WHAT ARE YOUR ORGANIZATIONAL
QUALITY GOALS?
Questions in your health history….
No-shows, scheduling, emergencies…..
 HRSA HAS ADOPTED THE FOLLOWING DEFINITION OF
COMPREHENSIVE PRIMARY ORAL HEALTH CARE THAT HAS
APPEARED IN POLICY AND PROGRAM GUIDANCE SINCE
1997:
 COMPREHENSIVE PRIMARY ORAL HEALTH SERVICES IS DEFINED AS
PERSONAL ORAL HEALTH CARE, DELIVERED IN THE CONTEXT OF FAMILY,
CULTURE, AND COMMUNITY, THAT INCLUDES ALL BUT THE MOST
SPECIALIZED ORAL HEALTH NEEDS OF THE INDIVIDUALS BEING SERVED.
 THE RANGE OF SERVICES SHOULD INCLUDE PREVENTIVE CARE AND
EDUCATION, OUTREACH, EMERGENCY SERVICES, BASIC RESTORATIVE
SERVICES, AND PERIODONTAL SERVICES.
 ADDITIONAL SERVICES MAY INCLUDE BASIC REHABILITATIVE SERVICES
THAT REPLACE MISSING TEETH TO ENABLE THE INDIVIDUAL TO EAT,
BENEFIT FROM ENHANCED SELF-ESTEEM, AND HAVE INCREASED
EMPLOYMENT ACCEPTABILITY.
Patients need to take
some responsibility for
their own care!
Education!
Education!
Education!!!!!!!!!!!!!!!!!!
SURGERY
 Surgery
(from the Greek: χειρουργική cheirourgikē (composed of χείρ,
"hand", and ἔργον, "work"), via Latin: chirurgiae, meaning "hand work") is
an ancient medical specialty that uses operative manual and
instrumental techniques on a patient to investigate and/or treat a
pathological condition such as disease or injury, or to help improve bodily
function or appearance.
 Surgery
 As
is a technology consisting of a physical intervention on tissues.
a general rule, a procedure is considered surgical when it involves
cutting of a patient's tissues or closure of a previously sustained wound.
Other procedures may be considered surgery if they involve "common"
surgical procedure or settings, such as use of a sterile environment,
anesthesia, antiseptic conditions, typical surgical instruments, and suturing
or stapling.
WE ALL WANT TO:
1.
Improve Access - Every infant and child is
worthy of the opportunity to benefit from
contemporary knowledge and measures that
will improve his or her oral health, overall
health, and health trajectory.
2.
Improve oral health outcomes - Oral health is
the window to the entire body.
HAVE YOU TAKEN ON ANY PROJECTS
TO INTEGRATE MEDICAL AND
DENTAL?
IF
NOT, WHY?
Opportunities
NC Oral Health Collaborative
6/17/2014
1
Medical-Dental Integration
MEDICAL-DENTAL INTEGRATION
All
CHC Medical patients should be dental patients
Probable not possible!
High priority populations:
Children
Pregnant women
HIV/RW
Diabetics
Cardiovascular disease
ALL OF OUR CLINICS SEE CHILDREN!
Why?
How
In
do we attract more?
the age of corporate dental clinics?
Thoughts?
DAP (DENTAL ACCESS PROGRAM)










2006-2007
2007-2008
2008-2009
2009-2010
2010-2011
2011-2012
2012-2013
2013-2014
2014-2015
2016
9 SCHOOLS
9 SCHOOLS
20 SCHOOLS
11 SCHOOLS
17 SCHOOLS
23 SCHOOLS
34 SCHOOLS
36 SCHOOLS
36 SCHOOLS
36 schools
329 STUDENTS
353 STUDENTS
900 STUDENTS
953 STUDENTS
1532 STUDENTS
1612 STUDENTS
2,136 STUDENTS
1,911 STUDENTS
1,952 STUDENTS
approx. 2,800 students
IREDELL COUNTY WAS ADDED IN SCHOOL YEAR 2010-2011
 Melissa Boughman RDH, Dental Access Coordinator

