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Public Health Sealant Delivery Programs: Optimal Delivery and the Cost of Practice Acts

School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta

Paul M. Griffin, PhD

School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, pgriffin{at}isye.gatech.edu

Julie L. Swann, PhD

School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta

Background. The greatest unmet health need for US children is dental care. School-based sealant programs target low-income, high-risk second graders and are effective in preventing caries for as long as the sealant material remains in place. However, it is not clear whether such programs make efficient use of available resources and staffing. Methods. The authors used discrete event simulation to determine the optimal combinations of staffing levels and sealant stations for school-based sealant programs. Using data provided by state programs and the literature, they modeled different-sized programs under different practice act constraints and determined times and associated costs. A detailed economic analysis was done for Wisconsin. Results. For general, direct, or indirect supervision, it is optimal to have only 1 dentist or no dentists for no supervision. For general supervision, it is optimal to have the dentist and dental assistant to come on separate days to screen. The cost savings for adding an assistant and chair averaged over all of the program sizes and travel distances ranged from 4.50% (SE= 0.89) to 10.94% (SE= 0.56). Significant cost savings also result from reducing the required supervision level (8.72% [SE = 1.61] to 29.96% [SE= 1.67]). The cost of the practice act for the state of Wisconsin for 2003 was from $83,041 to $346,156, significantly more than its annual budget. Conclusions. States could save money by relaxing restrictions on the type of personnel who can deliver sealants in public health settings and by productivity gains through proper consideration of staffing. The savings could be used to improve access to sealant programs and further reduce disparities in oral health.

Key Words: public health • sealant • dental care • children • cost savings.

References

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This version was published on December 1, 2007

Medical Decision Making, Vol. 27, No. 6, 762-771 (2007)
DOI: 10.1177/0272989X07302134


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This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Scherrer, C. R. Articles by Swann, J. L. Search for Related Content PubMed PubMed Citation Articles by Scherrer, C. R. Articles by Swann, J. L. Pubmed/NCBI databases Medline Plus Health Information Child Dental Health School Health Social Bookmarking                         What's this?