Title: Integrated Community-Based Dental Care: Interim Results of a Randomized Trial
Joana Cunha-Cruz (Presenter)
University of Washington
Douglas Conrad, University of Washington
Colleen Huebner, University of Washington
Sharity Ludwig, Advantage Dental Services, LLC
Jeanne Dysert, Advantage Dental Services, LLC
Melissa Mitchell, Advantage Dental Services, LLC
Mike Shirtcliff, Advantage Dental Services, LLC
Gary Allen, Advantage Dental Services, LLC
Charles Spiekerman, University of Washington
Peter Milgrom, University of Washington
Objectives: Dental caries and care are associated with marked socioeconomic, racial and rural disparities. Although children and adolescents with public insurance are entitled to dental care and oral health has improved for all demographic groups, disparities have not decreased in the last decade. To address these issues, an integrated community-based dental care system with a clinical care guideline protocol and pay for performance of healthcare workers was implemented in rural Oregon. Our objective is to describe dental care utilization during the first two years of implementation of the program.
Methods: The dental care delivery system and payment changes (PREDICT) was implemented as a quality improvement project within a large Dental Care Organization (DCO) and was tested in a cluster randomized controlled trial. The target populations were 41,000 Medicaid-eligible children (< 21 years old) in 7 rural counties in Oregon State, USA. Data were collected from staff and community surveys, administrative and dental health records.
Results: Baseline assessments indicated patient satisfaction with care and staff readiness to implement changes were high, but access to care could be improved. During the two-year implementation, access to dental care increased and utilization of services following the guidelines increased. Overall utilization, preventive services provided based on patient risk, and secondary prevention services provided at community and clinic settings will be reported.
Conclusions: The interim analysis of the 2-year project will reveal if the delivery and payment changes were able to improve access and quality of care to low income children and adolescents. Implementation challenges and lessons learned from the implementation of the project in communities at different stages of collaboration between the dental care, school and other community organizations will be highlighted.