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      A Machine Learning Approach to Uncovering Hidden Utilization Patterns of Early Childhood Dental Care Among Medicaid-Insured Children

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          Abstract

          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.

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          Most cited references45

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          Influences on children's oral health: a conceptual model.

          Despite marked improvements over the past century, oral health in America is a significant problem: caries is the most common chronic disease of childhood. Much oral health research examines influences primarily in the oral cavity or focuses on a limited number of individual-level factors. The purpose of this article was to present a more encompassing conceptual model of the influences on children's oral health. The conceptual model presented here was derived from the population health and social epidemiology fields, which have moved toward multilevel, holistic approaches to analyze the complex and interactive causes of children's health problems. It is based on a comprehensive review of major population and oral health literatures. A multilevel conceptual model is described, with the individual, family, and community levels of influence on oral health outcomes. This model incorporates the 5 key domains of determinants of health as identified in the population health literature: genetic and biological factors, the social environment, the physical environment, health behaviors, and dental and medical care. The model recognizes the presence of a complex interplay of causal factors. Last, the model incorporates the aspect of time, recognizing the evolution of oral health diseases (eg, caries) and influences on the child-host over time. This conceptual model represents a starting point for thinking about children's oral health. The model incorporates many of the important breakthroughs by social epidemiologists over the past 25 years by including a broad range of genetic, social, and environmental risk factors; multiple pathways by which they operate; a time dimension; the notion of differential susceptibility and resilience; and a multilevel approach. The study of children's oral health from a global perspective remains largely in its infancy and is poised for additional development. This work can help inform how best to approach and improve children's oral health.
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            Review on determining number of cluster in K‐means clustering

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              Predicting caries in permanent teeth from caries in primary teeth: an eight-year cohort study.

              Several cross-sectional studies report that caries in primary teeth is correlated with caries in permanent teeth. This eight-year cohort study sought to determine if caries in the primary dentition can predict caries in the permanent dentition of the same individuals and, if so, with what degree of prediction accuracy. A total of 362 Chinese children, from 3 to 5 years old at the time of the 1992 baseline study, were re-examined in 2000. The study found statistically significant associations between caries prevalence in primary and permanent dentitions (p < 0.01). Children having caries in their primary teeth were three times more likely to develop caries in their permanent teeth (relative ratio = 2.6, 95% CI = 1.4-4.7; p < 0.001). Caries on primary molars had the highest predictive value (85.4%). This study demonstrates that caries status in the primary teeth can be used as a risk indicator for predicting caries in the permanent teeth.
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                Author and article information

                Contributors
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                18 January 2021
                2020
                : 8
                : 599187
                Affiliations
                [1] 1Research Information Solutions and Innovation, Abigail Wexner Research Institute, Nationwide Children's Hospital , Columbus, OH, United States
                [2] 2Division of Pediatric Dentistry, College of Dentistry, The Ohio State University , Columbus, GA, United States
                [3] 3Department of Dentistry, Nationwide Children's Hospital , Columbus, OH, United States
                [4] 4Nationwide Children's Hospital , Columbus, OH, United States
                Author notes

                Edited by: Bhavna Pahel, University of North Carolina at Chapel Hill, United States

                Reviewed by: Peter Milgrom, University of Washington, United States; Suman Kundu, Vanderbilt University Medical Center, United States; Robert Schroth, University of Manitoba, Canada

                This article was submitted to Children and Health, a section of the journal Frontiers in Public Health

                Article
                10.3389/fpubh.2020.599187
                7848156
                33537275
                89202901-b7de-450e-9881-1207e8235608
                Copyright © 2021 Peng, Zeng, Townsend, Liu, Huang and Lin.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 26 August 2020
                : 14 December 2020
                Page count
                Figures: 3, Tables: 4, Equations: 0, References: 50, Pages: 10, Words: 6882
                Categories
                Public Health
                Original Research

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

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