Article Figures & Data
Figures
- Figure 1.
This map illustrates the geographic location of the five federally qualified health centers included in this study.
Tables
- Table 1.
Core Clinical Domains for the Integration of Oral Health and Primary Care Practice
Core Clinical Domain Definition Risk assessment The identification of factors that affect oral health and overall health Oral health evaluation Integrating subjective and objective findings based on completion of a focused oral health history, risk assessment, and a clinical oral health screening Preventive intervention Recognition of options and strategies to address oral health needs identified by risk assessment and evaluation Communication and education Targets individuals and groups regarding the relationship between oral and systemic health, risk factors for oral health disorders, effect of nutrition on oral health, and preventive measures appropriate to mitigate risk at both the individual and population levels Interprofessional collaborative practice Shares responsibility and collaboration among health care professionals in the care of patients and populations with, or at risk of, oral disorders to ensure optimal health outcomes Bluegrass Community Health Center Holyoke Health Center, Inc. Salina Family Healthcare Center Salud Family Health Centers Yakima Valley Farm Worker's Clinic Location Midwest Northeast Midwest West Pacific Northwest Sites (n) 2 6 1 10 18 Dental Services No Yes Yes Yes Yes Total patients served (n) 6,155 19,038 9,681 69,601 127,950 Patients living at or below 200% of the federal poverty line (%) 98.7 36* 85.7 92.7 93.1 Cost per patient per year ($) 695.04 2034.94† 943.54 810.75 1,026.12 Source: Health center data came from 2014 Health Center Profiles, which are publically available at http://bphc.hrsa.gov/uds/datacenter.aspx? q = d.
↵* The proportion of patients living at or below 200% of the federal poverty line reported in the Uniform Data System (UDS) for Holyoke Health Center, Inc., was 36% and seemed to be an outlier. As such, additional data were collected directly from Holyoke Health Center, which suggested that 96% of patients were living below 200% of the federal poverty line. For the purpose of consistency and to reduce biases between data sources, UDS data re reported in this table.
↵† Holyoke Health Center confirmed the high cost per patient per year was a result of the more comprehensive dental care it provides compared with other federally qualified health centers (FQHCs). Holyoke Health Center reported having on staff 1.5 full-time equivalents of an oral surgeon and providing endodontic and periodontal services not generally provided at other FQHCs.
Bluegrass Community Health Center Holyoke Health Center Salina Family Healthcare Center Salud Family Health Center Yakima Valley Farm Workers Clinic Model Type Physician Champion Physician Collaborator Physician-led Interprofessional Care Team Physician-led Interprofessional Care Team Physician Collaborator Target Population Pediatric and chronic disease patients Pediatric, veterans, HIV patients, etc. Pediatric Pediatric Pediatric Risk Assessment Performed by: registered nurse or certified nurse assistant Entered into HER by nurse, or medical assistant Performed by: dental hygienist through EHR; “Inreach” connects primary care patients to oral health services Performed by: dental hygienist Performed by: EHR and Outreach and Primary Care Team Members Oral Health Evaluation Provided by: family physician Performed by: nurses and medical assistants, family physician confirms or alters Performed by: dental hygienist on a family physician-led care team Performed by: dental hygienist on a family physician-led care team Limited oral screening performed by family physician; Oral health assessment performed (generally same-day) by: dental assistant or dentist at dental clinic Preventive Intervention Fluoride varnish; Performed by: family physician Fluoride varnish; Performed by: nurse or medical assistant, under a standing order of family physician Fluoride varnish; Performed by: dental hygienist Fluoride varnish; Performed by: dental hygienist Fluoride varnish; Performed by: dentist or dental assistant at dental clinic Communication and Education Performed by: all care team members, led by family physician's commitment to oral health education Performed by: nurse or medical assistant, reinforced by family physician Performed by: dental hygienist, reinforced by family physician Performed by: dental hygienist, reinforced by family physician Performed by: WIC staff in WIC clinics, dental staff at dentist visits Interprofessional Collaborative Practice Family physician refers to community dentists for further dental treatment EHR facilitates collaboration between medical/dental Dental hygienists work as interprofessional care team members on a collaborative practice model under physician leadership Open communication between medical and dental for consults and appointments Dental Outreach Coordinator serves as hub to facilitate same-day dental appointments for patients whom the family physician has flagged as needing dental services Strategic Factors Family physician acts as “champion” for oral health integration in primary care Family physician collaborates with care team to ensure patient receives referral to co-located dental clinic through EHR Family physician leads an interprofessional care team to seamlessly integrate oral health into the primary care setting A culture of oral health integration is created, as family physician has open-door policy for impromptu dental consults A dental care coordinator and EHR are leveraged to facilitate interprofessional collaboration among medical and dental Key Informant Tool: Matrix and Questions
