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Research ArticleCritical Issues in Dental Hygiene

Embedding Dental Hygienists into Medical Care Teams: Implementation and evaluation of a medical-dental integration approach in Colorado

Patricia A. Braun, Catia Chavez, Cherith Flowerday, Anna Furniss and Miriam Dickinson
American Dental Hygienists' Association June 2023, 97 (3) 21-27;
Patricia A. Braun
Denver Health and Hospitals, Denver, CO, USA
Adult and Child Center for Health Outcomes, Research and Delivery Science, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
MD, MPH
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  • For correspondence: [email protected]
Catia Chavez
Adult and Child Center for Health Outcomes, Research and Delivery Science, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
MPH
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Cherith Flowerday
Denver Health and Hospitals, Denver, CO, USA
BS
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Anna Furniss
Adult and Child Center for Health Outcomes, Research and Delivery Science, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
MS
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Miriam Dickinson
Adult and Child Center for Health Outcomes, Research and Delivery Science, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
PhD
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Abstract

This case report describes the implementation approach and evaluation of a medical-dental integration (MDI) project in Colorado that embedded dental hygienists (DHs) into 10 medical practice settings. Through the MDI Learning Collaborative, DHs were integrated into primary care medical care practices to provide full-scope dental hygiene care to patients. Dental hygienists were trained to collect quality-improvement metrics on all encounters, including untreated tooth decay, and referred patients with restorative needs to partnering dentists. Cross-sectional, aggregated clinic-level oral health metrics were submitted monthly from 2019-2022. Descriptive statistics were used to describe the population receiving MDI care and interviews were conducted with MDI staff to describe their perspectives on this approach to comprehensive care. A logistic regression model, adjusted for time and practice, compared untreated dental caries in established vs new MDI patient-visits. From 2019-2021, integrated DHs completed 13,458 visits to low-income patients, Medicaid (70%, n=9,421), uninsured (24%, n=3,230), SCHIP (3%, n=404), private (3%, n=404), of various ages: 0-5 (29%, n=3,838), 6-18 (17%, n=2,266), 18-64 (51%, n=6,825), >65 (4%, n=529). A total of 912 visits were provided to pregnant patients. Services included caries risk assessment (n=9,329), fluoride varnish (n=6,722), dental sealants (n=1,391), silver diamine fluoride (n=382), x-rays (n=5,465) and scaling/root-planing (n=2,882). Improvement was found in untreated decay of established vs. new patient-visits in four of the practices. Dental hygienists integrated into medical teams provided full-scope dental hygiene care to patients and expanded access to dental services. Medical-dental integration (MDI) care was variably associated with reduction in untreated decay. Integrating dental hygienists into primary care medical practices has potential to improve oral health-related outcomes, however access to restorative dental care remains a challenge.

Keywords
  • medical dental integration
  • dental hygienists
  • dental hygiene care
  • access to care
  • vulnerable populations
  • Received April 26, 2023.
  • Accepted May 19, 2023.
  • Copyright © 2023 The American Dental Hygienists’ Association
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American Dental Hygienists' Association: 97 (3)
American Dental Hygienists' Association
Vol. 97, Issue 3
June 2023
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Embedding Dental Hygienists into Medical Care Teams: Implementation and evaluation of a medical-dental integration approach in Colorado
Patricia A. Braun, Catia Chavez, Cherith Flowerday, Anna Furniss, Miriam Dickinson
American Dental Hygienists' Association Jun 2023, 97 (3) 21-27;

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Embedding Dental Hygienists into Medical Care Teams: Implementation and evaluation of a medical-dental integration approach in Colorado
Patricia A. Braun, Catia Chavez, Cherith Flowerday, Anna Furniss, Miriam Dickinson
American Dental Hygienists' Association Jun 2023, 97 (3) 21-27;
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  • Article
    • Abstract
    • INTRODUCTION
    • MEDICAL DENTAL INTEGRATION APPROACH
    • IMPLEMENTATION PHASE I
    • IMPLEMENTATION PHASE II
    • MAINTENANCE PHASE
    • EVALUATION PHASE
    • RESULTS
    • CONCLUSION
    • ACKNOWLEDGEMENTS
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Keywords

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  • access to care
  • vulnerable populations

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