Oral Health Initiative
The Beginning
In response to a sense of overwhelming community need, in 2005 VNA approached
Erie Family Health Center to plan an Oral Health Initiative (OHI) to help
avert an oral health crisis in Chicago. Erie agreed to house and administer
a regional oral health facility, and VNA agreed to build support for the
OHI via collaboration among local foundations. Following the VNA
lead, several Chicago area foundations awarded grants to Erie in support
of the OHI. With this support, oral health education and counseling
became a part of routine pediatric and prenatal office visits at Erie’s
Albany Park site, and an innovative curriculum was implemented to cross-train
medical and dental providers, promoting the integration of holistic care
across the specialties.
Due to demand for additional services combined with Erie’s
effective model of care, a larger dental center was opened in October 2007
at Erie’s Humboldt Park clinic, doubling Erie’s capacity to
provide oral health services to the community.
Current Status
Services at the Humboldt Park clinic are currently provided
for pregnant women referred by Erie providers and children, and this spring
Erie will expand access to oral health care at the Humboldt site to its
patients with HIV/AIDS. Erie has also applied for a federal expansion
grant for the site, which if awarded will allow expanded access to care
for adult parents of Erie’s pediatric oral health patients who are
not enrolled as Erie patients.
Outcomes
Late 2008 marked the third and final year of grants totaling
$136,998 awarded to Erie Family Health Center under VNA’s original
Oral Health Initiative. We have been very fortunate to have
this project experience success almost since its inception, but it ended
on some particularly high notes worth sharing. Highlights of year three
include:
- In the past year, 2,221 unduplicated patients have been served through 7,702 visits. This is slightly below the goal to reach 2,809 patients, however, more visits were offered than the forecasted 7,023, indicating an appropriate adjustment to account for a higher need among existing patients.
- 96% of pediatric patients who visited the dental center at least twice over the past year received preventive services (goal was 90%), and 91% of pediatric patients received anticipatory guidance concerning oral health care (goal was 80%). Erie’s Oral Health Educator provided 186 presentations in school settings, reaching over 3,700 children (goal was 100 presentations).
- 70% of patients completed an oral health treatment plan within one year of their first visit (goal 65%); and 83% of dental patients reported brushing their teeth at least twice per day (goal 80%).
As a result of this initiative,
Erie’s patient population is now more effectively served
through a combined medical and dental home; patients receive anticipatory
guidance and wellness information from both dental and medical
providers; patients are applying better health practices to their
lifestyles and behavior (brushing, avoiding baby bottle tooth decay);
and the oral health of patients has improved, helping to decrease
disparities in the Latino community.
Erie has also made a significant
contribution to the knowledge of community-based dentistry: it
offers a program that is financially sound, employs an effective
staffing model, is run from a state-of-the-art facility, and offers
a preventive model of care to ensure oral health in the long term. Erie
has provided several state and national presentations to help improve
oral health service delivery to the underserved, and has become
a nationally recognized leader in safety net oral healthcare.
Lessons Learned: What Works
There were several lessons
learned by this grant that are transferable to other settings. For
example, in general, an effective oral health program links the
medical and dental homes; promotes a preventive model of care;
uses state-of-the-art technology; trains dental students in community
dentistry; has an oversight team of oral health experts; and has
a strong commitment to quality.
VNA was the first private
funder to support the oral health program, and Erie was able to
leverage other support to secure additional funding to pilot the
program at the Albany Park center, and to then build the dental
center in Humboldt Park. Three years after the Albany Park center
opened, Erie received an extremely competitive federal service
expansion grant ($250,000 every year), which will allow Erie to
provide oral healthcare services to the entire family, as well
as open the clinic an additional evening during the week and Saturday
mornings.
Lessons Learned: Challenges
The OHI was not, of course,
without challenges. The higher than anticipated percentage
of patients who developed new cavities challenged Erie to determine
the causes. Among them was the fact that Erie began to care
for more adults which slightly limited its capacity for children’s
services. Some children also need to be sedated to have cavities
filled, and not all patients follow through on referrals. In response
to these findings and new research regarding the disease, Erie
has increased protective services to children with caries.
Other operations challenges
that have been overcome involve the hiring of flex dentists to
cover for dentists when they take vacations, and the creation of
increased capacity to manage electronic dental records (because
they store more images, and therefore require more room, than other
health records).
Net Result
Overall, VNA board and staff are pleased with the real life, real world outcomes to our Oral Health Initiative, and offer our congratulations to Erie and gratitude to our foundation partners who joined us in this project.
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