Use of the RE-AIM Chronic Care Framework to Evaluate Efforts to Expand Access to Oral Health Care for HIV+ Patients: Select Baseline Data and Evaluation Design

In 2006, Montefiore Medical Center's HIV primary care program, CICERO, and Montefiore's dental program, was one of 15 sites awarded a grant to improve HIV patients access to oral health care. Baseline data from 2007 show that CICERO served 1166 poor, minority HIV patients. Prior to the intervention, in 2007, 157 (13.5%) patients had a documented dental visit. These patients were African American (43.3%), women (59.9%), 44 (median) years of age, and had historically low median CD4 counts of 211 and current median CD4s of 420. The remaining 1009 patients were comparable in ethnicity, gender, and median age, but had slightly higher median CD4 counts historically(258) and currently (435). The intervention uses a mobile van and patient navigators to connect HIV+ patients seen during medical visits with dental providers. The Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) framework in conjunction with a Quality Improvement approach will be used to evaluate this non-randomized design and in the short term allow us to document the interventions Reach and Adoption -i.e., looking at the increase in the percent of patients receiving dental care and increases in the number of clinical sites and practitioners referring to dental care. Oral health outcomes will also be collected, and the joint use of RE-AIM framework and QI will let us assess how far we have penetrated into the HIV+ patient population, our ability to sustain people in care, and whether we have reached our proposed target of enrolling at least 75% of HIV patients in dental care.