Join Now; Mailing Lists. Information for List Users; Information for List Owners; SIGCHI and Accessibility; Membership Benefits; Involvement and Volunteering; Local SIGCHI Chapters Index; About SIGCHI. Designing a Benchmarking Plan 2 DRAFT -- February 2013 Participation in an environmental or energy efficiency program that requires energy benchmarking. Many organizations are participating in energy efficiency programs that. James Walker called for a better link between strategic business planning and human resources planning in an article that appeared in Human Resource Planning, Spring 1978. Other articles have answered this call; these include.
Preventing Chronic Disease . Edelstein, DDS, MPH; Marcy Frosh, JD; Theresa Anselmo, MPH, BSDH, RDH Suggested citation for this article: Hirsch GB. Edelstein BL, Frosh M, Anselmo T.
A simulation model for designing effective interventions in early childhood caries. Prev Chronic Dis 2. DOI. http: //dx. doi. PEER REVIEWEDAbstract. Introduction. Early childhood caries (ECC) — tooth decay among children younger than 6 years — is prevalent and consequential, affecting nearly half of US 5- year- olds, despite being highly preventable.
Various interventions have been explored to limit caries activity leading to cavities, but little is known about the long- term effects and costs of these interventions. This study of Colorado preschool children models 6 categories of ECC intervention — applying fluorides, limiting cariogenic bacterial transmission from mothers to children, using xylitol directly with children, clinical treatment, motivational interviewing, and combinations of these — to compare their relative effect and cost.
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Results. The model projects 1. Interventions targeting the youngest children take 2 to 4 years longer to affect the entire population of preschool- age children but ultimately exert a greater benefit in reducing ECC; interventions targeting the highest- risk children provide the greatest return on investment, and combined interventions that target ECC at several.
Some interventions save more in dental repair than their cost; all produce substantial reductions in repair cost. Conclusion. By using data relevant to any geographic area, this system model can provide policy makers with information to maximize the return on public health and clinical care investments. Top of Page. Introduction. Early childhood caries (ECC) — tooth decay among children younger than 6 years — is highly prevalent and consequential in the United States, despite being highly preventable. Forty- four percent of 5- year- olds have cavity experience (1).
Early disease predicts lifelong cavities (2) because the process that results in cavities, once established, tends to be stable and chronic. ECC manifests frequently as pain and infection and disproportionately affects low- income children (3). Medicaid and the Children’s Health Insurance Program (4). The problem facing policy makers is selecting interventions that have greatest potential for reducing both disease and costs.
System dynamics is “a methodology for better anticipating the likely effects of interventions in dynamically complex situations” (5). It maps the causes of a persistent problem and uses computer simulation to compare alternative policies and intervention strategies that might alleviate the problem. System dynamics has been applied to health care delivery and population health for chronic conditions affecting oral health and to various public health initiatives. Although it does not predict. The objective of this study was to formulate a system dynamics model to assess and compare ECC interventions for benefits and costs among young children in Colorado.
Its framework can be applied to other locales. Top of Page. Methods. Our basic model structure, developed by a work group of pediatric medical, dental, and public health experts, separates children by age (0- 6, 7- 2.
ECC (low, moderate, high), using household income as a surrogate for risk. Risk is considered a key element in determining allocation of public health and dental care resources (6,7).
Caries experience may vary over time with changes in socioeconomic status (8) and preventive interventions. Stages of ECCCaries is the disease process that causes cavities (Figure 1). The natural history of ECC begins with a newly erupted tooth that is not yet colonized by cariogenic bacteria. It progresses through the establishment of a biofilm that may be visible as plaque, followed by demineralization of the enamel resulting in a. With continued progression, the enamel breaks down, resulting in a cavity. Various preventive and disease management interventions may affect this progression at any point along the way.
At each point in the simulation, children move in at least 2 directions as they age and as ECC stages progress. With intervention, children can move in an additional direction if the intervention is sufficient to change risk. Figure 1. Stages of early childhood caries development among children aged 0 to 5 years. Symbols with 2 triangles touching at their vertices represent “valves,” indicating that various factors control the rates of flow.
These factors include both biological variables such as normal rates of caries development and effects of interventions such as fluoride varnish in slowing those rates of progression. Interventions change rates of flow from. ECC prevalence. The model calculates a number of variables including overall fraction of children with cavities and cumulative costs of restorative care so that program costs, cost savings for restorative care, and net costs can be. Data sources. We used multiple data sources to quantify the model and the effects of simulated interventions. To determine ECC prevalence by age and income and confirm the previously reported relationship between oral health and income, we obtained state- specific information from the Colorado Child Health Survey (9) (Rickey Tolliver, State of Colorado, written communication, November 5, 2.
