Mosen David M, Banegas Matthew P, Dickerson John F, Fellows Jeffrey L, Brooks Neon B, Pihlstrom Daniel J, Kershah Hala M, Scott Jason L, Keast Erin M
J Am Dent Assoc. 2021 Apr;152(4):302-308. doi: 10.1016/j.adaj.2020.12.010.
The integration of medical and dental care in the dental setting offers a unique opportunity to close medical care gaps, such as providing immunizations and laboratory-based tests, compared with traditional nonintegrated settings.
We used a matched cohort study design among patients 65 years or older (n = 2,578) with an index dental visit to the Kaiser Permanente Northwest medical-dental integration (MDI) program from June 1, 2018, through December 31, 2019. MDI patients were matched 1:1 to non-MDI controls (n = 2,578) on 14 characteristics. The Kaiser Permanente Northwest MDI program focuses on closing 23 preventive (for example, flu vaccines) and disease management care gaps (for example, glycated hemoglobin testing) within the dental setting. The closure of all care gaps (yes versus no) was the outcome for the analysis. Multivariable logistic regression was used to evaluate the association between exposure to the MDI program and level of office integration (least, moderate, and most integration) with closure of care gaps. All data were obtained through Kaiser Permanente Northwest's electronic health record.
MDI patients had significantly higher odds (odds ratio [OR], 1.46, 95% confidence interval [CI], 1.29 to 1.65) of closing all medical care gaps than non-MDI patients. Greater MDI integration was associated with significantly higher odds of gap closure compared with non-MDI (least integration: OR, 1.18, 95% CI, 1.02 to 1.37; moderate integration: OR, 1.70, 95% CI, 1.36 to 2.12; most integration: OR, 2.08, 95% CI, 1.73 to 2.50).
Patients receiving dental care in an MDI program had higher odds of closing medical care gaps compared with similar patients receiving dental care in a non-MDI program.
MDI is effective at facilitating delivery of preventive and disease management medical services.
与传统的非整合式医疗环境相比，在牙科环境中整合医疗和牙科护理提供了一个弥合医疗护理差距的独特机会，例如提供免疫接种和实验室检测。
我们采用匹配队列研究设计，研究对象为2018年6月1日至2019年12月31日期间首次到凯撒永久医疗集团西北分部医疗-牙科整合（MDI）项目就诊的65岁及以上患者（n = 2578）。MDI患者与非MDI对照（n = 2578）按14个特征进行1:1匹配。凯撒永久医疗集团西北分部的MDI项目致力于在牙科环境中弥合23项预防性（如流感疫苗接种）和疾病管理护理差距（如糖化血红蛋白检测）。分析的结果是所有护理差距的弥合情况（是与否）。采用多变量逻辑回归来评估参与MDI项目与办公室整合程度（最低、中等和最高整合）与护理差距弥合之间的关联。所有数据均通过凯撒永久医疗集团西北分部的电子健康记录获得。
与非MDI患者相比，MDI患者弥合所有医疗护理差距的几率显著更高（优势比[OR]为1.46，95%置信区间[CI]为1.29至1.65）。与非MDI相比，更高程度的MDI整合与护理差距弥合几率显著更高相关（最低整合：OR为1.18，95%CI为1.02至1.37；中等整合：OR为1.70，95%CI为1.36至2.12；最高整合：OR为2.08，95%CI为1.73至2.50）。
与在非MDI项目中接受牙科护理的类似患者相比，在MDI项目中接受牙科护理的患者弥合医疗护理差距的几率更高。
MDI在促进预防性和疾病管理医疗服务的提供方面是有效的。
