For over 35 years, the Damiano Lab has conducted externally funded research on health services and public policy research, specifically examining underserved populations’ access to and quality of primary care services in Iowa.
Our research often uses mixed methods (primary data collection, secondary data analysis, and qualitative methods) to explore challenging health policy related questions. We regularly collaborate with experts in oral health, behavioral health, economics, and public policy.
Our current projects:
Evaluation of the Iowa Medicaid Expansion
Patient-Centered Dental Home: Model Development & Measurement
Kindergarten Vision Screenings in Iowa
Iowa Medicaid Evaluations
Our lab is currently leading an evaluation of the Iowa Health and Wellness Plan (IHAWP)—Iowa’s Medicaid expansion program—focusing on the impact of the waiver to modify aspects of the IHAWP program approved by the Center for Medicare and Medicaid Services. Iowa's waiver includes the addition of healthy behavior incentive requirements for IHAWP members, the elimination of retroactive eligibility, the non-coverage of non-emergency transportation services, an $8 copayment for emergency department services, and modifications to the Iowa Dental Wellness Plan (DWP). Our evaluation research has been conducted since the IHAWP program was established in 2014.
For over a decade, we have evaluated the experiences of community dental clinics, private practice dentists, and Medicaid enrollees across the state to understand the effects of the DWP in Iowa.
Research supported by the Center for Medicare and Medicaid Services and the Iowa Department of Health and Human Services.
Project Highlights:
Variation in dentist participation between dental medicaid managed care organizations
"Dentists' Medicaid participation is a critical factor affecting dental care access for Medicaid beneficiaries. This study examined the variation in participation overall and in predictors of dentist participation between two Medicaid dental Managed Care Organizations (MCOs) in Iowa's Dental Medicaid program.
There was considerable variation in dentist-reported acceptance of new adult and child Medicaid patients, and in the factors affecting acceptance of new patients between MCOs in Iowa dental Medicaid."
Dentist-reported differences in services provided to patients with public vs. private dental insurance
- Prosthodontic procedures had the greatest difference in services provided (including complete dentures, removable partial dentures, and crown and bridge services).
- Endodontic services were the least frequently provided category of services provided by dentists for both patient groups.
- Patterns were generally similar among both urban and rural providers.
Published in BMC Oral Health (2023)
Transportation barriers for Iowa Medicaid-enrolled adults with and without non-emergency medical transportation services
Iowa is one of a few states not required to provide NEMT (non-emergency medical transportation) for adults in their Medicaid expansion program if not medically exempt or under age 21. We found recipients without NEMT reported fewer transportation barriers than recipients with NEMT. For example, 6% of expansion members without NEMT reported transportation-related missed health visits (past 6 months) vs 15% for expansion members with NEMT and 11% for traditional Medicaid members. Few Medicaid group differences remained in adjusted models. NEMT benefit impact was limited by low reported awareness and use of the benefit and higher vulnerabilities in NEMT-eligible populations. Adults in all Medicaid groups could benefit from transportation services, but innovation is needed to determine more effective ways to meet transportation needs
The Patient-Centered Dental Home
Established in 2015, the PCDH is a four-phase project that aims to improve dental research by creating standardized definitions for dental care and providing specific standards for researchers to use when measuring the quality of dental care received by patients.
This allows researchers to more accurately evaluate patient care and identify areas for improvement.
Research supported by the CareQuest Institute for Oral Health.
Project Highlights:
The Patient-Centered Dental Home: A Framework for Quality Measurement, Improvement, and Integration
- We identified more than 500 existing oral health care measures and standards.
- Our National Advisory Committee's quantitative ratings and qualitative comments resulted in a total of 61 measure concepts and 47 measures and standards retained for inclusion in the framework.
- Results: Paved the way for future development and implementation of core measure sets to identify and evaluate a PCDH, facilitating quality improvement and dental-medical integration.
Published in The JDR Clinical & Translational Research (2024)
PCDH Core Set: Claims and Electronic Dental Record Based Measures for Pilot Implementation
- We identified claims- and EDR-based measures for inclusion in a core set of measures and standards. This core set will be used to operationalize the Patient-Centered Dental Home (PCDH) framework that was developed in earlier phases of this project.
- The project's Steering Committee recommended 9 pediatric measures and 9 adult measure for inclusion in a core set of claims- and EDR-based measures for pilot implementation.
Read more about the PCDH
Project framework, reports, & news articles found here!
Kindergarten Vision Screening in Iowa
With the support of the Delta Dental of Iowa Foundation, we are evaluating the effectiveness of a state law requiring vision screening and referral for all kindergarteners in Iowa. Ultimately it is the parent’s responsibility to have the child screened and provide “proof” of the screening to their child’s school; however, there are three non-profit organizations (Prevent Blindness Iowa, Iowa KidSight, and Vision to Learn Iowa) assisting Iowa parents and schools with screenings and referrals.
Our objective is to identify the current effectiveness of the screening program and any gaps in screening and referral, with the hopes of increasing children’s access to vision care and improving their quality of life at school and home.
Study 1: Vision Screening in Iowa School Year 2023
The study team received data from the three non-profits regarding their screening and referral of children during the 2022-2023 school year. A report was completed in August 2025 that evaluated the geographic distribution of screenings across Iowa by the three organizations. Results of the research included:
- There were vision screenings being conducted with school-aged children in every county in Iowa by at least one of the three non-profits.
- 19 counties appear to have had more limited penetration by the vision screening programs by these organizations (less than 50% as determined by the available data).
The report is currently under review by the Delta Dental Foundation of Iowa.
Study 2: Evaluation of Iowa Screening Data from the Iowa Immunization Registry Information System (IRIS)
Data for academic year 2025 was recently received from the Iowa Department of Health and Human Services which includes all vision screenings conducted and submitted to the registry for children in Iowa. Data analysis is currently underway.
Research supported by Delta Dental of Iowa
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