2012 CHOP (CHILD HEALTH OUTREACH
PROGRAM)
 Goals:
 1.
Educate caregiver and children about oral
health, caries transmission, pediatric dental
specialty care and especially the one year
dental visit.
 2.
Relieve burden of accessing care by
directly scheduling dental appointments at
the location of their choice for children and
caregiver while at their pediatric medical visit.
 Integrate
oral health into the medical visit.
CHOP (CHILD HEALTH OUTREACH PROGRAM)
 Components:
 1.
Full time bilingual staff member
 2.
Office space in the pediatric medical clinic
 3.
Laptop computer
 4.
Wireless internet (VPN), EDR capable
 5.
Salary, benefits, and equipment funded by
dental clinic
CHOP (CHILD HEALTH OUTREACH PROGRAM)
 Success!!!!!!!!!!!!!!!!!!!!
 The
income brought into our dental clinics due to the
program far exceeds the salary and benefits of the
liaison (115-125 new patient appointments monthly)
 Most
are new patients or those who have not seen a
dentist in more than six months
 No
parent has declined having the liaison provide oral
health education during the child’s medical visit
 The
show rate of liaison scheduled patients for the first
quarter of 2015 is 88% which closely approximates our
dental clinic show rate
CHOP (CHILD HEALTH OUTREACH PROGRAM)
• Program began in August 2012
• 914 appointments made
• 114 per month
• 512 appointments kept
• 64 new patients per month
• Now over 1400 new patients appointments
kept annually with 85%+ show rate
• PowerPoint 10 slides/bOHP [email protected]
BABY ORAL HEALTH PROGRAM
(BOHP)
Cindy
Cruz
http://www.babyoralhealthprogram.org/
http://www.prenataloralhealth.org/vide
o/mothers1-english.mp4
All dentists see pregnant patients!

But most general dentists, as a rule, only treat as
emergency cases.
 Why
don’t many general dentists treat pregnant
patients?
 Fear
(recent ADA Journal article)
 Lack
of medical consultation

Phase I Dentistry (extractions, fillings, etc.)

Many have Medicaid
 Regular
Medicaid vs. Pregnancy Medicaid
DIABETES

Collaborative between GFHS Dental Clinic and Gaston Diabetes Center

Both entities are part of Gaston Family Health Services (GFHS)

Appointments for Adult patients are often difficult to obtain at the
Dental Clinic but there is a great need for persons with diabetes to have
dental care.

When patients complete their diabetes self management education,
then a referral is made directly to the Dental Clinic by the Gaston
Diabetes Center. If patients with diabetes, without diabetes education
or high A1c, are seen by the Dental Clinic, then they are referred to the
Gaston Diabetes Center. Both entities see patients from GFHS as well as
physicians in the local area. We now require and record a starting A1c.

Most patients are eager to have the appointment for either dental care
or diabetes education.
CLOSING THE LOOP!
Referral
Dental
from Medical
remediation of situation
Acknowledgment
back to Medical
of treatment
DATA?
HOW VITAL IS IT?
ACCURATE, MEANINGFUL, TIMELY….
1/5 Health Center patients should be dental patients……
How many children are there in your program?
THE AFFORDABLE CARE ACT
Where will we be?
In 2012 35% utilization age 25-45
versus 2002 45% utilization same age
group

Why?
Where
will you be in 2016 and
beyond?
How
do we get there?
BY THE NUMBERS (2002/2012/2025)
 Year/US
population
25-45
% Seeking care
#
DDS
 287,000,000
99,800,000
45%
44,910,000
173K
 314,000,000
81,146,000
35%
28,000,000
190K
 335,000,000
<by %
<by %
201K
PATIENTS
CONNECTIONS
 William
Donigan DDS, MPH
 Dental Director
 Gaston Family Health Services (704) 862-5376
 [email protected]