When Two Becomes One: An Effective Model for Medical Dental Integration for Ohio
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When Two Becomes One: An Effective Model for Medical Dental Integration for Ohio by Mark Doherty
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When Two Becomes One: An Effective Model for Medical Dental Integration for Ohio
- 1. When Two Becomes One: Mark Doherty October 24, 2011 An Effective Model for Medical-Dental Integration
- 2. What do you think of when you hear: Medical-Dental Integration
- 3. ???? ? ? ? ?
- 4. Communication Coordination Sharing of Information Co-located or Separate? Medical Home-Dental Home-Patient Centered Home? Treatment at the Point of Contact Collaborative Care Reverse Co-location Referrals
- 8. Predicted, dentally related, cumulative costs according to age at the first preventive visit. Savage M F et al. Pediatrics 2004;114:e418-e423 ©2004 by American Academy of Pediatrics
- 18. Spectrum of Integration/Collaboration of OH & PC Care Model Business Model Implementation Issues Examples Evidence Base Outcomes MODELS OF MEDICAL/DENTAL COLLABORATION / INTEGRATION Separate locations Co-Located Min Collaboration More Collaboration Min Collaboration Part Integrated Dental more Integrated into PC
- 19. Continuum Separate locations Outside referrals only CHC Pvt Little to no communication Good communication
- 20. Continuum Co-Located No formal collaboration
- 21. Continuum Co-Located Formal collaboration Refer Discuss Warm handoffs Communicate Coordinate Formal relationship With a policy
- 22. Continuum Co-Located Partial Integration Screening Guidance CRA Fl Varnish Referral Non-dental providers providing OH services Dental suite in Primary care
- 25. Cavity Risk Assessment (CRA)
- 26. Smiles for Life
- 30. Partnering to Strengthen and Preserve the Oral Health Safety Net 2400 Computer Drive, Westborough, MA 01581 Tel: 508-329-2280 Fax: 508-329-2285 www.dentaquestinstitute.org A PROGRAM OF THE
Editor's Notes
- Coordinated care service delivery models connecting oral health primary care and medical primary care lead to promising approaches of collaboration and integration .Comprehensive health care system supports dental collaborations/integration that treats the patient at the point of care where the patient is most comfortable and applies a patient-centered approach to treatment. Integrated care models include Fl Varish from the medical side and blood pressure testing from the dental side.Others would be Oh screening, anticipatory guidance, Caries Risk Assessment……..HIV testing, Blood glucose level testing.
- Predicted, dentally related, cumulative costs according to age at the first preventive visit.
- IOM report_____more use of Non-Dental Providers
- Distinctions are: 1] Separate locations where the CHC refers to an outside provider. Model can then have a range of communication from minimum to a lot. It can be minimally coordinated or actually more highly coordinated through case management. The amount of communication and or coordination determines if it is considered minimally or more collaborative.2] The next model is co-located where PC and OH range from having distinct department locations in the same building with minimum communication/coordination through a high degree of communication/coordination .There may even be a partial integration where some dental services are provided by non dental health providers. Last, 3]is the more fully integrated system where there is a high degree of communication and coordination, warm handoffs and direct consults and maybe even a even a dental suite in primary care for real time direct referrals from the medical visit right into the dental chair.
- Co-Location—important first step to finer integration Offers best chance of creating partially or more fully integrated model. Evidence is that children from emergence of first tooth to 5 years in the safety net practice receive most health care (and families comfortable) receiving oral health guidance from PCPs. Opportunity is to have partially integrated PCP: 1) screening and referral based on caries risk assessment; 2) anticipatory guidance; and 3) consideration of fluoride varnish. Seek blended system with very young children. Start with fully integrated system in health care where children with low risk are getting primary oral health at well-child visits while high-risk kids are getting primary oral health care in both settings
- Reverse co-location: oral health having a process that identifies patients with health problems and has protocols and/or designated access for referrals to medical. Another way that primary care and oral health can develop a strong collaborative relationship.
- There isn’t in our systems right now a fully integrated model because training for specialized oral health services remains separate; however, an example of the most fully integrated program is all co-located, partially integrated systems intact with a dental suite housed in the primary care location
- This is an example of the CRA that we created at the DH CHC for PC providers to use at the well child visits . This was created in Centricity which was our EMR.
- The PC providers at many CHCs use the Smiles for Life curriculum to upgrade their OH knowledge and confidence
- We suggest starting a collaborative or integrated system with children. The model is well known and it has many positives including a financial potential that can help subsidize care on other groups of patients who do not have the same benefits that many kids in CHCs have.