PROJECT SUMMARY/ABSTRACT: Oral health is associated with many common systemic diseases.
Medicare age-eligible patients (i.e., adults age 65+ years) represent a population at high risk for both types
of disease, as well as a high prevalence of unmet social and economic needs (e.g., food insecurity or social
isolation) which may contribute to poor health outcomes. As the population ages and a larger proportion of
patients require dental services and chronic disease prevention and management, a clinically integrated
model that coordinates care across clinical functions (e.g., dental and medical), activities, and sites may
maximize the value of health services for older patients. The dental setting is an ideal location in which to
conduct medical care interventions, such as chronic disease screening, by collaborating with other health
care professionals. The Kaiser Permanente Northwest (KPNW) health plan and Permanente Dental
Associates implemented a novel program that integrated dental and medical care, the Dental-Medical
Integration Program (DMIP), in 2018. The DMIP provides enhanced preventive and disease management
services with the goal of closing critical evidence-based medical care gaps to improve longer term health
outcomes. The DMIP presents an ideal opportunity to evaluate a natural experiment, which will be conducted
using a retrospective cohort design of Medicare patients age =65 who received dental care between
7/1/2018-12/31/2019 and had 1 or more medical care gaps at time of their visit. The proposed specific aims
are: Aim 1. Evaluate the association between dental-medical integration and closure of evidence-
based medical care gaps among Medicare patients aged =65 years; Aim 2. Characterize the
frequency and type of unmet social and economic needs among Medicare patients aged =65 years
seen for dental care in DMIP clinics and assess whether having social or economic needs are
associated with closure of evidence-based medical care gaps. This study will provide valuable
information on the relationship between DMIP and medical care gap closure and improve our understanding
of the extent to which unmet social and economic needs affect this relationship. Study findings may serve as
initial evidence of the benefit of a comprehensive population-based approach to identifying and resolving
medical care gaps in the dental setting. Moreover, results will have policy significance, addressing prior calls
by stakeholder groups including the National Academy of Medicine, Cigna, and Aetna, for further investment
in more robust dental-medical integration programs across the U.S. to expand access to recommended
treatments and promote better overall health. Ultimately, this study will inform the development of
hypotheses and research questions about the effect of DMIP on long-term health outcomes to be tested in a
future R01.
