Integrated care delivery is at the core of patient-centered medical homes (PCMHs). The extent of integration of dental services in PCMHs for adults is largely unknown. We first identified dental–medical integrating processes from the literature and then conducted a scoping review using PRISMA guidelines to evaluate their implementation among PCMHs. Processes were categorized into workforce, information-sharing, evidence-based care, and measuring and monitoring. After screening, 16 articles describing 21 PCMHs fulfilled the inclusion criteria. Overall, the implementation of integrating processes was limited. Less than half of the PCMHs reported processes for information exchange across medical and dental teams, referral tracking, and standardized protocols for oral health assessments by medical providers. Results highlight significant gaps in current implementation of adult dental integration in PCMHs, despite an increasing policy-level recognition of and support for dental-medical integration in primary care. Understanding and addressing associated barriers is important to achieve comprehensive patient-centered primary care.
Background:
Integration of social services in health care delivery is increasingly recognized as a potential strategy for improving health and reducing the use of acute care services. Collaborative models that provide older adults with case management, linkages to social services, and assistance with health care navigation have emerged as promising strategies.
Objective:
The objective of this study was to evaluate the Community Care Connections (CCC) program, a cross-sector collaboration designed to align social and health care services for older adults.
Research Design:
We compared hospitalizations and emergency department (ED) visits 90 days after enrollment with a propensity score–matched group of non-CCC patients. Subgroup analyses were also conducted for adults with hypertension, diabetes, and high cholesterol.
Subjects:
A total of 1004 patients enrolled in CCC between June 1, 2016, and November 15, 2018, and 1004 matched patients from the same metropolitan area.
Measures:
Mean hospitalizations and ED visits per patient 90 days after CCC enrollment.
Results:
Mean hospitalizations were lower among CCC patients 90 days after enrollment than among non-CCC adults [difference=−0.039, 95% confidence interval (CI): −0.077 to −0.001, P=0.044]. They were also lower among CCC patients with hypertension (difference=−0.057, 95% CI: −0.103 to −0.010, P=0.017). However, 90 days after enrollment mean ED visits were higher among CCC patients relative to non-CCC adults (difference=0.238, 95% CI: 0.195–0.281, P<0.001).
Conclusions:
Connecting older adults to social services while being served by the health care system may lead to decreases in hospitalizations. Cross-sector partnerships that address social and economic needs may reduce the use of costly health care services.
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