Promoting Children’s Health Equity With Medical-Dental Integration

Abstract

Background: 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.Methods: 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.Results: 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.Conclusions: 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.

Strategies and indicators to integrate health equity in health service and delivery systems in high-income countries: a scoping review

“…This review was limited to sources from high-income countries with developed economies: 56 from the United States, 41 , 43 – 46 , 52 , 54 , 56 , 59 , 64 – 68 , 71 , 73 , 74 , 78 , 80 , 83 , 84 , 89 , 92 , 95 – 97 , 99 – 101 , 103 , 105 – 107 , 115 , 119 – 121 , 124 , 125 , 128 , 134 – 139 , 142 – 147 , 149 – 151 , 153 20 from Canada, 35 , 37 , 39 , 40 , 42 , 48 – 50 , 63 , 86 , 88 , 90 , 91 , 98 , 104 , 108 , 113 , 141 , 152 , 155 16 from the United Kingdom, 38 , 53 , 55 , 61 , 62 , 69 , 70 , 81 , 85 , 87 , 112 , ...…”

“…Of the remaining included sources, almost half (n=56) did not define health equity or related concepts. 38 , 41 – 46 , 48 , 51 , 54 – 56 , 58 , 60 – 62 , 64 , 66 , 67 , 69 , 70 , 72 , 75 , 76 , 78 – 80 , 83 , 84 , 87 , 89 , 92 , 94 , 96 , 99 , 100 , 103 , 105 , 108 , 110 , 112 , 114 , 115 , 120 , 122 – 125 , 128 , 134 , 137 , 139 , 140 , 142 , 147 , 154 Fifty sources did not define health equity, but did include definitions of related concepts of interest (eg, health inequity/inequality, SDOH). 21 , 37 , 39 , 40 , 47 , 49 , 52 , 53 , 57 , 59 , 63 , 65 , 71 , 73 , 74 , 77 , ...…”

“…Of the included studies only 55% (n=67) were identified as using a framework or model to guide the research. 21 , 35 , 37 – 41 , 44 , 47 , 48 , 50 , 52 , 54 – 56 , 61 – 63 , 66 , 71 , 73 – 78 , 83 – 85 , 88 , 92 – 94 , 96 , 98 , 101 – 107 , 109 – 112 , 116 – 118 , 123 , 127 , 130 , 131 , 133 , 135 – 138 , 140 , 141 , 143 – 145 , 149 , 151 – 153 The most reported framework was Health Equity Impact Assessment (n=4), 37 , 98 , 133 , 135 followed by the Quality and Outcomes Framework (n=2), 61 , 112 and the Dismantling Racism framework (n=2). 71 , 73 All the remaining sources (n=59) used unique frameworks to operationalize their health equity work within a specific organizational or system context.…”

“… 71 , 73 All the remaining sources (n=59) used unique frameworks to operationalize their health equity work within a specific organizational or system context. 21 , 35 , 38 – 41 , 44 , 47 , 48 , 50 , 52 , 54 – 56 , 62 , 63 , 66 , 74 – 78 , 83 – 85 , 88 , 92 – 94 , 96 , 101 – 107 , 109 – 111 , 116 – 118 , 123 , 127 , 130 , 131 , 136 – 138 , 140 , 141 , 143 – 145 , 149 , 151 – 153 The health equity work described in our included sources took place in multiple settings that ranged from a whole health system to clinical and community health service providers, meaning there was substantial variation in the frameworks that were used. This made it challenging to assess their utility.…”

“… 21 , 36 , 37 , 40 , 47 , 50 , 51 , 53 – 55 , 57 , 59 , 60 , 66 , 68 , 69 , 71 , 74 , 76 , 78 , 79 , 81 , 82 , 88 , 90 – 92 , 94 , 95 , 98 , 100 , 102 , 103 , 106 – 108 , 110 , 111 , 113 – 116 , 118 – 121 , 123 – 126 , 129 – 135 , 139 , 143 – 146 , 148 , 149 , 151 , 153 , 154 When indicators were included (n=54), sources revealed a considerable array of indicators that were employed to measure health equity integration. 35 , 38 , 39 , 41 – 46 , 48 , 49 , 52 , 56 , 58 , 61 – 65 , 67 , 70 , …”