Factors Contributing to Labor Efficiency in School Sealant Programs in 11 US States, 2017-2023.

OBJECTIVES

Financial viability can be a challenge in implementing school sealant programs (SSPs). We provided efficiency benchmarks for 2 measures-clinical labor time and labor cost per child-to help SSPs evaluate their performance and quantify the effect of implementation practices on these efficiency measures.

METHODS

We analyzed a convenience sample of data from 107 SSPs delivering sealants in 11 US states to 58 664 students during school years 2017-2018 through 2022-2023. We estimated measures of sealant service efficiency (SSE) per child sealed (SSEtime and SSElabor cost) and used multivariable linear regression models to identify associations between SSP practices and each SSE measure. Because of their skewed distributions, we log-transformed SSE measures. To aid interpretation, we converted resulting regression coefficients back to their original linear scales (hours and US dollars).

RESULTS

The median SSEtime and SSElabor cost were 0.95 hours (IQR, 0.56-1.53) and $43.25 (IQR, $23.22-$74.91). The smallest SSP size (sealing 11-60 students) as compared with the largest (sealing 390-14 589 students) was associated with an increase in SSEtime of 0.34 hours (20 minutes; β = 0.399, SE = 0.189, P = .04) and SSElabor cost of $14.45 (β = 0.431, SE = 0.200, P = .03). The use of dentists as dental operators was also significantly associated with increased SSElabor cost at an increase of $3.61 (β = 0.126, SE = 0.140, P = .02).

CONCLUSIONS

Our findings suggest that SSP labor efficiency could increase with program size (ie, economies of scale) and by using nondentist operators when possible.