P2.K202: Improving Patient Health Outcomes through Medical Dental Integration in Ohio

Background: Dental caries (decay) is one of the most prevalent yet preventable chronic diseases in children. It is associated with many factors that contribute to a child’s health and development such as experiencing acute and chronic pain, challenges with eating, difficulty sleeping, and compromised speech development. Therefore, it is important for pediatricians to provide oral health services such as oral risk assessments, fluoride varnish applications, and referrals to a dental home during routine well-child visits. Also, compared to dentists, most children see a pediatrician multiple times before their first birthday.

Project Description: MORE CareTM is a program that leverages medical-dental integration (MDI) to close patient care gaps between siloed healthcare professions. Ohio is piloting this program with buy in from over 40 stakeholders across the state. The pilot consists of 7 health system affiliated or private pediatric medical and dental practices that engaged in a virtual 9-month active learning community and are undergoing 16-months of performance monitoring until Dec 2024. Throughout the program, participants submit monthly data on metrics such as patient demographics, number of preventive oral services provided (oral health risk assessments, fluoride varnish applications, patient self-management goals), and number of dental referrals to their MORE Care dental partner. Qualitative interviews were also conducted to help understand the program's impact.

Discussion: This pilot helped participants become familiar with MDI and implement it in their own practices. As of January 2024, MORE Care medical practices increased their oral health interventions services by 4% over baseline (1%). During this evidence building stage, program data were leveraged to build reports and other resources to keep stakeholders, including local legislators and decision makers, apprised of program progress.
During interviews, the pediatricians and dentists spoke passionately about how all people deserve to not be in pain and should have affordable and accessible care. CareQuest Institute staff also spoke about the invaluable collaboration they experienced with the community partners and program participants.
Although challenges around implementing new services, creating referral systems, and sharing data arose during the program, solutions were also identified. These include incentivizing medical and dental providers who work together to care for mutual patients, establishing oral health related expectations in medical settings, and refining data collection software and systems to seamlessly collect and share data.

Conclusion: When providing oral health services during routine well-child visits, pediatricians improve patient health outcomes by increasing patient awareness and access to care. Participants from all practice types showed improvement with their knowledge and skills to provide oral health risk assessments, self-management goals, fluoride varnish application, and dental referrals. Although data collection is ongoing, preliminary data show a sustained level of improvement for oral health services provided in a medical setting and buy in for enhancing medical dental integration in Ohio.