Transcript The Case for Change - Safety Net Medical Home Initiative

The Case for Change:
Incorporating Oral Health in
Routine Medical Care
Objectives
• Make the case that oral health is an essential
component of primary care.
• Present a practical framework for how to deliver
preventive oral healthcare as a component of
routine medical care.
• Share resources to implement this in our
practice setting.
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Why Focus on Oral Health?
• Oral health is an essential component of
overall health.
• Oral disease is a transmissible and chronic
infectious disease that affects our patients.
• It’s possible to intervene and change
the trajectory.
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What Is the Problem We Are Trying
to Solve? A Prevention Gap
• Dental caries (cavities) and periodontal disease (gum
disease) are largely preventable.
• Yet nationwide, among all ages, incomes, and life
experiences, we have an unacceptably high burden of these
chronic diseases.
• We’ve seen little improvement in oral health status over the
past 20 years, and pervasive disparities remain: Poor and
near-poor 5-year-olds are more than two times as likely to
have tooth decay than their middle-income peers.
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The Burden of Oral Disease: Children
Decay: Tooth decay is the
most common chronic
disease of childhood.
• Pain and infection can result
in impaired nutrition and
growth.
Ages 2–5
25%
Ages 12–15
50%
• Untreated decay puts children
at risk for dental disease in
adulthood.
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The Burden of Oral Disease: Adults
25% ages 20–64 have
untreated caries.
19% ages 35–44 have destructive
periodontal diseases.
Cumulative result?
25% of adults 65 and older have no teeth.
Oral cancer kills over 8,000 people each year, 2.0x
the number who die of cervical cancer, a major preventive
care focus.
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Oral Disease Impacts Overall Health
“The mouth is a mirror for the body.” U.S. Surgeon General
Oral complications reflect, exacerbate, and
may even initiate other health problems.
• New evidence is demonstrating a relationship
between periodontal disease and:
• Diabetes
• Ischemic vascular disease
• Pre-term delivery and low birth weight
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Poor Oral Health Compromises
More Than Health…
Oral pain can restrict activity, impair nutrition, and disturb
sleep.
• Adults lose 164 million work • Children lose 54 million
hours each year due to oral
school hours each year due
complications and dental care.
to oral complications and
dental care.
• Older adults with missing or no
teeth report lower overall
• Poor oral health = higher
quality of life.
school absence and poorer
academic performance.
• Adults with missing teeth are
more likely to report trouble
• Poor oral health impacts
finding employment.
language and self-esteem.
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Access and Affordability Challenges
• In most communities, dental care is the most common
unmet health need.
• 40% of the population lacks dental insurance, 2.5x
the percentage of those lacking medical insurance.
• Many patients turn to the ER as a last resort; most are sent
home with painkillers and antibiotics, but their problem
hasn’t been solved.
• Late-stage interventions (e.g., extractions) waste valuable
healthcare resources and introduce unnecessary risks
for patients.
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In Our Community
• ADD CONTENT HERE
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How Can We Improve This
Picture?
Expand the oral disease prevention workforce by
engaging primary care teams in the
fight against oral disease.
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Why Us?
We have regular contact
with high-risk groups:
• Children
• Pregnant women
• Adults with diabetes
Total population at
risk for caries and
periodontal disease
Population
receiving regular
medical care
Population receiving
regular dental care
We are well equipped for the work:
• We routinely assess risk, screen for disease,
offer preventive interventions, and refer patients to
specialists when treatment is needed.
• We can apply these core competencies to oral disease.
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This Is a Natural Extension of What We
Already Do…
• Provide information about healthy diet, measure BMI.
• Advise on sunscreen, look for suspicious moles.
• Oral disease is a common problem with serious health
impacts.
• Patient and family behavior (self-care) is key.
• Most problems can be recognized early and treated
to reduce impact.
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What Can We Do and How?
• Incorporate preventive oral healthcare in
routine medical care for all patients.
• Organize dental referrals as we do for
medical-surgical referrals.
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Oral Health Delivery Framework
Five actions primary care teams can take to protect and promote their
patients’ oral health. Within the scope of practice for primary care, possible
to implement in diverse practice settings.
Preventive interventions: Fluoride therapy, dietary counseling to protect teeth and
gums, oral hygiene training, therapy for substance use,
medication changes to address dry mouth.
Citation: Hummel J, Phillips KE, Holt B, Hayes C. Oral Health: An Essential Component of Primary Care.
Seattle, WA: Qualis Health; June 2015
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Our Plan
• Decide on a population of patients to
target: adults with diabetes, pediatrics,
pregnant women, other?
• Clinical assessment
• Workflow analysis: current and future state
• Planning for structured referrals
• EHR modifications and report creation
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Additional Resources
• Oral Health
Implementation
Guide
• Sections 1 and 2:
Introduction and
the Case for
Change
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Oral Health: An Essential Component
of Primary Care
• White paper, published June 2015
• A call to action:
 Case for change
 Oral Health Delivery Framework
 Supporting actions from stakeholders
 Case examples from early leaders: Confluence Health, The
Child and Adolescent Clinic, Marshfield Clinic
Available at: http://www.safetynetmedicalhome.org/changeconcepts/organized-evidence-based-care/oral-health
Hummel J, Phillips KE, Holt B, Hayes C. Oral Health: An Essential Component of Primary Care. Seattle, WA: Qualis Health; June 2015
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About the Oral Health Integration in Primary Care Project
The Organized, Evidence-Based Care Supplement: Oral Health Integration joins the Safety Net Medical Home Initiative Implementation
Guide Series.
The goal of the Oral Health Integration in Primary Care Project was to prepare primary care teams to address oral health and to
improve referrals to dentistry through the development and testing of a framework and toolset. The project was administered by
Qualis Health and built upon the learnings from 19 field-testing sites in Washington, Oregon, Kansas, Missouri, and Massachusetts,
who received implementation support from their primary care association. Organized, Evidence-Based Care Supplement: Oral Health
Integration built upon the Oral Health Delivery Framework published in Oral Health: An Essential Component of Primary Care, and was
informed by the field-testing sites’ work, experiences, and feedback. Field-testing sites in Kansas, Massachusetts, and Oregon also
received technical assistance from their state’s primary care association.
The Oral Health Integration in Primary Care Project was sponsored by the National Interprofessional Initiative on Oral Health, a
consortium of funders and health professionals who share a vision that dental disease can be eradicated, and funded by the
DentaQuest Foundation, the REACH Healthcare Foundation, and the Washington Dental Service Foundation.
For more information about the project sponsors and funders, refer to:
• National Interprofessional Initiative on Oral Health: www.niioh.org.
• DentaQuest Foundation: www.dentaquestfoundation.org.
• REACH Healthcare Foundation: www.reachhealth.org.
• Washington Dental Service Foundation: www.deltadentalwa.com/foundation.
The guide has been added to a series published by the Safety Net Medical Home Initiative, which was sponsored by The Commonwealth Fund,
supported by local and regional foundations, and administered by Qualis Health in partnership with the MacColl Center for Health Care Innovation.
For more information about the Safety Net Medical Home Initiative, refer to www.safetynetmedicalhome.org.
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