Denver Health and Hospital, Denver, CO, USA.
University of Colorado Anschutz School of Medicine, Department of Family Medicine, Aurora, CO, USA.
JDR Clin Trans Res. 2024 Oct;9(1_suppl):32S-40S. doi: 10.1177/23800844241273771.
The Rocky Mountain Network of Oral Health is 1 of 3 regional projects funded by the Health Resources and Services Administration (2019 to 2024) focusing on caries prevention through medical-dental integration (MDI) in community health centers (CHCs). MDI models included provision of preventive oral health services (POHS) at medical visits by the medical team (model 1), by integrated dental hygienists (DHs; model 2), or a hybrid of these models (model 3). The overarching aim is to evaluate the effectiveness of these models on 3 objectives: (1) ≥50% receive POHS, (2) ≥75% with high caries risk receives dental referral, and (3) ≥30% of parents/caregivers set an oral health goal for the child.
Primary care association practice facilitators (PFs) recruited 22 CHCs to participate from Arizona, Colorado, Montana, and Wyoming. CHCs completed oral health needs assessments prior to participating. PFs coached CHCs using an MDI change package. CHCs submitted monthly and 6-mo, aggregated, deidentified population metrics for children aged 0 to 40 mo receiving well-child care visits. Monthly CHC-specific reports were used by PFs with teams in continuous quality improvement activities. POHS delivery trends over time were assessed using a linear mixed model, adjusting for number of eligible patients during each 6-mo reporting period.
Participating CHCs were urban (55%), rural (36%), and frontier (8%). Twelve (55%) had co-located dental clinics. Ten CHCs implemented model 1, 5 implemented model 2, and 7 implemented model 3. From September 2020 to August 2023, CHCs reported providing 91,604 POHS to eligible children. After adjustment, there was significant improvement over time for all objectives: objective 1: (5, 90) = 4.66, = 0.0008; objective 2: (5, 90) = 2.99, = 0.0151; objective 3: (5, 90) = 4.56, = 0.0009.
The implementation of 3 MDI models across 22 CHCs in 4 states resulted in a meaningful increase in POHS delivery. POHS delivery by both medical and embedded DHs was associated with the most substantial increase in POHS delivery.
The results of this study can be used by medical and dental providers when deciding which approach they wish to use when planning the delivery of preventive oral health services at medical visits.
落基山口腔健康网络是由卫生资源与服务管理局（2019 年至 2024 年）资助的三个区域项目之一，专注于通过医疗-牙科整合（MDI）在社区卫生中心（CHC）预防龋齿。MDI 模型包括由医疗团队在医疗访问时提供预防性口腔健康服务（POHS）（模型 1）、由整合牙科保健师（DHs；模型 2）提供或混合这些模型（模型 3）。总体目标是评估这些模型在以下三个目标上的有效性：（1）≥50%的人接受 POHS，（2）≥75%高龋齿风险的人获得牙科转诊，（3）≥30%的父母/照顾者为孩子设定口腔健康目标。
初级保健协会实践促进者（PFs）从亚利桑那州、科罗拉多州、蒙大拿州和怀俄明州招募了 22 家 CHC 参与。CHC 在参与之前完成了口腔健康需求评估。PFs 使用 MDI 变更包对 CHC 进行辅导。CHC 每月和每 6 个月汇总，为接受幼儿保健访问的 0 至 40 个月儿童提交去识别的人群指标。PFs 使用每月特定于 CHC 的报告，在持续质量改进活动中与团队一起使用。通过线性混合模型评估随时间推移的 POHS 提供趋势，调整每个 6 个月报告期内的合格患者数量。
参与的 CHC 是城市（55%）、农村（36%）和边境（8%）。有 12 家（55%）设有合作牙科诊所。10 家 CHC 实施了模型 1，5 家实施了模型 2，7 家实施了模型 3。从 2020 年 9 月至 2023 年 8 月，CHC 报告为符合条件的儿童提供了 91604 次 POHS。调整后，所有目标均随时间显著改善：目标 1：（5,90）= 4.66，= 0.0008；目标 2：（5,90）= 2.99，= 0.0151；目标 3：（5,90）= 4.56，= 0.0009。
在 4 个州的 22 个 CHC 中实施 3 种 MDI 模型，导致 POHS 提供量显著增加。医疗和嵌入式 DHs 提供的 POHS 与 POHS 提供量的最大增加有关。
当医疗和牙科提供者决定在计划医疗访问时提供预防性口腔健康服务时，可以使用本研究的结果。
