Diseases of the oral cavity are some of the most prevalent health conditions in the United States. Fifty-nine percent of children aged 5-17 and 85% of adults over 18 have caries experience in at least one tooth. Sixty-one percent of adults 25 years and older and 86% of adults 45 and older have at least one site of periodontal disease in the mouth.1
Disparities exist in both the prevalence and severity of oral diseases within the US population. For example, Mexican American and African-American adults and children have more untreated decay than Whites and African-American and Mexican American adults are more likely to have gingivitis or more severe periodontal disease bone loss than Whites. 1 Concurrently, more than 1 in 3 Americans does not have dental insurance coverage and Hispanics have a lower rate of dental insurance coverage than African-Americans and Whites.2
Despite the fact that such a large percentage of the population suffers from dental caries and periodontal disease, these conditions are preventable and manageable. Caries and periodontal disease are now understood to be chronic diseases caused by specific transmissible bacteria, in which onset, severity and duration are modulated by multiple factors.
The traditional paradigm of surgical treatment of caries and periodontal disease has historically utilized the majority of oral heath expenditures. This end-stage approach can be viewed as a failure of disease prevention, and while surgical intervention is needed to remove existing disease, it should be complemented by identification of high-risk individuals at the earliest possible stages, in order to deliver appropriate interventions that could prevent, delay or arrest disease progression.
The mouth and oral cavity are an integral and interrelated part of the human body and research has shown associations between chronic periodontal disease and several systemic conditions such as diabetes, low birth weight outcomes and cardiovascular disease.1
Health center populations are composed of patients with the highest levels of oral disease, but who are least able to access care. HRSA data show that while health centers treat 14 million medical users, there is only capacity for 2.1 million dental users. This unmet need combined with the chronic nature of oral disease and desired focus on prevention and control of risk factors, makes oral health a suitable area for developing collaborative interventions based on the Planned Care model.
In 2005 HRSA initiated the Oral Health Disparities Collaborative (OHDC) pilot to study whether the Planned Care model was applicable to management of oral disease within a group of four community health centers. The aim of the collaborative was to develop comprehensive primary oral health care system change interventions, based upon the Planned Care model and evidence-based concepts, that generated major improvements in process and outcome measures for:
- Early Childhood Caries prevention and treatment
- Perinatal oral health
Additionally, emphasis was placed on practice redesign and office efficiencies that supported improvements in the targeted areas.
Core Perinatal Measures
- % Pregnant women with comprehensive dental exam completed while pregnant
- % Pregnant women with completed Phase I dental treatment plan within 6 months of exam
- % Pregnant women with Self Management Goal set while pregnant
Core Early Childhood Caries Measures
- % Children with dental evaluation by age 12 months
- % Children 12-60 months with dental evaluation completed in last 12 months
- % Children 12-60 months with completed Phase I dental treatment plan within 12 months of exam
- % Children 12-60 months with documented Self Management Goal
The pilot ended its first year of work with significant progress in applying and translating collaborative methodology to oral health. Measures, Steps to Success (change package) and a manual were developed.
Through the work of the OHDC pilot, it became clear that successful application of the Planned Care model to oral health in the pilot health centers required transformation of every aspect of the health center organization. The work became an opportunity to integrate oral health with the medical, administrative and financial systems of the individual health centers. Traditional paradigms of how and when dental care is delivered were replaced with new organizational designs that increased access and quality of care. Teams experienced increased success as medical-dental integration increased, and were also able to make a business case for collaborative participation.
To assist health center leaders with implementing an Oral Health Collaborative, the faculty and participating teams of the OHDC Pilot have developed the Oral Health Disparities Collaborative Implementation Manual. The Manual includes the OHDC detailed measures and Steps to Success (change package). The on-line version of the Manual also contains direct links to specific resources and tools listed in the Steps to Success section. These resources and tools can also be accessed directly through the HRSA Knowledge Gateway Library.
Click here to access the complete Oral Health Disparities Collaborative Implementation Manual. Again, links to specific resources are located in the Steps to Success section of the Manual. Click here to go directly to the Oral Health section of the Library. Click here for the OHDC Measures and the OHDC Steps to Success (change package)
Key Contact Information:
Jay Anderson DMD, MHSA, HRSA
janderson@hrsa.gov
Tracy Jacobs RN, BSN, IHI
tjacobs@ihi.org
References
1. U. S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000.
2. Behavioral Risk Factor Surveillance Survey 2001
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