Baseline Practice-Level Oral Health Characteristics of Medical Practices Participating in the Colorado Medical-Dental Integration Project
To investigate the baseline oral health characteristics of leadership and healthcare professionals working in medical practices participating in the CO-MDI Project.
Caries is the most common chronic disease of childhood, and it is largely preventable. Access to preventive dental services is limited for low-income, publicly-insured children. The Colorado Medical-Dental Integration Project (CO-MDI) integrated registered dental hygienists (RDH) into pediatric and family medicine medical practices with large percentages of low-income children. Integrated RDHs provide basic preventive dental services including caries risk assessment, fluoride varnish application, scaling and root-planing, sealants, and restorative care referral services, all focused on young, low-income children.
Using a mixed-methods approach, we conducted baseline qualitative, semi-structured key informant interviews (KIIs) with three people in leadership positions at each of the 17 participating practices (n=51) before project implementation. Interview participants were selected as those who made administrative decisions about the CO MDI project and had knowledge of potential changes within their practice systems. The KIIs were structured to assess the leaderships’ attitudes toward the project, factors that facilitated their participation, and their readiness for project implementation. KIIs were recorded, transcribed, and reviewed for recurring themes. We measured the baseline oral health characteristics of the healthcare professionals (MD, NP, PA) working in the participating practices with an online survey. The 20-item survey was developed to assess healthcare professionals’ oral health knowledge, attitudes, beliefs and behaviors and to assess their practice’s readiness to implement the CO MDI Project.
The practice leadership KIIs revealed several factors that facilitated implementation: recognizing the patients’ need for preventive dental services, patients’ interest in the care, and the ability to bill Medicaid/SCHIP for the preventive services provided. Reported barriers included designing effective workflows to integrate the RDH into the existing care team and concerns about the long-term sustainability of the project. At the time of this abstract submission, the online survey was still being administered. Preliminary survey responses (> 63% response rate) indicated that practice healthcare professionals understood the importance of oral health in their patients and that they had a role in addressing their patients’ oral health problems. Factors facilitating their readiness to participate in CO-MDI included their patients’ need for preventive dental services and the convenience of patients receiving medical and dental care in the same place. Barriers included the lack of time to provide oral health preventive services and their practices’ ability to adapt to new interventions.
Practice leaders and healthcare professionals are ready to implement medical-dental integration to expand limited access to preventive dental services to underserved children. Identified barriers must be overcome to facilitate future implementation of medical-dental integration.
- Copyright © 2017 by the American Academy of Pediatrics