Publications

2017
Dolce M, Parker J, Marshall C, Riedy C, Simon L, Barrow J, Ramos C, DaSilva J. Expanding Collaborative Boundaries in Nursing Education and Practice: The Nurse Practitioner-Dentist Model for Primary Care. Journal of Professional Nursing [Internet]. 2017;November-December (33(6) :405-409. Publisher's VersionAbstract

Highlights

  • The Affordable Care Act necessitates collaboration between nursing and dentistry.
  • Nurse practitioner education should include leadership and teamwork training.
  • The NPD Program holds promise for improving oral and systemic health for patients and populations.

Abstract

The purpose of this paper is to describe the design and implementation of a novel interprofessional collaborative practice education program for nurse practitioner and dental students, the Nurse Practitioner-Dentist Model for Primary Care (NPD Program). The NPD Program expands collaborative boundaries in advanced practice nursing by integrating primary care within an academic dental practice. The dental practice is located in a large, urban city in the Northeast United States and provides comprehensive dental services to vulnerable and underserved patients across the age spectrum. The NPD Program is a hybrid curriculum comprised of online learning, interprofessional collaborative practice-based leadership and teamwork training, and clinical rotations focused on the oral-systemic health connection. Practice-based learning promotes the development of leadership and team-based competencies. Nurse practitioners emerge with the requisite interprofessional collaborative practice competencies to improve oral and systemic health outcomes.

Borrell LN. Oral Health Inequities: An AJPH Supplement to Help Close the Gap. American Journal of Public Health [Internet]. 2017;107 (S1) :S5-S6. Publisher's Version
Simon L, Eve E, Dolce M, Allareddy V, Nalliah R. Physician Assistant Student Perceptions of an Interprofessional, Peer-to-Peer Oral Health Curriculum Led by Dental Students . The Journal of Physician Assistant Education. 2017;28 (4) :210-213.Abstract
PURPOSE Physician assistants (PA) are health care team members who often work in primary care. Providing oral health education to PAs during training could improve oral health for vulnerable patients who seek treatment in the primary care setting and who are less able to access dental care. The purpose of this study was to assess the effectiveness of a peer-to-peer oral health curriculum taught by dental students to their PA student colleagues. METHODS Dental students presented an interactive, case-based curriculum, followed by a hands-on oral examination training session. PA student feedback was obtained, and results were analyzed. RESULTS Students found the content to be highly relevant and well presented. Conveying oral health competencies to future primary care providers may reduce oral health disparities. CONCLUSIONS PA students reported improved understanding of oral health and indicated they would incorporate what they had learned into their future clinical practice.
Nasseh K, Vujicic M. The impact of the affordable care act's Medicaid expansion on dental care use through 2016. Journal of Public Health Dentistry [Internet]. 2017;77 (4) :290–294 . Publisher's VersionAbstract
OBJECTIVE:

To examine the impact of the Affordable Care Act on dental care use among low-income adults ages 21-64.

METHODS:

Our analysis uses national survey data from the 2010-2016 Gallup Wellbeing-Index. We use a differences-in-differences analysis to assess changes since the end of 2013 in dental care use among low-income adults. We compare changes in states that expanded Medicaid and offer adult Medicaid dental benefits versus changes in other states.

RESULTS:

Relative to the pre-reform period and other states, in Medicaid expansion states with adult dental benefits, dental care use increased 3-6 percentage points in 2016.

CONCLUSIONS:

In Medicaid expansion states with adult dental benefits, evidence suggests that low-income adults have greater access to dental care.

nasseh_et_al-2017-journal_of_public_health_dentistry.pdf
Nicolas M.OreskovicMD MPH, German O.GallucciDMD PD, I.ChaseDDS I, E.MillirenMPH C, Tracy K.RichmondMD MPH. Oral health status and longitudinal cardiometabolic risk in a national sample of young adults. The Journal of the American Dental Association [Internet]. 2017;148 (12) :930-935. Publisher's VersionAbstract

Background

Dental and cardiometabolic diseases are highly prevalent, share many common risk factors, and begin during youth. Despite poor dental health being known to influence dietary behaviors that are in turn linked to cardiometabolic health, the role of oral health on concomitant and future cardiometabolic disease is understudied. We sought to determine the association of oral health with cardiometabolic markers during adolescence and early adulthood.

