Thursday, October 17, 2024
10/17/2024
Early access to preventive oral health care (POHC) can improve maternal and child health (MCH) oral health outcomes, however, populations with low socioeconomic status, and those from racial/ethnic minority groups often encounter social and structural barriers to care. In Wisconsin (WI), less than half of children enrolled in Medicaid receive preventive dental services. Pregnant women of color and pregnant women on public insurance experience dental disparities and are less likely to receive a dental cleaning during pregnancy. In an effort to reduce the disease burden for young children and prenatal populations, Children’s Health Alliance of WI and the Medical College of WI launched the WI Medical Dental Integration (WI-MDI) project in 2019 to create statewide system change to increase early access to preventive dental care through integration of a dental hygienist into primary care teams. To date, 14 clinics have integrated 18 hygienists across 11 health systems reaching over 17,000 children and pregnant women. While progress has been made, advancement in a multi-pronged integrated POHC approach is needed that considers unique health system and community needs as well assesses and addresses barriers that impede advancement toward MCH oral health equity. A significant opportunity exists to address oral health needs and invest in prevention locally through an integrated POHC model in primary care and through enhancement of the dental knowledge and skillset of medical providers. The integrated POHC approach also necessitates support at the state level, including policy implementation, addressing education requirements, and surveillance. Building on prior efforts and learnings, with this Maternal Child Health - Improving Oral Health Integration (MCH-IOHI) project, through the collaborative leadership of the MCH-IOHI Alliance, with input from individuals with lived experience, the MCH-IOHI National Consortium and primary care partners, MCH-IOHI Key Personnel will implement a two-tier, state and local, improvement approach that addresses: Policy & Practice: State policy and infrastructure will be assessed to inform implementation of four state level improvement strategies. At the local level, Key Personnel will assist sites in addressing oral health inequities by implementing an evidence-based integrated POHC model. Efforts will initially focus on children ages 1-21 years, followed by an expansion to reach pregnant women and other MCH populations such as Children and Youth with Special Health Care Needs. The primary integrated POHC model to be implemented is a dental hygienist added to the primary care team to provide assessment, fluoride, anticipatory guidance, silver diamine fluoride, if applicable, and care coordination during existing medical appointments. Outreach & Education: To improve oral health literacy, a state gap analysis will be conducted, and a corresponding health literacy plan will be executed. To improve POHC knowledge and skill among non-dental primary care providers, a gap analysis will be conducted and associated oral health trainings will be developed and implemented. Data, Analysis & Evaluation: State surveillance data will be assessed and enhanced to support improved access, better define and monitor MCH population disparities and identify factors influencing MCH oral health outcomes. A measurable plan to efficiently collect clinic data across primary care sites to assess population impact and areas needing further improvement will be established. Expanding access to integrated POHC is a crucial approach to improving access and disease prevention for MCH populations. Practice model change, provider skill development, outreach and education, supporting policies and ongoing data collection and surveillance are necessary to reach the intended project outcome of long term sustainability to reduce the burden of dental disease in MCH populations in WI.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).