Domain Topic Area Question Perspective Target Informant Basic Administrative Information Administrative Please tell me about your organization (organizational type, number of clinical sites, primary geography, average number of patients, etc). Administrative Administrator Model Design and Implementation Education/Training Please describe the education/training program(s) that are used by your organization. Administrative Administrator, Clinical Director, Care Team Members Education/Training Why was this education/training program selected? Administrative Administrator, Clinical Director Education/Training How well do you think the training program prepared you/your team for implementation? Administrative, clinical Administrator, Clinical Director, Care Team Members Education/Training Please describe any strengths or weakenesses in the education/training program. Administrative, clinical Administrator, Clinical Director, Care Team Members Resource Requirements From the administrative perspective, please describe the resources (human and non-human) required to implement your current program. Administrative Admininstrator, Clinical Director Resource Requirements Where these resources already available with your organization or where they acquired specifically for the purpose of integrating the model? Administrative Admininstrator, Clinical Director Financial mechanism What mechanism(s) are used to finance the integration of oral health services into priamry care delivery at your organization? Administrative Admininstrator, Clinical Director Target population What population does your model focus on reaching? Administrative and clinical Admininstrator, Clinical Director Target population Why was this population selected? Administrative and clinical Admininstrator, Clinical Director Clinical services Please describe the specific oral health services that are delivered as a part of the model. Administrative, clinical, community Admininstrator, Clinical Director, Care Team Members, Patients/Families Care Team Members Which care team members are directly involved in the delivery of oral health services and what are their specific roles? Administrative and clinical Admininstrator, Clinical Director, Care Team Members Patient Selection What protocols/strategies are used to identify patients? Administrative and clinical Admininstrator, Clinical Director, Care Team Members Clinical operations Please describe the process(es) for delivery of oral health services in the primary care setting. Administrative, clinical, community Admininstrator, Clinical Director, Care Team Members, Patients/Families Evaluation Measures of Success What measures are you using (or plan to use) to evaluate the success with your model? Administrative and clinical Admininstrator, Clinical Director, Care Team Members Methods of Evaluation What tools (clinical data, patient surveys, etc.) are you using to gather information to evaluate your program? Administrative and clinical Admininstrator, Clinical Director, Care Team Members Interaction Please describe your interaction (who was the patient, what services were provided, and by whom) with the oral health integration program. Community Patient/Family Impact How did this program impact your families ability to access to dental services? Community Patient/Family Satisfaction How pleased are you with the oral health services you received? Community Patient/Family Strategic Factors Internal facilitators Please describe the people, processes, or other resources within your organization or the health center which supported integration. Administrative, clinical, community Admininstrator, Clinical Director, Care Team Members, Patients/Families External facilitators Please describe the people, processes, or other resources outside of your organization or the health center which supported integration. Administrative and clinical Admininstrator, Clinical Director, Care Team Members Internal barriers Please describe the people, processes, or other resources within your organization or the health center which were a barrier to integration. Administrative and clinical Admininstrator, Clinical Director, Care Team Members External barriers Please describe the people, processes, or other resources outside of your organization or the health center which were a barrier to integration. Administrative and clinical Admininstrator, Clinical Director, Care Team Members Addressing barriers Please describe how these barriers where overcome or addressed. Administrative and clinical Admininstrator, Clinical Director, Care Team Members Sustainability and Expansion Please describe the plans, if any exist, for long term sustainability of the model within your organization. Administrative and clinical Admininstrator, Clinical Director, Care Team Members Sustainability Factors What factors, if any, will be required for or influence longterm sustainability of the model within your organization? Administrative and clinical Admininstrator, Clinical Director, Care Team Members
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