

Purpose: School-based oral health programs (SBOHPs) provide opportunities to address oral health inequities by providing convenient access points for care. No published guidelines on SBOHP implementation existed. Our work describes how philanthropic, public, and academic organizations partnered to support dental safety net providers with designing comprehensive SBOHPs in North and South Carolina., Description: A multi-sector leadership team was established to manage a new SBOHP philanthropic-funded grant program organized into two phases, Readiness and Implementation, with the former a 6-month planning period in preparation of the latter. Readiness included technical assistance (TA) delivered through coaching and 15 online learning modules organized in four domains: operations, finance, enabling services, and impact. Organizations could apply for implementation grants after successful TA completion. Process evaluation was used including a Readiness Stoplight Report for tracking progression., Assessment: Ten Readiness grantees completed the TA. A variety of models resulted, including mobile, portable and fixed clinics. Descriptive analysis was conducted on the readiness stoplight reports. Components of the operation and finance domains required were the most time-intensive, specifically the development of policy manuals, production goals, and financial performance tracking., Conclusion: The program's structure resulted in (a) a two-state learning community, (b) SBOHP practice and policy alignment, and (c) coordinated program distribution. TA improvements are planned to account for COVID-19 threats, including school closures, space limitations, and transmission fears. Telehealth, non-aerosolizing procedures, and improved scheduling and communication can address concerns. Organizations considering SBOHPs should explore similar recommendations to navigate adverse circumstances., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: Routine preventive dental care is important to overall child health and well-being. However, the experience of adversity in childhood may prevent children from getting adequate preventive care. This study seeks to explore how the prevalence of adverse childhood experiences (ACEs) and the role of a protective adult may be associated with dental care utilization in childhood., Methods: Data from the 2016 South Carolina Behavioral Risk Factor Surveillance System (SC BRFSS), which interviews adults eighteen year of age and older, were used in this study. Dental care utilization in childhood was measured as the adult retrospectively reported frequency of dental care in childhood: at least once every 2 years (adequate dental care) or less often than every 2 years (inadequate dental care). ACEs were determined by asking about each of respondent's childhood exposure to eleven childhood experiences, including divorce, parental incarceration, domestic violence, drug and alcohol abuse, mental illness and emotional, physical or sexual abuse. The presence of a protective adult in childhood included respondents who had an adult who made them feel safe and protected during childhood. Descriptive and bivariate statistics explored differences in the adequacy of child dental care by ACE exposure, the presence of a protective adult and selected demographic characteristics. Multivariate regression models were used to examine the impact of counts and types of ACEs and the presence of a protective adult with inadequate childhood dental care., Results: The unweighted study sample included 7079 respondents ageing from 18 to 79 years of age Sampling weights were used for all analyses. Among all respondents, 71.7% reported receiving adequate dental care during childhood; 28.3% responded that they received inadequate dental care. Adjusting for sociodemographic characteristics, respondents who experienced four or more ACEs had a higher likelihood of inadequate dental care than respondents who reported no ACEs (aOR 2.79; 95% CI 2.77-2.82). The odds of reporting inadequate dental care were lower among those grew up with an adult who made them feel safe and protected (aOR 0.38; 95% CI 0.37-0.39)., Conclusions: The presence of protective factors may mitigate the effects of ACEs on paediatric dental care. This research contributes to the literature through the further identification of the role of dentists in identifying signs of abuse and neglect., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Context: Because of persistent effects of early childhood caries and impacts of dental health professional shortages areas, the integration of oral health in primary care settings is a public health priority. In this study, we explored oral health interprofessional practice (OHIP) as an integrative pathway to reduce oral health disparities. OHIP can include performing oral health risk assessments, describing the importance of fluoride in the drinking water, implementing fluoride varnish application, and referring patients to a dental home., Objective: To conduct a formative evaluation of how 15 pediatric primary care practices implemented the adoption of OHIP in their clinical settings., Design: Using an ecological framework, we conducted a qualitative process evaluation to measure the factors that inhibited and facilitated OHIP adoption into pediatric settings. Document review analysis and qualitative interviews were conducted with pediatric practices to contextualize challenges and facilitators to OHIP adoption., Setting and Participants: A total of 15 Children's Health Insurance Program Reauthorization Act pediatric practices located in 13 South Carolina counties participated in this study., Main Outcome Measures: Outcomes of interest were the facilitators and challenges of OHIP adoption into pediatric primary care practices., Results: Thematic analysis revealed challenges for OHIP adoption including limited resources and capacity, role delineation for clinical and administrative staff, communication, and family receptiveness. OHIP training for clinical practitioners and staff and responsiveness from clinical staff and local dentists were facilitators of OHIP adoption. Twelve key recommendations emerged on the basis of participant experiences within OHIP, with developing an active dental referral network and encouraging buy-in from clinical staff for OHIP adoption as primary recommendations., Conclusion: We demonstrated the effectiveness of a learning collaborative meeting among pediatric primary care providers to adopt OHIPs. This work reveals an actionable pathway to support oral health equity advancement for children through an additional access point of preventive oral care, reinforcement of positive oral health behaviors, and interaction between parent and child for overall health and wellness of the family.

