Harvard School of Dental Medicine, Boston, Massachusetts (K.C., H.W., J.B., C.A.R.)
Harvard Medical School, Boston, Massachusetts (T.W., L.S.H., R.S.P.).
Ann Fam Med. 2023 Feb;21(Suppl 2):S22-S30. doi: 10.1370/afm.2918.
The Teaming and Integrating for Smiles and Health (TISH) Learning Collaborative was developed to help health care organizations accelerate progress in integrating delivery of oral and primary care. By providing expert support and a structure for testing change, the project aimed to improve the early detection of hypertension in the dental setting and of gingivitis in the primary care setting, and to increase the rate of bidirectional referrals between oral and primary care partners. We report its outcomes.
A total of 17 primary and oral health care teams were recruited to participate in biweekly virtual calls over 3 months. Participants tested changes to their models of care through Plan-Do-Study-Act cycles between calls. Sites tracked the percentages of patients screened and referred, completed the TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) and Interprofessional Assessment questionnaires, and provided qualitative feedback and updates in storyboard presentations.
On average, with implementation of the TISH Learning Collaborative, sites displayed a nonrandom improvement in the percentages of patients screened for hypertension, referred for hypertension, referred to primary care, and referred for gingivitis. Gingivitis screening and referral to oral health care were not markedly improved. Qualitative responses indicated that teams made progress in screening and referral workflows, improved communication between medical and dental partners, and furthered understanding of the connection between primary care and oral care among staff and patients.
The TISH project is evidence that a virtual Learning Collaborative is an accessible and productive avenue to improve interprofessional education, further primary care and oral partnerships, and achieve practical progress in integrated care.
“微笑与健康协作组织”（TISH）学习协作组织旨在帮助医疗保健组织加快整合口腔和初级保健服务的进展。通过提供专业支持和测试变革的结构，该项目旨在提高口腔环境中高血压的早期发现率和初级保健环境中牙龈炎的发现率，并提高口腔和初级保健合作伙伴之间双向转诊的比例。我们报告其结果。
共招募了 17 个初级和口腔卫生保健团队，在 3 个月内每两周进行一次虚拟电话会议。参与者通过电话会议之间的“计划-执行-研究-行动”循环来测试他们的护理模式的改变。各站点跟踪筛查和转诊患者的百分比，完成团队 STEPPS（团队策略和工具以提高绩效和患者安全）和跨专业评估问卷，并通过故事板演示提供定性反馈和更新。
平均而言，随着 TISH 学习协作组织的实施，各站点在筛查高血压患者的百分比、转诊高血压患者的百分比、转诊至初级保健的患者百分比以及转诊至牙龈炎的患者百分比方面均显示出非随机改善。牙龈炎的筛查和转诊至口腔保健并没有明显改善。定性反应表明，各团队在筛查和转诊工作流程方面取得了进展，改善了医疗和牙科合作伙伴之间的沟通，并进一步加深了工作人员和患者对初级保健和口腔保健之间联系的理解。
TISH 项目证明，虚拟学习协作组织是一种可行且富有成效的途径，可以改善跨专业教育，进一步加强初级保健和口腔合作伙伴关系，并在综合护理方面取得实际进展。