Methods

Our sample included 11,556 participants with data from waves 1 (when participants were aged 12 to 19 years) and 4 (when they were aged 26 to 32 years) of the National Longitudinal Study of Adolescent to Adult Health. Multivariable linear and logistic regression separately examined associations between different markers of oral health (that is, missing teeth, periodontal disease, and deferred dental care) and markers of cardiometabolic health (that is, lipids, blood pressure, and body mass index), adjusting for sociodemographic characteristics.

Results

Mean age was 29 years at follow-up (wave 4). In adjusted analyses, deferred dental care during both adolescence (β = 1.25; 95% confidence interval [CI], 0.6 to 2.0; P = .001) and early adulthood (β = 0.9; 95% CI, 0.4 to 1.3; P < .001) was associated with an increased body mass index during early adulthood. Deferred dental care in early adulthood was also associated with increased systolic (β = 0.9; 95% CI, 0.4 to 1.5; P = .002) and diastolic (β = 1.0; 95% CI, 0.5 to 1.5; P < .001) blood pressure values and an increased likelihood of being hypertensive (odds ratio = 1.2; 95% CI, 1.0 to 1.3; P = .03).

Conclusions

In this nationally representative study deferred dental care during adolescence and concurrently in early adulthood was associated with poorer cardiometabolic disease during early adulthood. Providing better access to dental care may have benefits not only for oral health but also for long-term cardiometabolic health.

Practical Implications

Deferred dental care during adolescence and early adulthood, but not recent tooth loss or periodontal disease, is associated with increased risk of cardiometabolic disease.

