摘要：Objectives. We documented emergency department (ED) visits for nontraumatic dental problems and identified strategies to reduce ED dental visits. Methods. We used mixed methods to analyze claims in 2010 from a purposive sample of 25 Oregon hospitals and Oregon’s All Payer All Claims data set and interviewed 51 ED dental visitors and stakeholders from 6 communities. Results. Dental visits accounted for 2.5% of ED visits and represented the second-most-common discharge diagnosis in adults aged 20 to 39 years, were associated with being uninsured (odds ratio [OR] = 5.2 [reference: commercial insurance]; 95% confidence interval [CI] = 4.8, 5.5) or having Medicaid insurance (OR = 4.0; 95% CI = 3.7, 4.2), resulted in opioid (56%) and antibiotic (56%) prescriptions, and generated $402 (95% CI = $396, $408) in hospital costs per visit. Interviews revealed health system, community, provider, and patient contributors to ED dental visits. Potential solutions provided by interviewees included Medicaid benefit expansion, care coordination, water fluoridation, and patient education. Conclusions. Emergency department dental visits are a significant and costly public health problem for vulnerable individuals. Future efforts should focus on implementing multilevel interventions to reduce ED dental visits. There are about 2 million annual emergency department (ED) visits in the United States for nontraumatic dental problems, representing 1.5% of all ED visits. 1 Dental visits to the ED have increased over the past decade. 2–6 Management of dental problems in the ED consists primarily of management of pain and infection through analgesics and antibiotics. 7 Most EDs are not equipped to provide definitive dental care. 8–10 Previous studies 1–7,9,11–16 have identified lack of insurance, Medicaid insurance, young adult age (18–44 years), and Black race as related to ED dental visits. Furthermore, elimination of state adult Medicaid dental benefits, for example in Oregon 11 and Maryland, 12 led to increases in ED dental visits, underscoring the importance of comprehensive dental coverage for Medicaid beneficiaries. In Oregon, medical and dental benefits under the Medicaid program (Oregon Health Plan) were previously administered through separate fee-for-service programs. As part of an Affordable Care Act State Innovation Waiver, Oregon integrated medical, dental, and behavioral health care into regional Coordinated Care Organizations (CCOs) in 2014. 13 A CCO performance goal is to reduce ED visits, including those involving nontraumatic dental problems. The Oregon Health Plan expanded coverage to an additional 220 000 individuals, primarily adults. Most enrollees receive services through managed care in which dental care organizations are paid on capitation. Adult coverage was limited to emergency care until 2014, when comprehensive dental benefits were reintroduced for all adults. There remain important gaps in knowledge, such as procedures, prescriptions, repeat ED dental visit rates, and costs. More importantly, the determinants of and potential solutions to reduce ED dental visits have not been described from the perspectives of ED dental visitors, ED providers, dentists, and health system managers. As part of an effort by local foundations to reduce barriers to oral health, we investigated 2 hypotheses in this mixed-methods study. First, ED dental visits are common, are related to insurance status, result in palliative but not definitive care, and are costly. Second, ED dental visits are caused by modifiable health system, community, provider, and patient factors. 17
