Clinical Practice

  • Nurse taking blood pressure

    Clinical Models that Integrate Medical and Dental Care

Piloting new models of care to develop best practices for clinics of the future.

 

NURSE PRACTITIONER-DENTIST MODEL (NPD)
Innovative model where a Nurse Practioner works in the dental clinic.

A full-time nurse practitioner works in the Harvard Dental Center’s Teaching Practices and serves as a consultant and care navigator for older adult patients with hypertension and/or diabetes. Patients are screened for either condition and, if unmet needs are identified, are referred to an NP who can provide a Medicare Wellness Visit, point-of-care testing, and a referral to a medical home.

In addition, nurse practitioner students from Northeastern rotate through the dental clinic to develop skills in oral health screening  and diagnosis. Since February 2016 dozens of NP students have rotated through the dental clinic and have enhanced their oral health skills. This effort is being piloted through an agreement with HRSA, HSDM, and the Northeastern School of Nursing,

News about the program:

A Guide for Implementing Collaborative Care in U.S. Dental Schools - PDF Download
Harvard, Northeastern project bring dental, primary care together
Fluoride and a physical: Patients see docs at the dentist

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EQUITABLE CARE FOR THE ELDERLY (ECE)
Training programs, developed at HSDM, that support health centers around the nation in addressing gaps in care among seniors.

The ECE project aims to improve health care access and outcomes for vulnerable senior populations by developing training resources for heath care providers who serve the elderly, particularly in underserved areas. Examples include webinars that teach strategies for delivering care to patients with dementia, disabilities, depression or a chronic health condition.

The need is enormous—in 2010 there were 40.3 million people aged 65 and above (13% of overall population). By 2050 the percentage is projected to grow to 20.9. At the same time, the number of physicians with advanced geriatrics training is declining and many are opting out of Medicare.

The ECE project is funded by a $1.5M grant from the National Cooperative Assistance Agreement (NCA) that was awarded to HSDM’s Christine Riedy and an interdisciplinary team from Beth Israel Deaconess Medical Center, Simmons College of Social Work, SUNY Nursing, HMS Primary Care and Harvard TH Chan School.

 

COLLABORATORS IN PRACTICE
Partnerships with health systems and communities to better integrate oral health with primary care services.

Two of our partners, CareMore—an eight state Medicare advantage plan, and Commonwealth Care Alliance (CCA)—a Massachusetts based care and benefits provider, focus on providing care to Medicare and Medicaid populations that traditionally have had challenges accessing oral health care services.

We are working with both organizatins to develop best practices for the integration of dental services for medically complex patients. Together we are learning how to most effectively deliver oral health care to these vulnerable populations and we are studying the associated health and cost outcomes.