We used a positive response to a question querying parents about children’s prior dental pain, cavities. ECC on clinical examination. The National Health and Nutrition Examination Survey (NHANES) stratifies pediatric. FPL) (1. 0), but Colorado data supported using income breaks of up to 2. FPL (1. 8. 6% ECC prevalence) for “high risk,” 2.
FPL (1. 5. 0% ECC prevalence) for “moderate risk,”. FPL (8. 4% ECC prevalence) for “low risk.” We categorized children for whom income data were not available (6. ECC experience. Of the 4. Colorado’s population of 0- to 5- year- olds, 3. To quantify the fraction of children with. Colorado findings to reflect treated and untreated cavity prevalence reported for the 1. NHANES survey after adjusting for Colorado’s income distribution.
A prior secondary analysis of these NHANES data (1. Colorado income bands. We derived the fraction of children with symptomatic cavities from the Government Accountability Office, which conducted a secondary analysis of NHANES data to determine the number of children considered to be “in urgent need of treatment” (1. To estimate. precavity caries fractions, we backward- extrapolated the rate of change in cavities between age groups (between the youngest and middle age groups from the Colorado survey and between middle and older age groups from NHANES).
Results. were consistent with a study that measured both precavity lesions and cavities among children (1. We used the model to more finely calibrate rates of children moving between stages of tooth decay and finally adjusted the model by using data on rates of childhood dental fillings from the Medical Panel Expenditure Survey (MEPS) (1. We revised recurrence rates (new cavities among children with prior repair) upward to maintain the model’s ability to reflect initial prevalence patterns.
The model. produces restorative visit rates that fall within the range suggested by MEPS data. In addition to the prevalence of ECC, the model seeks to anticipate the extent of primary- tooth cavity experience, measured in average numbers of decayed and filled teeth. Using NHANES data (1. Colorado’s income distribution and rates of cavity experience for 6- to 2.
To calculate cost savings attributable to avoided restorative care from various interventions, we obtained data for care delivered in both dental offices and ambulatory or hospital sites under general anesthesia. For office- based care, MEPS reported average restorative dental costs of $2. We attributed an average cost of $7,2. Medicaid data adjusted to reflect market- level charges for the 1. Colorado Medicaid (M. Sajovitz, Colorado Department of Health Care Policy and Financing, written communication, September 1. National Survey of Ambulatory Surgery (1.
M. Hall, Centers for Disease Control and Prevention . To provide baseline values, the model was quantified with fractions of children by age and risk with detectable levels of cariogenic bacteria, specifically Streptococcus mutans. On the basis of studies of S. Simulations with the model were run over 1. We weighted results against estimated program costs to estimate costs, benefits, and net savings for various interventions. Interventions were applied to entire populations or to age or risk subgroups. Interventions considered in the analysis included 1) educational programs that reduce consumption of sugary drinks, nocturnal bottle use, and other harmful behaviors; 2) efforts to reduce S.
Motivational interviewing is a brief interactive approach to counseling and educating parents that focuses on skills that move patients to action. Interventions were clustered into 6 categories: fluoride exposure. Top of Page. Results.
The Table reports projected disease levels in terms of the percentage of children with cavities, percentage of children with untreated cavities, and total numbers of decayed and filled teeth for the population. The. Table also reports cumulative costs of restorative care, savings in restorative care compared to no intervention, and cumulative program costs.
For example, simulation 1. Colorado. children younger than 6 years (1. Fluoride interventions.
Simulation 1. 1 assumes that community water fluoridation is expanded to 2. Colorado’s population not currently served; that fluoridation reduces cavity prevalence by 2. CDC (1. 9) to compensate for other sources of pediatric fluoride exposure (William Maas, Pew Center on the States, written communication, September 2. The next. 3 simulations consider variants of fluoride varnish application: to all children older than 6 months twice annually (1. All assume that fluoride varnish reduces decay of primary teeth by one- third (2.
CDC - Designing and Building Healthy Places. Healthy places are those designed and built to improve the quality of life for all people who live, work, worship, learn, and play within their borders - - where every person is free to make choices amid a variety of healthy, available, accessible, and affordable options.