ORCID

0009-0007-8316-5431

Keywords

Teledentistry, oral services, emergency department, Medicaid policies, digital readiness

Subject Categories

Health and Medical Administration | Health Services Administration

Abstract

Teledentistry has been promoted as a strategy to minimize emergency department (ED) visits for non-traumatic dental conditions (NTDCs). However, it remains unclear whether structural readiness or temporary policy expansion drives sustained reductions in reliance on the ED. This study integrates Andersen’s Behavioral Model of Health Services Use and Diffusion of Innovation (DOI) theory to examine determinants of Medicaid NTDC ED utilization and Tele-dentistry adoption.

Andersen’s model posits that utilization is shaped by predisposing, enabling, and need factors, whereas DOI theory emphasizes structural attributes that influence adoption, including relative advantage, compatibility, complexity, trialability, and observability. Combining these frameworks allows for a more comprehensive understanding of telehealth adoption and policy impacts on ED use. Using county-year panel data from Arizona and Florida, the study estimated four Andersen-informed regression models, followed by DOI-informed structural equation modeling, and difference-in-differences analyses.

In Andersen-based regression models, the Hispanic population and dental density were associated with fewer ED visits for NTDC, whereas the population aged 18-64 years was associated with more ED visits for NTDC. Structural equation modeling revealed that stronger adoption environments were significantly associated with lower Medicaid ED utilization. Difference-in-differences analyses indicated that post-2020 changes were driven by structural adoption intensity rather than the pandemic policy itself. These findings suggest that structural determinants of health shape Medicaid NTDC ED utilization. While pandemic-era telehealth flexibilities increased short-term adoption, sustained reductions in avoidable ED visits are contingent upon embedded infrastructure, workforce capacity, and system integration. Policymakers should prioritize broadband expansion, provider engagement, and stable reimbursement frameworks to achieve long-term reductions in avoidable emergency dental visits among the Medicaid population.

Completion Date

2026

Semester

Summer

Committee Chair

Gurupur, Varadraj

Degree

Doctor of Philosophy (Ph.D.)

College

College of Community Innovation and Education

Department

Department of Public Affairs

Format

PDF

Document Type

Dissertation

Language

English

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