Predicting dental treatment workload of U.S. Military personnel

Military Medicine, Jun 2001 by Chisick, Michael C

As the demographic composition of the U.S. armed forces shifts, so does dental treatment workload (DTW). To date, the effects of such shifts on DTW have been speculative. This study seeks to build regression models to predict the DTW of recruit and active duty military personnel as service demographic factors shift. The data come from a 1994-1995 random sample of 13,050 active duty and 2,711 recruit personnel. Dental treatment needs were charted for all participants. Patient demographic variables-age, sex, race, education, branch of service, and annual dental utilization (for all); home region and marital status (recruits only); and rank (active duty only)were noted. Treatment needs were converted to composite time values. Respondent demographic factors were regressed on composite time values to determine which factors influence DTW using backward, stepwise, linear regression. Resuits show that DTW varies across demographic categories. The magnitude and direction of change in DTW as service demographic variables shift can be predicted with linear regression models.

Introduction

In section 733 of Public Law 102-190, Congress mandated the Secretary of Defense to conduct a comprehensive study of the military medical care system, including dentistry.1 Pursuant to this Congressional mandate, the Assistant Secretary of Defense ordered the secretaries of the military departments to conduct the necessary beneficiary surveys to satisfy the mandate.2 The 1994-1995 Tri-Service Comprehensive Oral Health Survey (TSCOHS) was funded by the Office of the Assistant Secretary of Defense, Health Affairs, to provide the requisite data on dental care for military members and their families.3 To date, the TSCOHS has provided guidance to Congress and to military health policy makers on access to dental care 4-7 perceived need for dental care,8,9 quality of dental care,10,11 delivery of preventive dental services,12-14 tobacco use,15 dental insurance statUS,16 and costs of military dental care.17 In addition, by-products of the TSCOHS include the first electronic military dental epidemiologic survey instrument and the first electronic military field patient record.18,19

This paper addresses predicting or forecasting military dental treatment workload (DTW). Such information is essential to determine "the optimal military and Department of Defense civilian staffing... to achieve the most cost-effective delivery of health services."1 The DTW of any population will vary with demographic composition, changing disease rates, improving technology, and fluctuating political and economic trends.20-24 The demographic composition of the U.S. armed forces responds to changes in recruitment and retention policies, national unemployment levels, competition for skilled and unskilled workers in the national economy, service benefits and pay, and the attractiveness of military service, among other factors.

Before this study, the effect of demographic shifts on the DTW of U.S. military personnel has been speculative. The purpose of this study is to show how regression models of DTW will enable more rational, evidence-based planning to meet the oral health needs of the nation's armed services.

Methods

The data for this study come from the TSCOHS, a 30-site cross-sectional survey of Army, Navy, Marine, and Air Force active duty and recruit personnel. A detailed description of the study design is available elsewhere.25 The recruit sample (N = 2,711) was drawn at four recruit in-processing centers using stratified, systematic, random sampling. With the assistance of the Defense Manpower Data Center, a target sample of 20,000 active duty personnel was drawn at 26 U.S. military installations using stratified, multistage, random sampling. After removing service members who had retired, left the service, or transferred to other locations, the target sample was reduced to 15,915. The entire recruit sample and 82% of the active duty sample (N = 13,050) participated in the survey with informed consent.

A single military dentist at each study site charted the dental treatment needs of all study participants. Radiographs were used. Examiners were instructed to record treatment needed to optimize the patient's oral health assuming no barriers to care. Examiners recorded the patient's age, sex, race, education, and branch of service. Respondents provided their rank (active duty only), home region (recruits only), marital status (recruits only), and annual dental utilization (all) on self-administered electronic questionnaires. Recruit data were collected from February to July 1994. Active duty data were collected from April 1994 to January 1995.

Treatment needs were converted to composite time values (CTVs). Since the 1970s, the military dental care systems have assigned a numeric rating to every dental procedure to reflect the relative amount of time required to complete that procedure; this rating is called the CTV. For example, when completing a single surface amalgam restoration, clinicians customarily claim credit for the following procedures: other examination, patient handling time, rubber dam, local anesthesia, and a one-surface amalgam, for a total of 3.5 CTVs.