Oral Health and Primary Care: Exploring Integration Models and Their Implications for Dental Hygiene Practice

Background: Historically, the oral health care system has been separated both administratively and clinically from the larger health care delivery system. Despite this historical separation, providing oral health care services lies within the scope of all health care professionals' practices. Current efforts to shift the compartmentalized American health care system to a total patient care model provide an opportunity to integrate oral health care with primary care in order to improve the population's oral health. This article seeks to acquaint dental hygienists, the oral health care professionals focused on disease prevention, with new and emerging models of oral health care delivery and interprofessional collaborative practice in the hope that they soon will participate in and expand the implementation of these practice models. Methods: This study focused on five health centers, all of which have been identified as organizational leaders in the development and implementation of models designed to support the integration of oral health care with primary care. Quantitative information on each health center was derived from annual reports submitted to the Uniform Data System (UDS) and information on the integration models was obtained through structured key informant interviews. Results: Each organization has incorporated oral health risk assessment, clinical assessments, education, preventive interventions, and dental care coordination into primary care services. One organization provides oral health care as part of its outreach services and programs. The health care team members involved in integration vary. Some of the health centers primarily call on doctors to implement integration of oral health care while others employ dental hygienists, nurses, medical assistants, and outreach team members. Interprofessional collaboration was observed in each organization but took on different forms. Conclusions: Although their methods of integrating oral health care with primary care differed, the five health centers described in this study successfully used integration to improve the delivery of oral health care services to their patients. All of these organizations placed a high value on interprofessional collaboration regardless of the particular collaborative model employed and identified a champion tasked with overseeing the improvement of oral health care delivery.The development of this article was supported by the National Association of Community Health Centers through funding provided by the DentaQuest Foundation

Policy Report: 2014 Indiana Dentist Workforce

Information on the oral health workforce is critical to understanding oral health system capacity and informing policy. Unfortunately, the response rate to the emailed version of the survey was extremely low (13.4%) as compared to previous years. It is unclear whether these respondents are representative of Indiana’s dentist workforce; however, these data, representing the most current information available on a sample of this workforce, are presented in this report

Integration of Oral Health with Primary Care in Health Centers: Profiles of Five Innovative Models

Health centers are leading the way in integrating oral health with primary care. Much can be learned by exploring the models that health centers have developed and adopted to achieve integration. This Monograph, supported by the DentaQuest Foundation and authored by Hannah L. Maxey, PhD, MPH, RDH, Assistant Professor and Director of Health Workforce Studies, Department of Family Medicine, Indiana University School of Medicine, presents information on five health centers that have successfully integrated oral health with primary care. It has been developed for the purpose of organizing and presenting information on successful models which may be useful to health centers and other organizations considering the implementation of similar initiatives. Each health center’s model is summarized within the framework of the five domains of the Integration of Oral Health and Primary Care Practice initiative (IOHPCP), and full information on each of the models, such as the role of all care team members, is found within the profile for each health center.National Association of Community Health Centers supported by the DentaQuest Foundatio

Comprehensive Strategy for Evaluation of Clinical Health Coaches in Chronic Disease Management

poster abstractPurpose: As chronic disease rises to the top of morbidity and mortality causes in the United States, improving chronic disease management, particularly at healthcare administration and patient engagement levels, becomes a rising public health concern. Clinical Health Coaches (CHCs) are an innovative role in primary care settings, collaborating with patients to improve patient outcomes. There is a need for best practices guidelines of the CHC role, as there is currently no standardized training program. Iowa Chronic Care Consortium (ICCC) developed a CHC training program which is being implemented in an Indiana Rural Health Association pilot program. This study seeks to develop an evaluation tool for ICCC training and its effectiveness in chronic disease management. Methods: An extensive literature review was performed on previous evaluations of similar health coach role implementation in chronic disease management. ICCC training was completed to further understand the training program. Results: A collaboration of the chronic care model and ICCC’s proposed CHC model was determined to be the most appropriate tool for evaluation. From these models, 5 key domains were identified including: patient engagement, self-management support, patient experience, patient satisfaction, and delivery system design. This comprehensive approach will allow for both qualitative and quantitative analysis. Discussion & Implications: These survey tools will be administered to both patients and CHCs as a part of an evaluation of ICCC training and its effectiveness. As a result of this study, the CHC program could be expanded to more primary care settings to improve health outcomes in chronic disease patients. Learning objectives: Design an evaluation tool for clinical health coach training in chronic disease management. Evaluate the effectiveness of clinical health coach implementation in chronic disease management in a primary care setting

Exploring Current and Future Roles of Non‐Dental Professionals: Implications for Dental Hygiene Education

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153551/1/jddjde017033.pd

State policy environment and the dental safety net: a case study of professional practice environments’ effect on dental service availability in Federally Qualified Health Centers

