Promoting Children's Health Equity With Medical-Dental Integration.

Abstract

Successful medical-dental integration is key to achieving children's health equity. In 2015, a community health center (CHC) in Boston, Massachusetts, implemented a model of interdisciplinary care in a nationwide pilot. Based on the Oral Health Delivery Framework, pediatricians were trained to assess dental caries risk and apply fluoride varnish. They were trained to offer education materials to patients, incorporate oral health assessment in pediatric practice, and document preventive dental care in the electronic health record. This study assessed the level of medical-dental integration achieved by the pilot and maintained over 2 years after program implementation. Deidentified data were provided by the CHC on all well-child visits during 2014 to 2018 for children 72 months or younger, including appointment dates, age, ethnicity, race, insurance status, and outcomes of interest (ie, whether a dental assessment was performed and whether fluoride varnish was applied). Outcomes were stratified by visit year to allow pilot (2015-2016) outcomes to be compared to pre-pilot (2014) and post-pilot (2017-2018) outcomes. Descriptive statistics were used to summarize the data. Pediatricians performed fluoride varnish applications and dental assessments in 25% and 0% of visits, respectively, at baseline; in 50.2% and 49.4% of visits, respectively, at the pilot's end; and in 56.7% and 57.3% of visits, respectively, 2 years post-pilot. The proportion of well-child visits during which pediatricians integrated oral health preventive measures increased by roughly 25% to 50% from baseline (2014) to the end of the pilot (2016) and by at least 5% from 2016 to 2018. The success of this medical-dental integration pilot underscores the need for broader implementation of interprofessional education and practice to promote children's health equity.