Denver Health and Hospitals, Denver, CO, USA
Adult and Child Center for Health Outcomes, Research and Delivery Science, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA.
J Dent Hyg. 2023 Jun;97(3):21-27.
This case report describes the implementation approach and evaluation of a medical-dental integration (MDI) project in Colorado that embedded dental hygienists (DHs) into 10 medical practice settings. Through the MDI Learning Collaborative, DHs were integrated into primary care medical care practices to provide full-scope dental hygiene care to patients. Dental hygienists were trained to collect quality-improvement metrics on all encounters, including untreated tooth decay, and referred patients with restorative needs to partnering dentists. Cross-sectional, aggregated clinic-level oral health metrics were submitted monthly from 2019-2022. Descriptive statistics were used to describe the population receiving MDI care and interviews were conducted with MDI staff to describe their perspectives on this approach to comprehensive care. A logistic regression model, adjusted for time and practice, compared untreated dental caries in established vs new MDI patient-visits. From 2019-2021, integrated DHs completed 13,458 visits to low-income patients, Medicaid (70%, n=9,421), uninsured (24%, n=3,230), SCHIP (3%, n=404), private (3%, n=404), of various ages: 0-5 (29%, n=3,838), 6-18 (17%, n=2,266), 18-64 (51%, n=6,825), >65 (4%, n=529). A total of 912 visits were provided to pregnant patients. Services included caries risk assessment (n=9,329), fluoride varnish (n=6,722), dental sealants (n=1,391), silver diamine fluoride (n=382), x-rays (n=5,465) and scaling/root-planing (n=2,882). Improvement was found in untreated decay of established vs. new patient-visits in four of the practices. Dental hygienists integrated into medical teams provided full-scope dental hygiene care to patients and expanded access to dental services. Medical-dental integration (MDI) care was variably associated with reduction in untreated decay. Integrating dental hygienists into primary care medical practices has potential to improve oral health-related outcomes, however access to restorative dental care remains a challenge.
本病例报告描述了科罗拉多州一项医疗-牙科整合 (MDI) 项目的实施方法和评估结果，该项目将牙科保健员 (DH) 嵌入到 10 个医疗实践环境中。通过 MDI 学习合作，DH 被整合到初级保健医疗实践中，为患者提供全面的牙科保健服务。DH 接受了培训，以收集所有就诊的质量改进指标，包括未经治疗的龋齿，并将有修复需求的患者转介给合作牙医。2019 年至 2022 年期间，每月从诊所层面提交横截面聚合口腔健康指标。使用描述性统计数据描述接受 MDI 护理的人群，并对 MDI 工作人员进行访谈，以了解他们对这种综合护理方法的看法。对经过时间和实践调整的未治疗龋齿进行逻辑回归模型比较，比较了既定 MDI 患者就诊和新 MDI 患者就诊的未治疗龋齿情况。2019 年至 2021 年期间，整合后的 DH 为低收入患者完成了 13458 次就诊，其中 Medicaid（70%，n=9421）、无保险（24%，n=3230）、SCHIP（3%，n=404）、私人保险（3%，n=404），年龄从 0-5 岁（29%，n=3838）、6-18 岁（17%，n=2266）、18-64 岁（51%，n=6825）、65 岁以上（4%，n=529）。共有 912 次就诊为孕妇提供服务。服务包括龋齿风险评估（n=9329）、氟化物涂料（n=6722）、牙面封闭（n=1391）、银胺氟化氢（n=382）、X 光（n=5465）和洁治/根面平整（n=2882）。在四个实践中，发现既定患者就诊与新患者就诊相比，未经治疗的龋齿情况有所改善。整合到医疗团队中的牙科保健员为患者提供了全面的牙科保健服务，并扩大了获得牙科服务的机会。医疗-牙科整合（MDI）护理与未经治疗的龋齿减少之间存在关联，但获得修复性牙科护理仍然是一个挑战。将牙科保健员整合到初级保健医疗实践中有可能改善与口腔健康相关的结果，但获得修复性牙科护理仍然是一个挑战。
