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In Frontiers in public health

Background: Early childhood dental care (ECDC) is a significant public health opportunity since dental caries is largely preventable and a prime target for reducing healthcare expenditures. This study aims to discover underlying patterns in ECDC utilization among Ohio Medicaid-insured children, which have significant implications for public health prevention, innovative service delivery models, and targeted cost-saving interventions. Methods: Using 9 years of longitudinal Medicaid data of 24,223 publicly insured child members of an accountable care organization (ACO), Partners for Kids in Ohio, we applied unsupervised machine learning to cluster patients based on their cumulative dental cost curves in early childhood (24-60 months). Clinical validity, analytical validity, and reproducibility were assessed. Results: The clustering revealed five novel subpopulations: (1) early-onset of decay by age (0.5% of the population, as early as 28 months), (2) middle-onset of decay (3.0%, as early as 35 months), (3) late-onset of decay (5.8%, as early as 44 months), (4) regular preventive care (67.7%), and (5) zero utilization (23.0%). Patients with early-onset of decay incurred the highest dental cost [median annual cost (MAC) = $9,499, InterQuartile Range (IQR): $7,052-$11,216], while patients with regular preventive care incurred the lowest dental cost (MAC = $191, IQR: $99-$336). We also found a plausible correlation of early-onset of decay with complex medical conditions diagnosed at 0-24 months. Almost one-third of patients with early-onset of decay had complex medical conditions diagnosed at 0-24 months. Patients with early-onset of decay also incurred the highest medical cost (MAC = $7,513, IQR: $4,527-$12,546) at 0-24 months. Conclusion: Among Ohio Medicaid-insured children, five subpopulations with distinctive clinical, cost, and utilization patterns were discovered and validated through a data-driven approach. This novel discovery promotes innovative prevention strategies that differentiate Medicaid subpopulations, and allows for the development of cost-effective interventions that target high-risk patients. Furthermore, an integrated medical-dental care delivery model promises to reduce costs further while improving patient outcomes.

Peng Jin, Zeng Xianlong, Townsend Janice, Liu Gilbert, Huang Yungui, Lin Simon

2020

early childhood dental care, early childhood dental caries, health services research, healthcare expenditures, medicaid, medical-dental integration, pediatric dentistry, public health