Cavity Free at Three: Colorado s innovative model integrating oral health in prenatal care.

Transcription

1 Cavity Free at Three: Colorado s innovative model integrating oral health in prenatal care. NNOHA Conference, November 8th, 2016

2 Cavity Free at Three Goals Mission Eliminate early childhood caries in Colorado s children What We Do Cavity Free at Three teaches medical and dental providers how to deliver preventive oral health services for young children and pregnant women.

3 Treatment Guidelines The American Dental Association (ADA), the American Academy of Periodontology (AAP), the American Congress of Obstetricians and Gynecologists (ACOG) and other professional organizations recommend dental care during pregnancy

4 Prenatal Oral Health Research Association between periodontal disease and preterm birth, gestational diabetes, and low birth weight (Corbella et al., 2016; Guimaraes et al., 2012; Ha et al., 2014; Xiong et al., 2009.) Goal to decrease or delay the transmission of cavity-causing bacteria to babies by taking care of the mother (Weintraub et al, 2010; Douglass et al, 2008; Berkowitz, 2006). Pregnancy not a contraindication for dental treatment. Routine dental care, radiographs, restorations safe at anytime during pregnancy (Hartnett et al., 2016; National Consensus Statement, 2011; Rainchuso et al., 2013; Kurien et al., 2013)

5 Long-term AIM By September 2019, increase by 15% over the state baseline the percent of women who have received oral health care, defined by prophylaxis, during pregnancy.

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7 Prenatal Cavity Free at Three Model Medical Providers Educate the patient on the link between oral health and health of their baby Reassure safety to patients and dental professionals Conduct oral health screening (less than 1 minute!) Refer to a dentist and encourage dental home

8 Prenatal Cavity Free at Three Model Dental Providers See women at anytime during pregnancy Standard of care with a few pharmacological considerations (i.e. pregnancy is not a reason to alter treatment plan) Educate the client on oral health practices

9 Pre-Post Training Data Oral Health Services for Pregnant women increased from reported 24.8 % to reported 29.9% after Cavity Free at Three training

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12 Metro Community Provider Network (MCPN) Serving Denver Metro since Health Centers (and growing) In ,000 medical patients 7,900 dental patients 51% Medicaid, 39% uninsured

13 MCPN Timeline Integrating Oral Health in Prenatal Care

14 Evolution of Integration Models Medical Dental Integration Medical Dental Total Integration The mouth is connected to the body? Co-location

15 Co-Location FQHC with medical and dental services in the same building Part of the same organization, but not integrated Unified EHR system - medical and dental can communicate Options to refer/prioritize high need patients

16 Medical/Dental Integration (MDI) Models Model 1 Dental hygienist works within medical clinic (in peds pod and OB pod) Participates in morning huddles and is able to identify patients that need to be seen Screening, fluoride varnish (if necessary), caries risk assessment are done Schedule patient into dental clinic Model 2 Dental hygienist has entire hygiene operatory within medical clinic Able to screen and provide preventive services in medical clinic before referring to dental clinic Set up like a direct access dental hygiene clinic

17 Who is trained? All dental hygienists Cavity Free at Three Beginning to implement with all new dentists Medical providers/staff in clinics with MDI What resources are used? Cavity Free at Three brochures MCH brochures Cavity Free at Three goal setting sheets MDI Toolkit - developed for MCPN staff

18 Dental Codes used in Dental Clinic D1XXX D1110 Dental Codes used in Medical clinic DSCRN* D0190 D4XXX D4910 D4341/D4342 *Screening/Dummy code not currently trackable

19 Data Year Total # Pregnant Patients Total # Receiving Dental Services Percentage (%) % % %

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21 Practical Implementation Tips The nuances of working as a dental provider in a medical clinic Sensitivity of appointments Teamwork and flow with medical team Patient barriers - time availability and stress of OB appointments Communication and referral systems Billing/front desk systems Insurance codes per encounter or per day? Ways to identify uninsured patients so that billing for these encounters gets funneled to grant funding

22 Limitations No baseline data pre-2012 for comparison. Data pulled by claims data, dummy codes not trackable Some pregnant patients receiving care elsewhere Financial sustainability

23 Sustainability

24 Sustainability Buy-In from medical and dental providers Local trainings, focus groups, newsletters, etc. Protocols and scalability Billing procedures Grants Data Data drives organizations Utilize data to leverage grant opportunities and show success of programs Analyze data to improve current programs

25 Contact Information Colorado Department of Public Health and Environment Oral Health Unit cavityfreeatthree.org To send an , click on the Contact Us tab

26 Questions? Alyssa Aberle RDH, BSDH, MBA Metro Community Provider Network

27 Cavity Free at Three Funders Thanks to our funders for their support: Caring for Colorado Foundation; The Colorado Health Foundation; The Colorado Trust; Delta Dental of Colorado Foundation; Kaiser Permanente; Rose Community Foundation, Health Resources and Services Administration (HRSA) A special thanks to Metro Community Provider Network This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS), Grant Number: H47MC Information/content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government