College of Nursing and Health Sciences, University of Massachusetts Dartmouth, Dartmouth, MA, USA.
Harvard School of Dental Medicine, Boston, MA, USA.
J Public Health Dent. 2020 Sep;80 Suppl 2:S44-S49. doi: 10.1111/jphd.12419.
The United States health system is challenged to improve patient and population health, enhance patients' experience of care, and reduce health care costs. Value-based health care (VBHC) models are proposed to address these issues. Medical health systems are making strides toward VBHC, whereas dental care systems lag behind. The aims of this paper are to a) present study findings of an interprofessional practice model integrating oral health and primary care in a dental practice setting, and b) discuss practice and research implications for advancing VBHC approaches in oral health.
A nonexperimental research method was employed to evaluate the Nurse Practitioner-Dentist Model for Primary Care (NPD Model) at the Harvard Dental Center. Pretest/post-test design was used to assess clinical patient outcomes for a convenience cohort of Medicare beneficiaries (n = 31) with a reported diagnosis of hypertension and/or type 2 diabetes. Clinical outcome measures included: blood pressure, weight, body mass index (BMI), and Hemoglobin A1c.
Positive and significant improvements in biometrics (blood pressure, body weight, BMI, HbA1c) were found.
The NPD Model is an early prototype for interprofessional VBHC in oral health and holds promise for improving patient and population health outcomes. Integration of interprofessional VBHC in oral health is an imperative for achieving the Triple Aim to improve the overall health of our nation.
美国的医疗体系面临着改善患者和人群健康、提升患者的护理体验和降低医疗成本的挑战。基于价值的医疗保健（VBHC）模式被提出以解决这些问题。医疗保健系统正在朝着 VBHC 迈进，而牙科保健系统则落后了。本文的目的是：a）展示在牙科环境中整合口腔健康和初级保健的跨专业实践模式的研究结果，b）讨论在口腔健康中推进 VBHC 方法的实践和研究意义。
采用非实验性研究方法评估哈佛牙科中心的护士-牙医初级保健模式（NPD 模式）。采用预测试/后测试设计，对报告患有高血压和/或 2 型糖尿病的 Medicare 受益人的便利队列（n = 31）进行临床患者结局评估。临床结局测量包括：血压、体重、体重指数（BMI）和糖化血红蛋白（HbA1c）。
发现生物标志物（血压、体重、BMI、HbA1c）有积极显著的改善。
NPD 模式是口腔健康中跨专业 VBHC 的早期原型，有望改善患者和人群的健康结果。在口腔健康中整合跨专业 VBHC 是实现改善全民健康的三重目标的必要条件。
