JA Jones, VA CHQOER, Bedford, MA and Boston University; U Boehmer, VA CHQOER, Bedford, MA and Boston University; D Berlowitz, VA CHQOER, Bedford, MA and Boston University; A Pitman, VA CHQOER, Bedford, MA and Boston University; CL Christiansen, VA CHQOER, Bedford, MA and Boston University; NR Kressin, VA CHQOER, Bedford, MA and Boston University

Objectives: Quality dental care preserves teeth. We examined whether variations exist in rates of root canal therapy (a tooth preserving approach) across VA as a quality indicator for VA dental care. The development of this indicator is timely given the Surgeon General's Report on Oral Health that documents important disparities in oral health outcomes including tooth loss.

Methods: We examined rates of root canals [#root canals/(#root canals + #extractions)] in users of VA outpatient care using validated data from FY98 obtained from 69,297 dental visits made by 54,495 veterans. Data sources included the VA inpatient and outpatient clinic files (VISN, medical and dental ICD-9 codes, CPT codes) and the VA Dental Activity System (dental eligibility). The unit of the analyses was the visit. Root canal rates were calculated by VISN and emergency versus regular visits. Logistic regression modeled root canal rates, adjusting for dental care eligibility (emergency vs regular visit), VISN, and medically appropriate factors affecting the chance of a root canal (dental diagnoses and comorbid medical diagnosis-Charlson index, schizophrenia, and alcoholism).

Results: Crude root canal rates varied between VISNs from a low of 8.46% to a high of 26.53%, and between eligibility categories from 1.82% for emergency vs 18.25% for veterans with a regular visit. Among veterans with dental diagnoses of pulpitis, necrosis or abcess (conditions most likely to receive a root canal), the estimated probabilities of receiving a root canal varied by VISN from 40% to 78% based on logistic regression adjusted for visit type and comorbid medical conditions. Odds of receiving a root canal were reduced in persons with emergency visits (OR=0.05, 95%CI 0.05,0.06), dental caries (OR=0.12, 95%CI 0.11,0.13), and facial cellulitis (OR=0.12, 95%CI 0.8,0.19). Similarly, the odds of receiving a root canal were lower in persons with periodontal disease (OR=0.13, 95%CI 0.12,0.14), schizophrenia (OR=0.81, 95%CI 0.75,0.88), alcoholism (OR=0.67, 95%CI 0.62,0.73), and for each one unit increase in the Charlson index (OR=0.85, 95%CI 0.82,0.87).

Conclusions: Variation exists in the provision of outpatient dental procedures in VA. While dental diagnosis and comorbid medical conditions account for much of this variation, large differences remain based on VISN and VA dental eligibility.

Impact: These differences are important because tooth loss is associated with decrements in oral health and well being. These results document the first step in employing a Bayesian hierarchical approach to examine this variation. This work informs VA policy-makers regarding the extent of differences in their search for improvements in quality and equity across VA.