1-s2.0-s000281771730867x-main.pdf
Martin SA, Simon L. Oral Health and Medicine Integration: Overcoming Historical Artifact to Relieve Suffering. American Journal of Public Health [Internet]. 2017;107 (S1) :S30-S31. Publisher's Version
Etolue J, Obadan-Udoh E, Simon L, et al. Dental Providers' Perspectives on Diagnosis-Driven Dentistry: Strategies to Enhance Adoption of Dental Diagnostic Terminology. International Journal of Environmental Research and Public Health [Internet]. 2017;14 (7) :767. Publisher's VersionAbstract
The routine use of standardized diagnostic terminologies (DxTMs) in dentistry has long been the subject of academic debate. This paper discusses the strategies suggested by a group of dental stakeholders to enhance the uptake of DxTMs. Through unstructured interviewing at the 'Toward a Diagnosis-Driven Profession' National Conference held on 19 March 2016 in Los Angeles, CA, USA participants were asked how enthusiastic they were about implementing and consistently using DxTMs at their work. They also brainstormed on strategies to improve the widespread use of DxTMs. Their responses are summarized by recursive abstraction and presented in themes. Conference participants were very enthusiastic about using a DxTM in their place of work. Participants enumerated several strategies to make DxTMs more appealing including: the use of mandates, a value proposition for providers, communication and education, and integration with EHRs and existing systems. All groups across the dental healthcare delivery spectrum will need to work together for the success of the widespread and consistent use of DxTMs. Understanding the provider perspective is however the most critical step in achieving this goal, as they are the group who will ultimately be saddled with the critical task of ensuring DxTM use at the point of care.
Martin S, Simon L. Like Pulling Teeth: Expanding the Oral Health Workforce by Training Physicians in Dental Extractions. [Internet]. 2017;28 (3) :881-886. Publisher's VersionAbstract
In the United States, vulnerable populations at highest risk for poor oral health are more likely to visit a physician than a dentist. Patients in acute dental pain often present to hospital emergency departments or primary care offices where only palliative care is available. While numerous measures to improve oral health access in the United States are necessary, the authors propose that physician training incorporate techniques in dental diagnosis and primary dental care, including extraction where indicated, to allow providers to deliver definitive dental measures to patients unable to access the dental health care system. These skills will allow primary care providers to improve oral health, and ultimately strengthen ties to oral health providers that will improve patient care.
Simon L, Sue K, Williams R, et al. Dental Student-Delivered Care at a Student-Faculty Collaborative Clinic in a Correctional Facility. American Journal of Public Health [Internet]. 2017;107 (S1) :S85-S89. Publisher's Version
Simon L, Sengupta N, Nanavati S, Cericola M. Oral Health Integration Into a Pediatric Practice and Coordination of Referrals to a Colocated Dental Home at a Federally Qualified Health Center. American Journal of Public Health [Internet]. 2017;107 (10) :1627-1629. Publisher's VersionAbstract
We have integrated preventive oral health measures into preventive care visits for children at a federally qualified health center in Boston, Massachusetts. The program, started in 2015, covers 3400 children and has increased universal caries risk screening in primary care to 85%, fluoride varnish application rates to 80%, and referrals to a dental home to 35%. We accomplished this by minimizing pressures on providers' workflow, empowering medical assistants to lead the initiative, and utilizing data-driven improvement strategies, alongside colocated coordinated care.
Dolce MC, Parker JL, Marshall C. Expanding Collaborative Boundaries in Nursing Education and Practice: The Nurse Practitioner-Dentist Model for Primary Care. Journal of Professional Nursing [Internet]. 2017;33 (6) :405-409. Publisher's VersionAbstract
The purpose of this paper is to describe the design and implementation of a novel interprofessional collaborative practice education program for nurse practitioner and dental students, the Nurse Practitioner-Dentist Model for Primary Care (NPD Program). The NPD Program expands collaborative boundaries in advanced practice nursing by integrating primary care within an academic dental practice. The dental practice is located in a large, urban city in the Northeast United States and provides comprehensive dental services to vulnerable and underserved patients across the age spectrum. The NPD Program is a hybrid curriculum comprised of online learning, interprofessional collaborative practice-based leadership and teamwork training, and clinical rotations focused on the oral-systemic health connection. Practice-based learning promotes the development of leadership and team-based competencies. Nurse practitioners emerge with the requisite interprofessional collaborative practice competencies to improve oral and systemic health outcomes.
DMD LS, Kimberly Sue MD PD, BS RW, David Beckmann MD MPH, Matthew Tobey MD MPH, Marya Cohen MD MPH. Dental Student–Delivered Care at a Student–Faculty Collaborative Clinic in a Correctional Facility. American Journal of Public Health [Internet]. 2017;107 (51) :S85-S87. Publisher's VersionAbstract
People experiencing incarceration are uniquely vulnerable to poor health, including oral health. We implemented a dental clinic in a city jail in tandem with medical and mental health care. Students deliver dental care with a supervising dentist. Students also provide patient oral health education and train other students to conduct oral screenings. Dental students are exposed to correctional dentistry, and health professions students acquire oral health skills. All students learn about the unique needs of patients experiencing incarceration.
ajph.2017.303793.pdf
Kamyar Nasseh, Ph.D., Marko Vujicic PD, Michael Glick PD. The Relationship between Periodontal Interventions and Healthcare Costs and Utilization. Evidence from an Integrated Dental, Medical, and Pharmacy Commercial Claims Database. Health Economics [Internet]. 2017;26 (4) :519–527. Publisher's VersionAbstract
Periodontal disease has been linked to poor glycemic control among individuals with type 2 diabetes. Using integrated dental, medical, and pharmacy commercial claims from Truven MarketScan® Research Databases, we implement inverse probability weighting and doubly robust methods to estimate a relationship between a periodontal intervention and healthcare costs and utilization. Among individuals newly diagnosed with type 2 diabetes, we find that a periodontal intervention is associated with lower total healthcare costs (−$1799), lower total medical costs excluding pharmacy costs (−$1577), and lower total type 2 diabetes-related healthcare costs (−$408). © 2016 The Authors. Health Economics Published by John Wiley & Sons Ltd.
Sommers, Benjamin D. MD PD. Why Health Insurance Matters-and Why Research Evidence Should Too. Academic Medicine [Internet]. 2017. Publisher's VersionAbstract
In the current debate over the future of the Affordable Care Act (ACA), research evidence on the impact of the law and the effects of health insurance coverage in general is critical. Studies of health insurance expansion over the past decade have demonstrated that coverage expansions can produce significant reductions in mortality-particularly among minorities, those living in poorer areas, and those with chronic conditions potentially treatable with timely medical care. More recent studies of the ACA in particular demonstrate that the law has produced historically large reductions in the uninsured rate, with resulting improvements in access to care, perceived quality of care, and self-reported health. Yet much of the general public and many policy makers remain unaware of this evidence. Researchers and clinicians in academic medicine have a role to play in ensuring that critically important health policy decisions are made using rigorous evidence to best protect the interests of our patients.
why_health_insurance_matters_and_why_research.98224.pdf
2016
Evaluation of Cost Savings Associated with Periodontal Disease Treatment Benefit. Washington, DC: Avalere Health; 2016. avalere_health_estimated_impact_of_medicare_periodontal_coverage.pdf
Carrie H. Colla PD, Courtney Stachowski MPH, Kundu S, Harris B, Gregory Kennedy MS, Marko Vujicic PD. Dental Care Within Accountable Care Organizations: Challenges and Opportunities. ADA Health Policy Institute (HPI) and The Dartmouth Institute - Research Brief; 2016. Publisher's VersionAbstract

