Funded Projects

Problem:

Many Californians face serious obstacles in obtaining dental services. These individuals have complex medical, physical, or social conditions that make it difficult to get to a dentist's office. They are economically disadvantaged or living in underserved areas. It has been estimated that over 30% or more of the population of California, or over 11 million children and adults are not able to get their oral health needs met through the traditional dental care system. As a result, they have significantly worse oral health than those in other segments of the population. While AltaMed has an Oral Health Unit (OHU) serving children and pregnant patients in the community, the OHU does not provide on-site preventive procedures and therapeutic services, such as dental prophylaxis, periodontal scaling, and interim therapeutic restorations (ITR). Instead, AltaMed refers OHU patients to the closest AltaMed dental home. This referral process can lead to gaps in care/service.

Goals and Objectives:

Goal 1: Year 1, complete 300 visits at community locations, providing oral health education and screenings. Objective 1a: Hire key personnel to coordinate and provide oral health services for the program. Objective 1b: Conduct quarterly Advisory board meetings where the Board members will work closely with AltaMed to set project goals and priorities, engage community members, and ensure successful implementation of the Virtual Dental Home. Goal 2: Complete baseline assessment of community need for specific treatments. Objective 2a: Work with our Analytics team to develop a report for minor fillings, interim therapeutic restoration, and sealants. Objective 2b: Track the following treatments in year 1: minor fillings, interim therapeutic restoration, and sealants. Up to 40% of children served may require minor fillings or sealants. Set annual Dental Health Measure targets for Years 2-5. Goal 3: Year 2, complete 400 visits at community locations, providing education, screenings and intervention. Objective 3a: Review community partnership and address the population dental needs, setting a goal for each partnership to increase the visits to 400. Objective 3b: Track the numbers of visits on a monthly basis through our Electronic Health Records systems and reports developed by our analytics team. Goal 4: Year 3, complete 400 visits at community locations, providing education, screenings and intervention. Objective 4a: Track the numbers of visits on a monthly basis through our Electronic Health Records systems and reports developed by our analytics team. Objective 4b: AltaMed assesses patient experiences by conducting a Dental Services Survey through Press Ganey, allowing patients to provide feedback about their experiences with AltaMed's dental service providers. These surveys are conducted for a random sample of patients via email or traditional mail, and aggregated monthly and annually. The surveys assess Patient Appointment Experience, Doctor-Patient Interaction, Dental Team, Facility, and Overall Provider Assessment. Goal 5: Year 4, complete 400 visits at community locations, providing education, screenings and intervention. Objective 5a: Track the numbers of visits on a monthly basis through our Electronic Health Records systems and reports developed by our analytics team. Objective 5b: AltaMed will evaluate the program based on 1. Number of families receiving oral health education and preventive services 2. Number of visits scheduled at community sites 3. Number of visits completed at community sites 4. Number of children needing minor interventions/interim therapeutic restorations 5. Number of children referred to AltaMed Dental clinic for intensive interventions 6. Number of referral appointments completed.

Methodology:

The Oral Health Unit (OHU) will arrive at the community location, with a Dental Hygienist and Coordinator. The OHU will be equipped with a dental chair (suitable for pediatric patients), a portable x-ray kit, intra-oral camera, and required dental supplies to maintain sterility of equipment and safely perform minor procedures. All families served will receive oral health education, preventive screening, and health insurance assessment. The Hygienist will complete the oral exam, including x-rays, and document findings in the electronic medical record. Any minor issues identified during the exam, such as need for sealant or fluoride treatment, may be resolved immediately during the same visit. Any x-rays or film from intra-oral cameras will be transmitted via the electronic health record to a remotely located Dentist for review. The Dentist will review the film and patient record, complete an assessment, and send a report back to the OHU team (via the EMR) within 24 hours. If this patient is found to need additional services or intense intervention, the Coordinator will contact the patient and set an appointment for at an AltaMed Dental clinic, with follow up to ensure the family is able to complete the visit. When appropriate, the parent may be contacted and asked to return to the community location. This may occur if an issue is noted on x-ray that can be treated by the OHU team at the community location, if this is more convenient for the family than going to an AltaMed Dental clinic. In the first year, the OHU will operate two days per week, for 8 hours each day, in a community location (104 days per year), with assessments conducted for possible expansion in subsequent years.

Coordination:

Partnerships have been established with Women, Infant and Children, various head-start programs and are currently working on partnerships with school districts. These partnerships provide space for our dental unit to provide dental services at their sites.

Evaluation:

AltaMed's Dental Quality Goals are set annually. As the target population has lacked previous oral health access, during Year 1, AltaMed will assess the baseline in these areas. The following goals areas will then be set according to the baselines defined in Year 1. 1.Timely Completion of Treatment 2. Time out Documentation 3. Preventive Services for Children at Elevated Risk 4. Sealants for Children Aged 6-9 years old at Elevated Risk 5. Sealants for Children Aged 10-14 years old at elevated Risk 6. Topical Fluoride for Children at Elevated Risk 7/ Medical/Dental Integration.

Experience to Date:

Although the new scope of work was approved at the end of 2017-2018 budget year, AltaMed is now implementing the program at various community locations. With the assistance of our advisory board AltaMed has been able to do the following: 1. Hire the right personnel that is needed for the grant. 2. Obtained the equipment necessary to provide tele-dental visits 3. Developed the infrastructure that allowed our staff to record patient information in our electronic medical record system and be transmitted to the remotely located Dentist. 4. AltaMed strategically identified various partners in the Los Angeles and Orange County area that had our target population and allowed space to provide the dental services.