Objectives To determine whether and to what extent the state policy environment for the dental hygiene workforce affects the availability of dental services at Federally Qualified Health Centers (FQHCs). Methods We examined data drawn from the Uniform Data System on 1,135 unique FQHC grantees receiving community health center funding from the U.S. Health Center program between 2004 and 2012. The Dental Hygiene Professional Practice Index was used to quantify variations in state policy environment. We then examined the influence of state policy environment on the availability of dental care through generalized linear mixed-effects models. Results Approximately 80% of FQHCs reported delivering dental services. We consistently observed that FQHCs with favorable levels of state support had the highest proportion of FQHCs that delivered dental services, even more so than FQHCs with extremely high support. FQHCs located in the most restrictive states had 0.28 the odds of delivering dental services as did those located in the most supportive states. Conclusions The state policy environment for the dental hygiene workforce is likely associated with the availability of dental services at FQHCs. The greatest proportion of FQHCs delivering dental services was found in states with policy provisions supporting professional independence in public health settings. Nevertheless, additional research is needed to understand the specific mechanism by which these policies affect FQHCs

Policy Report: 2012 Indiana Pharmacist Workforce

In order to fully leverage the pharmacist workforce in primary care delivery, which is focused more and more on cost-effective and team-based models, the pharmacist workforce must be clearly understood. Policymakers and health professionals must examine data that depicts the practice characteristics, demographics, capacity, and even the evolving role of pharmacists. Furthermore, these data must influence policy discussions that may lead to a more efficient health system. This report provides a ‘snapshot’ of the most recent data on Indiana’s pharmacist workforce, identifies emerging issues, and presents information pertinent to workforce planning and policy

Policy Report: 2013 Indiana's Nursing Workforce

As Indiana plans for the development of a strong nursing workforce, data should be used to inform decisions that are able to 1) accurately describe the current workforce and 2) identify challenges and emerging issues. Data informed decisions will result in workforce policies and planning efforts that closely align with the actual health workforce needs. This report provides a ‘snapshot’ of the most recent data on Indiana’s nursing workforce, identifies emerging issues, and presents information pertinent to workforce planning and policy

Dental safety net capacity: An innovative use of existing data to measure dentists’ clinical engagement in state Medicaid programs

Background The demand for dentists available for state Medicaid populations has long outpaced the supply of such providers. To help understand the workforce dynamics, this study sought to develop a novel approach to measuring dentists’ relative contribution to the dental safety net and, using this new measurement, identify demographic and practice characteristics predictive of dentists’ willingness to participate in Indiana's Medicaid program. Methods We examined Medicaid claims data for 1,023 Indiana dentists. We fit generalized ordered logistic regression models to measure dentists’ level of clinical engagement with Medicaid. Using a partial proportional odds specification model, we estimated proportional adjusted odds ratios for covariates and separate estimates for each contrast of nonproportional covariates. Results Though 75% of Medicaid‐enrolled dentists were active providers, only 27% of them had 800 or more claims during fiscal year 2015. As has been shown in previous studies, our findings from the proportional odds model reinforced certain demographic and practice characteristics to be predictive of dentists’ participation in state Medicaid programs. Conclusions In addition to confirming predictive factors for Medicaid enrollment, this study validated the clinical engagement measure as a reliable method to assess the level of Medicaid participation. Prior studies have been limited by self‐reported data and variations in Medicaid claims reporting

Recruitment, Retention, and Evaluation Associated with American Recovery and Reinvestment Act of 2009

Healthcare workforce shortages are central to healthcare reform discussions and are critical areas of interest for Indiana State Department of Health (ISDH). The National Health Service Corps (NHSC) is a financial incentive program that provides scholarship or loan repayment to primary healthcare providers in return for periods of obligation serving federally designated underserved communities. The American Recovery and Reinvestment Act of 2009 (ARRA) increased funding to the NHSC program with the intent of strengthening and expanding the NHSC program capacity. In addition to building workforce capacity, funding was made available to State Primary Care Offices (PCOs) for the coordination and implementation of activities to support NHSC participants, enhance recruitment and retention post-obligation, and evaluation of the impact of ARRA funding for the NHSC program. Indiana Area Health Education Centers (AHEC) Network entered into a contract with ISDH for the purpose of supporting current ARRA-funded NHSC scholars, clinicians, and obligation sites to improve retention and provider satisfaction. In addition, a team of researchers at the Center for Health Policy (CHP) in the Richard M. Fairbanks School of Public Health, Indiana University Purdue University Indianapolis (IUPUI) were subcontracted to perform an evaluation of activities outlined in the AHEC contract and evaluate the impact of ARRA funding on NHSC clinician retention, primary healthcare access, and primary care capacity. The NHSC project team, comprised of key personnel from AHEC and CHP, developed and administered surveys, conducted key informant interviews facilitated focus groups to gather data representing perspectives and experiences from ARRA-funded NHSC clinicians and obligation sites administrators to identify key issues and generate recommendations for the Indiana NHSC Program. The NHSC project team was comprised of key personnel from AHEC and CHP. The team developed and administered surveys, conducted key informant interviews, and facilitated focus groups. The activities were carried out to gather data on perspectives and experiences of ARRA-funded NHSC clinicians and site administrators in order to generate recommendations for the Indiana NHSC Program