New Jersey FQHC Community Dental Health Coordinators Use Integrated Medical/Dental Patient Navigation to Improve Diabetes Outcomes

Abstract

Introduction: Diabetes is a significant risk factor for periodontal disease [2] and people with diabetes are three times more susceptible to periodontitis than those without diabetes [3]. These factors highlight the importance of aggressive treatment and follow-up of dental treatment for patients with diabetes, as well as coordination of care between the medical and dental teams. Zufall Health Center, a New Jersey federally qualified health center (FQHC), designed a process improvement plan at two project sites to promote better diabetes management by performing dental exams and cleanings and treating periodontal disease by scaling and planing in at least 100 high-risk, rural patients with uncontrolled diabetes, as measured by A1C. Baseline goals included completing periodontal treatment and improving A1C levels. Methods: Zufall deployed a community dental health coordinator (CDHC) to provide community-based prevention, care coordination, education, and patient navigation of wrap-around medical and oral health services for Type 2 patients with diabetes it serves. Key objectives included decreasing the number of patients with diabetes with A1C levels > 9 and increasing the number of dental exams and cleanings. Results/Conclusions: Of 154 enrolled patients, 103 with uncontrolled diabetes opted in to dental services. Of the 37 patients who completed cleanings or scaling and root planing (24%), 17 showed improvement in A1C levels (46%) by an average reduction of 1.8. Nearly all (15 of the 17) went from uncontrolled to controlled diabetes: 40% of the 38 patients receiving dental treatment. However, 70 of the 99 patients (70%) re-checked for A1C levels improved those levels, regardless of their participation in dental care. Traditionally, most improvement is achieved through medication adjustments. This data shows that, while the thrust of the project was the impact of dental interventions on A1C levels, the more critical intervention was the case management and access to care facilitated by the CDHC.