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

PLoS One. 2020 May 14;15(5):e0232898. doi: 10.1371/journal.pone.0232898. eCollection 2020.

Abstract

Background: Dental utilization patterns and costs of providing comprehensive oral healthcare for older adults in different settings have not been examined.

Methods: 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.

Results: 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.

Conclusion: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Comprehensive Dental Care / economics*
  • Comprehensive Dental Care / statistics & numerical data*
  • Dental Care for Aged / economics*
  • Dental Care for Aged / statistics & numerical data*
  • Humans
  • Long-Term Care / standards*
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Minnesota
  • Outpatients / statistics & numerical data*
  • Retrospective Studies

Grants and funding

The Gary and Mary West Health Institute (WHI - https://www.westhealth.org/what-we-do/research/) employed staff (PA, MO, IP, GN) and paid consultants (TF, EAS) to conduct this research. Apple Tree Dental (ATD - https://www.appletreedental.org/) also provided support for this study in form of compensation for BS, MH, and BP. WHI is a medical research institute that purchased data from ATD and utilized existing WHI staff and consultants who analyzed the data. WHI and ATD team members contributed to study design, interpretation of results, writing and reviewing the manuscript, and deciding to publish. The specific roles of all these authors are articulated in the ‘author contributions’ section.