Abstract
Integrating oral health performance measure into primary care
Laura Robbins, BS, CHES1, Susan Cote, RDH MS1, Eiren Menhenitt, BS2, Jennifer Dubail, MD, FAAP3 and Brian Youth, MD, FAAP4
(1)MaineHealth, Portland, ME, (2)Maine Health Accountable Care Organization, Portland, ME, (3)Maine Medical Partners, Portland, ME, (4)Maine Medical Center and Maine Medical Partners, Portland, ME
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Objective: Providing early pediatric oral health care in primary care has become standard of care recommended by USPSTF. Since 2008, From The First Tooth (FTFT) in Maine has trained 189 primary care practices statewide. Percent of children ages 12 – 47 months statewide who had received fluoride varnish by medical provider increased from 7% in 2011 to 24% in 2016 Q1-Q2 (Medicaid Data). In July 2016, Maine Medical Partners (5 pediatric practices, 18 pediatricians serving 2,755 children 9 – 47 mos.) included fluoride varnish as a quality performance measure.
Methods: FTFT integrated oral health metrics into the EHR, with interface to MaineHealth ACO (MHACO) Clinical Improvement Registry. Fluoride varnish metric is defined as “children ages 9 – 47 months with no dental home, and an office visit in the past 12 months who had fluoride varnish applied.” Children without teeth/whose parents refused were excluded. In 2015, MHACO sent monthly transparent data reports to pediatricians.
Results: From 7/2015 to 7/2016, there was a 14 % point increase in fluoride varnish (2015 – 45%; 2016- 59%). Range between practices in 2015 was 10% -72% and 2016 was 30% - 73%. Practice variance provided an opportunity for focused education.
Conclusion: Delivering data to providers increased awareness and fluoride varnish application. This resulted in pediatricians electing fluoride as a performance measure for 2017. In addition, MHACO developed a Pediatric Quality DashBoard with quarterly reporting of fluoride varnish, immunizations, BMI, and asthma to 6 health systems and 38 practices for quality measures tracking.
Administer health education strategies, interventions and programs Implementation of health education strategies, interventions and programs Provision of health care to the public Public health or related laws, regulations, standards, or guidelines Public health or related organizational policy, standards, or other guidelines
Abstract
Integrating Oral Health into State Standards for Medicaid ACOs in Massachusetts: Policy Recommendations & Strategies
Neetu Singh, DMD, MPH and Brian Rosman, JD
Health Care For All, Boston, MA
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Health reform has presented an opportunity in Massachusetts to explore new oral health financing models and delivery systems through the creation of state-based Medicaid and commercial Accountable Care Organizations (ACOs). In response, a robust group of dental providers, medical providers and community organizations have come together to establish the Oral Health Integration Project (OHIP) and advocate for the inclusion of oral health and dental services as a requirement of state standards for Medicaid and commercial ACOs. This presentation will discuss the current status of oral health integration into ACOs in Massachusetts as well as describe OHIPs specific recommendations and strategies for payment and delivery system reform. We will also discuss ongoing activities of OHIP, including budgetary, regulatory and legislative advocacy, and outline our framework for effective coalition building. Furthermore, we will share lessons learned from our engagement with a broad array of stakeholders, including consumers, state agencies, legislators, payers, providers and advocates. Finally, on-the-ground examples and experiences of oral health integration in Massachusetts community health centers will also be discussed.
Advocacy for health and health education Other professions or practice related to public health Public health or related organizational policy, standards, or other guidelines
Abstract
Elevating oral health interprofessional practice among pediatricians through a statewide quality improvement learning collaborative
Joni D. Nelson, PhD1, Amy Brock Martin, DrPH1, S. Melinda Spencer, PhD, MA2, Justin Moore, PhD, MS3 and Christine E. Blake, PhD, RD4
(1)Medical University of South Carolina, Charleston, SC, (2)Arnold School of Public Health, University of South Carolina, Columbia, SC, (3)Wake Forest School of Medicine, Winston-Salem, NC, (4)University of South Carolina, Columbia, SC
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background. Access to quality oral healthcare is vital for prevention of unwanted diseases and avoiding the burden of oral health complications. Using implementation science, we conducted a formative evaluation analysis of 18 pediatric primary care practices to understand the adoption of oral health interprofessional practices (OHIP) in pediatric settings. OHIP can include: performing oral health risk assessments, describing the importance of fluoride in the drinking water, fluoride varnish application and referring patients to a dental home. Methods. Using McLeroy’s ecological framework, we conducted a qualitative process evaluation to measure the factors that inhibited and facilitated adoption of OHIP into pediatric settings. A total of 15 of 18 CHIPRA pediatric practices participated in this study. Practices were located across 13 South Carolina counties. Document review analysis and qualitative interviews were conducted with pediatric practices to contextualize challenges and facilitators to OHIP adoption. Results. Thematic analysis revealed challenges for OHIP adoption including: limited resources and capacity, attention to delineated roles for clinical and administrative staff, communication, and family receptiveness. OHIP training for clinical practitioners and staff, buy-in and receptiveness from clinical staff and local dentist were facilitators of OHIP adoption. 12 key recommendations emerged based on QTIP participant experiences within OHIP adoption. Conclusions. We demonstrated the effectiveness of a learning collaborative among pediatric primary care providers to adopt interprofessional oral health practice. Our work reveals a sustainable pathway to increase access to preventive oral care.
Chronic disease management and prevention Other professions or practice related to public health Program planning Provision of health care to the public Public health or related education Public health or related public policy
Abstract
Colorado Medical-Dental Integration Project: The Dental Hygienist’s Perspective
Patricia A. Braun, MD, MPH, FAAP1, Katina Widmer Racich, MA2, Cherith Flowerday, BA3 and Allison Cusick, MPA, CHES3
(1)Denver Health | University of Colorado Anschutz Medical Center, Denver, CO, (2)University of Colorado Anschutz Medical Campus, Aurora, CO, (3)Delta Dental of Colorado Foundation, Denver, CO
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background: Evidence is building regarding the relationships between oral health and overall health. Tooth and gum diseases are largely preventable when dental care is accessed. Multiple Healthy People 2020 indicators target oral health, including increasing the percentage of Americans with a dental visit in the previous year from 44% to 49%. Integrating dental hygienists into medical care teams is an innovative approach to expand access to oral health services. This patient-centered, team-based approach moves beyond coordinated and co-located care. From 2015-16, the Colorado Medical-Dental Integration (CO MDI) Project integrated dental hygienists (RDHs) into medical care teams in sixteen Colorado medical practices.
Objectives: To investigate the dental hygienists’ perspectives regarding working in an integrated care model and factors that facilitate/create barriers to integration.
Methods: Qualitative, semi-structured key informant interviews (KIIs) are being conducted with 22 RDHs integrated into 16 medical clinics. Interviews are conducted 12-18 months after RDHs began implementing medical-dental integration. Participants were directly involved with the provision of care and have knowledge of changes within their practice systems related to integrating dental hygiene services. Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) conceptual framework, a KII guide was developed and piloted. The telephone KIIs are being recorded, transcribed, reviewed for recurring themes, and thematically categorized using Atlas.ti.
Results: Interviews are currently being conducted and analyzed. Results will be presented.
Conclusions: Integrating RDHs into medical care teams is an innovative approach to increase access to oral health services. The perspectives of dental hygienists are critical to understanding this work.
Administer health education strategies, interventions and programs Conduct evaluation related to programs, research, and other areas of practice Planning of health education strategies, interventions, and programs Provision of health care to the public