Cost and Workflow Impact of a Primary Care Based Multi-Level Pediatric Oral Health Intervention

A recent trial demonstrated the effectiveness of a primary care-based multilevel intervention to increase dental attendance in 3- to 6-year-old Medicaid-insured children. We estimate the cost and workflow impact for real-world practices wishing to implement this intervention.

Intervention practices from the trial integrated oral health (OH) questions into their electronic medical records (EMR). Providers received theory-based training on delivering OH education and provided "prescriptions" for dental visits and a list of Medicaid-accepting dentists. EMR enhancement and training costs were estimated by applying nationally-representative, role-specific hourly labor costs to reported time spent by study participants performing each activity. Study staff timed the OH portion of 2 to 3 randomly selected encounters per provider.

Twenty-eight providers from 9 intervention pediatric practices participated. The percentage of Medicaid patients in these practices ranged from 22% to 86%. Practices corresponding in size to the smallest, median, and largest in the intervention group can expect first-year implementation costs of $579.79, $863.86, and $1482.15, respectively, with subsequent annual maintenance costs of $167.11, $451.18, and $1069.47. Encounter time for the intervention averaged 38 s longer than for standard care (control group).

Implementation of this effective pediatric OH intervention appears to entail modest costs and lengthen encounters minimally.