O2084: Improving Early Access to Preventative Oral Health Care Through Integration of Dental Hygienists into Primary Care Medical Teams

Purpose/Objectives: Dental caries remains the most common chronic childhood disease despite it being largely preventable. Early access to oral health care can help prevent caries, but many young children dependent on Medicaid do not have a dental home. The Wisconsin Medical Dental Integration (WI-MDI) project aims to create systems change to improve access to oral health services and reduce dental disease disparities in early childhood and pregnancy through integration of dental hygienists into primary care medical teams.

Design/Methods: The MDI project executive team has collaboratively led the facilitation, coaching and implementation of the MDI model in Wisconsin. Early in the project the Advisory Council was formed and is composed of representatives from healthcare organizations, professional medical and dental associations, as well as individual oral health stakeholders from across the state. During the initial year of the project in 2019, the executive team in collaboration with the Advisory Council developed a project charter, change package, and a measurement strategy to support organizational capacities for MDI implementation (Figure 1). Initial implementation occurred through a learning collaborative model approach to accelerate learning and best practice implementation among various health care teams across the state. In response to the COVID-19 pandemic, the implementation method pivoted from an in-person learning collaborative to virtual 1:1 learning and coaching with quality improvement strategies to support health systems and clinics in project adoption and implementation.

Results: Since project initiation in 2019, five federally qualified health centers, one non-profit clinic, and two large health systems have enrolled in the project. Seven centers/systems have implemented the model and one additional clinic recently hired a dental hygienist to begin in an integrated role in summer 2023. Eight dental hygienists are active in their roles across nine clinics. The integrated dental hygienist, equipped with a portable dental supply caddy, moves between exam rooms as part of the well visit workflow, devoting 10 minutes to providing an Oral Health Risk assessment, fluoride varnish, silver diamine fluoride if indicated, anticipatory guidance, and referrals with supporting care coordination directly in the medical exam room (Figure 2). Four clinics began implementation with their pediatric patients and then expanded to their pregnant patients. Since project initiation in 2019 there have been approximately 15,000 visits with integrated dental hygienists.

Conclusion/Discussion: Dental hygienists have successfully been integrated into medical teams across the state thus creating a new early and frequent dental access point. Receiving data from some clinics has been challenging due to inability to pull efficient data reports from some electronic health records (EHR) and staffing capabilities. Next steps are to finalize a standardized EHR report that captures MDI process and outcome measures, obtain feedback from patients/caregivers to inform future adaptations, and support continued growth and spread of the model.