Research brief written by the ADA Health Policy Institute in partnership with The Dartmouth Institute for Health Policy & Clinical Practice. March 2016.

Key Messages  

  • Most accountable care organizations (ACOs) are not responsible for dental care as part of their ACO contract. Nine percent of the largest commercial contracts and 25 percent of Medicaid contracts hold providers responsible for the cost and quality of dental services.
  • The top reason ACOs report for excluding dental care is a lack of integrated health information technology. The perceived potential for cost savings associated with dental care is the top motivation among ACOs that include or plan to include dental care.  
  • Despite research suggesting that integration of dental care may benefit patients, financing and delivery of dental care remains disconnected from other health services, even among ACOs working to improve overall population health. Integration of dental care may present an opportunity for improved accountability for total health, yet to date, there is little incentive for ACOs to facilitate access to these services. 
ada_hpi_aco_brief.pdf
M. Beth Miloro DDS, Marko Vujicic PD. Physicians Dissatisfied with Current Referral Process to Dentists. Health Policy Institute, American Dental Association - Research Brief; 2016.Abstract

Research Brief written by the ADA Health Policy Institute (HPI), a thought leader and trusted source for policy knowledge on critical issues affecting the U.S. dental care system.

Key Messages

  • In a tertiary health care setting, physicians reported they were dissatisfied with the referral system to dentists, the coverage of dental care services for patients, and their ability to distinguish a worrisome oral lesion from a variant of normal.
  • More than half of worrisome lesions were referred to physician specialists instead of dentists specifically due to the lack of a referral system.
  • Efforts to improve the referral system to dentists, facilitate the creation of an electronic referral system, and promote dental education for physicians could increase both physician and dentist satisfaction and the quality and efficiency of care for patients.
ada_hpi_referral_brief.pdf
Vivek H. Murthy, MD MBA. Oral Health in America, 2000 to Present: Progress Made, But Challenges Remain. Public Health Reports. 2016;131 (March-April).Abstract
Perspective on progress of oral and medical integration by Vivek H. Murthy, MD, MBA, VADM, U.S. Public Health Service Surgeon General.
surgeon_general_2016.pdf
Lisa Simon DMD. Overcoming Historical Separation between Oral and General Health Care: Interprofessional Collaboration for Promoting Health Equity. AMA Journal of Ethics. 2016;18 (9) :941-949.Abstract
Since the founding of dental schools as institutions distinct from medical schools, dentistry—its practice, service delivery, and insurance coverage, for example—and dental care have been kept separate from medical care in the United States. This separation is most detrimental to undeserved groups at highest risk for poor oral health. As awareness grows of the important links between oral and general health, physicians and dentists are collaborating to develop innovative service delivery and payment models that can reintegrate oral health care into medical care. Interprofessional education of medical and dental students can help produce clinicians who work together to the benefit of their patients.
ama_j_ethics_vol.18_2016.pdf
Anita DuhlGlicken MSW, Renee W. Joskow, DDS MPHFAGDFACD. Before You Say Ahhhh.. Integrating Oral Health and Behavioral Health in Primary Care Settings. 2016.Abstract

Resources, tools, and tips for helping primary care providers engage patients in conversations about their oral health to identify patients with oral health concerns.

Authored and presented by:

Anita DuhlGlicken, MSW
Program Consultant, National Interprofessional Initiative on Oral Health
Associate Dean and Professor Emerita, University of Colorado School of Medicine

Renee W. Joskow, DDS, MPH, FAGD, FACD
Captain U.S. Public Health Service
Senior Dental Advisor, Health Resources and Services Administration

before_you_say_ahhhh.pdf

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