Objective: Analyze diagnostic and demographic factors to identify predictors of delinquency resulting in incarceration within a group of children/adolescents diagnosed with ADHD., Method: The study followed a cohort of 15,472 Medicaid covered children/adolescents with ADHD, ages 6 to 15 inclusive, between January 1, 2003, and December 31, 2006. The Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev. [ DSM-IV-TR]), 2000 Codes were used for qualifying diagnosis codes. Available demographic characteristics included race, sex, and residence. The outcome was incarceration at the South Carolina Department of Juvenile Justice during 2005-2006., Results: Among youth with ADHD, incarceration was more likely among black, male, and urban youth. Children/adolescents with comorbid ODD and/or CD were at greater risk compared with those with ADHD alone., Conclusion: Within ADHD-diagnosed youth, comorbid conditions and demographic characteristics increase the risk of incarceration. Intervention and treatment strategies that address behavior among youth with these characteristics are needed to reduce incarceration.

Purpose: The purpose of this study was to assess differences in dental and medical care utilization for dental problems between rural Head Start (HS) participants and a nonexposed group., Methods: A matched retrospective cohort study was conducted using chi-square, Poisson, and logistic regression models. We linked Medicaid claims and HS enrollment data for 7 rural counties in South Carolina to examine oral health service utilization in dental, primary care (PC), and emergency room (ER) settings. The exposed group included 985 HS participants during the 2007/2008 school year and the nonexposed group included 1,969 children enrolled in Medicaid but not HS., Results: HS participants were more than twice as likely to visit dentists for preventive, diagnostic, and restorative care (P<.001). The odds ratio of HS participants relative to the nonexposed group for PC visits for oral health problems was 1.94 (P=.03). No differences between HS participants and the nonexposed group for oral health-related ER visits were observed (P=0.33)., Conclusions: Head Start participants accessed dental care with greater frequency than the nonexposed group. Findings provide evidence that Head Start grantees positively impact dental service utilization for their children. Future research should examine the programmatic features to which the outcomes can be attributed and whether utilization trends continue after Head Start completion.

Purpose: Published advantages of and challenges with telemedicine led us to examine the scope of telemedicine adoption, implementation readiness, and barriers in a southern state where adoption has been historically low. We hypothesized that rural hospitals and primary care providers (RPCPs) differ on adoption, readiness, and implementation barriers. We examined the degree to which they differ on (a) telemedicine adoption or readiness; (b) telemedicine training needs; (c) current use of technology for patient care; and (d) environmental concerns in facilities for telemedicine., Methods: Paper surveys were sent to rural hospitals and RPCPs with response rates of 50% (n = 38) and 25.9% (n = 339), respectively. Three of 4 hospitals were represented. Chi-square analyses were used to test for differences between rural hospitals and RPCPs., Findings: Compared to RPCPs, rural hospitals were significantly more likely to report higher rates of telemedicine knowledge (P= .0007); planning for or implementing telemedicine (P < .0001); and reporting their disaster recovery data systems (P= .0002) and availability and location of outlets and connections (P= .03) as adequate for telemedicine. Rural hospitals were less likely to report having no telemedicine education needs (P= .04)., Conclusions: Telemedicine continues to be a viable solution for bridging geographic access gaps to a variety of specialty care. Users need assistance in understanding legal implications, care coordination, billing for services, and disaster data recovery. In rural areas, hospitals appear to best embody characteristics of facilities that successfully implement telemedicine and have the greatest degree of readiness., (© 2011 National Rural Health Association.)