Colocation Does Not Equal Integration: Identifying and Measuring Best Practices in Primary Care Integration of Children's Oral Health Services in Health Centers

Nadereh Pourat; Ana E Martinez; Leigh Ann Haley; James J Crall

doi:10.1016/j.jebdp.2020.101469

Colocation Does Not Equal Integration: Identifying and Measuring Best Practices in Primary Care Integration of Children's Oral Health Services in Health Centers

J Evid Based Dent Pract. 2020 Dec;20(4):101469. doi: 10.1016/j.jebdp.2020.101469. Epub 2020 Jul 14.

Authors

Nadereh Pourat¹, Ana E Martinez², Leigh Ann Haley², James J Crall³

Affiliations

¹ UCLA Center for Health Policy Research, University of California, Los Angeles, Los Angeles, CA, USA; UCLA School of Dentistry, University of California, Los Angeles, Los Angeles, CA, USA. Electronic address: pourat@ucla.edu.
² UCLA Center for Health Policy Research, University of California, Los Angeles, Los Angeles, CA, USA.
³ UCLA School of Dentistry, University of California, Los Angeles, Los Angeles, CA, USA.

PMID: 33303098
DOI: 10.1016/j.jebdp.2020.101469

Abstract

Objective: Improving oral health of low-income and uninsured young children remains challenging because of reluctance of general dentists to care for very young children or participate in Medicaid, limited involvement of primary care providers in children's oral health, and lack of parental awareness of the importance of early oral health care. These barriers can be addressed in health centers (HCs) that are the premier sources of primary care for low-income and uninsured populations and a significant Medicaid provider. Many HCs provide dental services on-site, but literature indicates that medical and dental services often remain siloed with limited interaction among providers in addressing the oral health needs of young patients including risk assessment, education, and caries prevention. Accordingly, we developed a conceptual framework and measuring tool for medical dental integration and sought to examine utility of this tool in a purposive sample of HCs.

Method: We developed a conceptual framework for integrated oral health delivery and designed a survey to measure this integration. We surveyed 12 HCs in Los Angeles County participating in a project to improve oral health-care capacity for young children after 2 years of implementation. We included measures of risk assessment, preventive interventions, communication and collaborative practice, and buy-in organized in structure and process domains. Two individuals independently scored the responses, and a third reviewed and finalized. We standardized final scores to range from 0 to 100.

Results: Overall integration scores ranged from 31% to 73% (mean = 64%). Process scores were higher than structure scores for nearly all HCs. Processes contributing to higher scores included referrals with warm hand-offs, leadership support for medical-dental integration, and involvement in dental quality improvement projects. Structure factors contributing to higher scores included the presence of medical oral health champions, linked electronic health records, and referral protocols.

Conclusion: We found that high levels of integration could be achieved despite structure and process limitations and sustainable integration depends on leadership and provider commitment and embedding of best practices in daily operations. Further research can illustrate the reliability of our tool and the impact of integration on access.

Keywords: Children; Co-location; Integrated care; Oral health services; Safety-net; Underserved population.

MeSH terms

Child
Child, Preschool
Health Services
Health Services Accessibility
Humans
Medicaid*
Oral Health
Primary Health Care*
Reproducibility of Results
United States