Longitudinal analysis of cost and dental utilization patterns for older adults in outpatient and long-term care settings in Minnesota

• Published in: PloS one Vol. 15; no. 5; p. e0232898
• Main Authors: Smith, Barbara J, Helgeson, Michael, Prosa, Brenda, Finlayson, Tracy L, Orozco, Mario, Asgari, Padideh, Pierce, Ian, Norman, Gregory, Aronoff-Spencer, Eliah
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 14.05.2020; Public Library of Science (PLoS)
• Subjects: Adult; Adults; Age; Aged; Aged, 80 and over; Ambulatory care; Analysis; Biology and Life Sciences; Care and treatment; Comprehensive Dental Care - economics; Comprehensive Dental Care - statistics & numerical data; Cost analysis; Costs; Demographic aspects; Dental care; Dental Care for Aged - economics; Dental Care for Aged - statistics & numerical data; Dental care services; Dentition; Economic aspects; Elderly patients; Engineering and Technology; Fruit trees; Government programs; Health aspects; Health care costs; Health care policy; Humans; Insurance; Insurance coverage; Long term health care; Long-term care; Long-Term Care - standards; Longitudinal Studies; Male; Medicaid; Medical care utilization; Medicine and Health Sciences; Middle Aged; Minnesota; Older people; Oral diseases; Oral health; Oral hygiene; Outpatients - statistics & numerical data; People and Places; Preventive medicine; Retrospective Studies; Setting (Literature); Social aspects; Teeth; Time; Tooth loss; Utilization; Minnesota; United States; United States > US; California
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0232898

Dental utilization patterns and costs of providing comprehensive oral healthcare for older adults in different settings have not been examined. Retrospective longitudinal cohort data from Apple Tree Dental (ATD) were analyzed (N = 1,159 total; 503 outpatients, 656 long-term care residents) to describe oral health status at presentation, service utilization patterns, and care costs. Generalized estimating equation (GEE) repeated measures analysis identified significant contributors to service cost over the three-year study period. Cohort mean age was 74 years (range = 55-104); the outpatient (OP) group was younger compared to the long-term care (LTC) group. Half (56%) had Medicaid, 22% had other insurance, and 22% self-paid. Most (72%) had functional dentitions (20+ teeth), 15% had impaired dentitions (9-19 teeth), 6% had severe tooth loss (1-8 teeth), and 7% were edentulous (OP = 2%, LTC = 11%). More in the OP group had functional dentition (83% vs. 63% LTC). The number of appointments declined from 5.0 in Year 1 (OP = 5.7, LTC = 4.4) to 3.3 in Year 3 (OP = 3.6, LTC = 3.0). The average cost to provide dental services was $1,375/year for three years (OP = $1,427, LTC = $1,336), and costs declined each year, from an average of $1,959 (OP = $2,068, LTC = $1,876) in Year 1 to $1,016 (OP = $989, LTC = $1,037) by Year 3. Those with functional dentition at presentation were significantly less costly than those with 1-19 teeth, while edentulous patients demonstrated the lowest cost and utilization. Year in treatment, insurance type, dentition type, and problem-focused first exam were significantly associated with year-over-year cost change in both OP and LTC patients. Costs for providing comprehensive dental care in OP and LTC settings were similar, modest, and declined over time. Dentate patients with functional dentition and edentulous patients were less costly to treat. LTC patients had lower utilization than OP patients. Care patterns shifted over time to increased preventive care and decreased restorative care visits.