Oral Health Integration Implementation Guide

1 Implementation SAFETY NET MEDICAL HOME INITIATIVEOral Health IntegrationIMPLEMENTATION Guide SUPPLEMENTORGANIZED, EVIDENCE-BASED CARE:October 2016 TABLE OF CONTENTSSECTION 1: Introduction to oral Health IntegrationIntroduction ..3 Benefits of Integrated oral Healthcare for Patients ..4 Highlighted Impact Data and Field-Testing Lessons ..5 The Change Concepts for Practice Transformation ..5 Health Information Technology: oral Health Integration in the Age of Health Information Technology ..7 SECTION 2: The Case for Change: Delivering Preventive oral Health Services in the Primary Care SettingIntroduction ..8 The Burden of oral Disease ..8 Incorporating oral Health in Routine Medical Care.

2 9 Primary Care s Role in Protecting and Promoting oral Health ..10 What Integrated Care Could Look Like: A Fictional Case Example ..11 Health Information Technology: Using Data to Make oral Health Integration an Organizational Strategic Priority ..13 SECTION 3: The oral Health Delivery FrameworkIntroduction ..15 oral Health Delivery Framework Development ..16 Responsibilities of Primary Care and Dental Care Teams ..17 oral Health Interventions in Primary Care ..19 Health Information Technology:Document the Role of Health Information Technology ..25 SECTION 4: How to Prepare for Successful ImplementationIntroduction ..30 Planning a Successful oral Health Integration Program.

3 30 Case Vignette: Selecting a Pilot Team at One Community Health ..34 Build the Will to Change ..35 Strategies for Engaging Patients and Families in oral Health Integration ..36 Case Vignette: HealthCore Clinic Lesson Learned: The Importance of Communication ..37 Case Vignette: Rinehart Clinic Community Partnerships ..38 The oral Health Pilot ..39 Overcoming Workflow Optimization Challenges ..48 Patient Reactions to Field-Testing ..52 Health Information TechnologyAssess and Build Capacity ..532 Implementation GUIDEORAL Health : AN ESSENTIAL COMPONENT OF PRIMARY CARE TABLE OF CONTENTS SECTION 5: Staffing Options and WorkflowIntroduction ..56 Staffing ..56 Staffing model one: clinician/clinical assistant dyad.

4 57 Staffing model two: advanced primary care teams ..59 Staffing model three: population Health personnel ..60 Workflow Structure ..61 Case Vignette: Integrating a Co-located Dental Hygienist at Community Health Centers of Benton and Linn Counties ..62 Health Information TechnologyUse of Health Information Technology Within the Optimized Workflow ..68 SECTION 6: Structuring Referrals to DentistryIntroduction ..70 Goals of a Structured Referral to Dentistry ..71 Key Features of a Dental Referral ..73 Strategies for Building a Referral Network ..74 Case Vignette: Referral Workflow Development at Brockton Neighborhood Health Center ..76 Case Vignette: Referral Challenges and Work-arounds for Heartland Community Health Center.

5 77 Health Information TechnologySupport for Structured Referrals ..81 SECTION 7: Using Data for Quality ImprovementIntroduction ..84 What is the oral Health Integration Goal? ..84 How To Determine If a Change Is an Improvement ..86 Using Run Charts To Tell a Story Over Time ..88 Case Vignette: Heart of Kansas Clinic Refines the Data Reporting Process ..89 Putting It Into Practice ..89 Case Vignette: Harborview Medical Center Women s Clinic s Chart Audit Work-around ..92 SECTION 8: Leveraging Success: Spreading and SustainingIntroduction ..93 Strategies for Sustainability: Clinical, Operational, and Financial Factors ..94 Spreading Improvements ..98 Case Vignette: Using Data to Support Spread at Sound Family Medicine.

6 99 Case Vignette: The Spread Process at Rodgers Health ..10 0 Conclusion ..10 0 SECTION 9: Field-Testing Results and Case ExamplesIntroduction ..101 Overall Intervention Distribution ..101 Framework Component Run Charts ..102 Field-Testing Results ..107 Appendix A: Annotated oral Health Integration Toolset ..109 References ..1113 Implementation GUIDEORAL Health : AN ESSENTIAL COMPONENT OF PRIMARY CARE SECTION 1 Introduction oral Health is an essential component of comprehensive primary care . The delivery of preventive oral healthcare is consistent with the principles of whole-person care and should be standard practice within a patient-centered medical home (PCMH) or advanced primary care practice.

7 The Integration of oral Health into primary care is not intended to displace dental care, but rather to expand the workforce addressing preventive oral Health and improve patient Health outcomes . In the last 20 years, three major publications have brought the importance of oral Health to policymakers attention: oral Health in America: A Report of the Surgeon General, released in 2000; Advancing oral Health in America, released in 2011 by the Institute of Medicine; and Integration of oral Health and Primary Care Practice, released in 2014 by the Health Resources and Services Administration (HRSA) . This Implementation Guide builds upon, and is aligned with, this prior work.

8 It offers guidance, resources, and tools to help primary care practices integrate oral Health into the primary care setting and achieve the vision of addressing oral Health as part of whole-person care . The Guide follows oral Health : An Essential Component of Primary Care (2015), which presented the oral Health Delivery Framework (further described in this Guide ) and called for actions to support Implementation . For more information on the development of the oral Health Delivery Framework, refer to page 16 . Recommendations made in this Guide are based on the experiences of 19 primary care practices that tested the oral Health Delivery Framework for 4 20 months and on input from a panel of experts in primary care and dentistry.

9 More information on field-testing sites is included on page 16; specific examples of their successes and challenges are profiled in case vignettes throughout this Guide , and shared through in-depth case examples available in Section 9: Field-Testing Results and Case Examples . oral Health is integral to overall Health . oral Health in America: A Report of the Surgeon GeneralALSO AVAILABLEOral Health : An Essential Component of Primary Care white paper4 Implementation GUIDEORAL Health : AN ESSENTIAL COMPONENT OF PRIMARY CARE Benefits of Integrated oral Healthcare for PatientsAll patients can benefit from integrated care . The story below illustrates how a primary care intervention for a common oral Health condition might have prevented unnecessary complications, pain, and suffering.

10 Ms. D s storyMs . D is a 48-year-old female, diagnosed with diabetes seven years ago, who weighs 254 pounds . She lives with her husband and two children and has medical and dental insurance . She works as a clerk at her local grocery store . Her problem list includes obesity, diabetes, and smoking .Since her diabetes diagnosis, she has regularly seen her primary care clinician but has struggled to keep her HbA1c level below 8 . She has a sweet tooth, and with a full-time job and two teenagers, she doesn t have much time for cooking meals at home . Ms . D has occasionally mentioned pain in her gums while eating over the last several years, but her clinician has focused instead on her blood pressure and glycemic control, being somewhat unsure about how to address Ms.