The Membership Organization of State Offices of Rural Health
Corporate sponsors are not only an important resource for funding for the mission of NOSORH, they are experts in rural health and often partners to the State Offices of Rural Health. NOSORH thanks the DentaQuest Institute for their continued support of our mission.
The DentaQuest Institute (DQI) is a nonprofit entity with a mission of promoting optimal oral health through quality care and prevention. As the current oral health care delivery system is becoming more person-centered and prevention-focused, health care professionals are better able to not only stabilize disease, but more importantly, prevent it from happening. DQI’s unique, hands-on approach of working directly with their partners allows them to facilitate oral health and support partners’ efforts to improve patient care.
“When it comes to our partnerships, we use the definition that if you care about somebody’s health, you care about their oral health,” said Dr. Sean Boynes, Director of Interprofessional Practice at DQI. “It’s not just a dentist who is an oral health care provider, it’s anybody who takes an interest in facilitating overall health, recognizing that the teeth and gums are part of the body.”
Included in DQI’s list of partners are State Offices of Rural Health (SORH). The Institute has been around for a while, but their focus on rural health is new. Their first initiative with a specific focus on rural health is MORE Care (Medical Oral Expanded Care). The idea behind MORE Care is to address rural health disparities by reaching out to primary care providers in rural health clinics (RHC) to integrate oral health within the practice and enable the coordination of care by linking them with dental care teams in rural communities.
DQI partnered with the South Carolina Office of Rural Health and Medical University of South Carolina for Phase 1 of the More Care initiative in 2015. Using their experiences from Phase 1, MORE Care began Phase 2 of the pilot by expanding into Colorado and Pennsylvania. With support from the Colorado Rural Health Center and the Pennsylvania Office of Rural Health, they are further examining oral health integration strategies and the development of dental referral networks. In addition, toolkits and online practicums are currently being developed with the goal of eventually employing them across the country.
“The ultimate goal of the project is to form interprofessional oral health networks comprised of care pathways, which are both integrated and coordinated, for patients,” said Boynes. “At the end of the day, we think about the rural person and their ability to access a completed care pathway. We see RHCs as leaders in these rural communities to help facilitate this with their dental care team partners.”
Dr. Boynes, who previously practiced at a rural FQHC in South Carolina, understands the challenges that face rural and underserved communities and brings that experience to his work at DQI.
“The states are very different and the rural environment is not an easy environment to conquer, but the Institute shares the interest of the SORHs and NOSORH to improve the health of rural communities in the United States. We’re committed to going into rural communities and trying to change them on a wide scope to improve their health.”
The first white paper on the MORE Care project is slated to be released later this month. For more information on the DentaQuest Institute, please visit their website at www.dentaquestinstitute.org. For a full listing of NOSORH sponsors, click here.
The South Carolina Office of Rural Health is partnering with Dr. Amy Martin of the Medical University of South Carolina and SC Rural Health Research Center at the University of South Carolina to identify best practices to incorporate oral health interprofessionalism into rural health clinics. SCORH wants to develop a national model for SORHs interested in providing technical assistance for oral health integration to meet the objectives of the Triple Aim.
Dr. Martin explains that, “After working on a 3-year grant to build capacity within oral health safety net clinics, it became apparent that we needed to look at a more systemic approach to building oral health capacity in our state.” Dr. Martin approached Dr. Graham Adams with the SCORH to develop a partnership to investigate how to integrate oral health into rural health clinics for early identification of oral disease and how SORHs can best provide technical assistance for rural health clinics to integrate oral health services into primary care.
In rural South Carolina, oral disease is the number one avoidable reason an uninsured adult visits the ER. Therefore, rural hospitals and clinics have a vested interest in addressing oral health shortages. The SCORH is already working with 106 clinics to implement Primary Care Medical Homes, so this oral health project was a natural fit. “Primary Care Providers will still be practicing medicine, but they will also be practicing medicine in the mouth,” says Dr. Martin.
For the past 18 months, Martin and Adams have worked with DentaQuest Institute to help them understand the breadth of rural health providers and the value of state offices of rural health in providing technical assistance. “Amy is such a good advocate for the SORH model and a champion for integrating SORHs more broadly into the greater healthcare system. She understands SORHs and sees the value there,” says Adams. The DentaQuest Institute was convinced of the merit of this pilot and agreed to fund a one-year demonstration.
Over the next year, the SCORH will work with 7 clinics to integrate oral health services into its primary practice. In addition, the SCORH has partnered with SORHs in Colorado, Iowa, New Mexico, and Pennsylvania to develop a national model for SORHs interested in providing technical assistance to rural health providers to help them become an integrator of oral health.
Using the 2014 HRSA report on “Integration of Oral Health and Primary Care Practice,” Martin developed a framework for oral health integration with three levels of care. The primary intervention involves risk assessments and participatory guidance for children and adults. The main focus for children is to identify caries and possibly provide fluoride varnish. The main focus for adults is identifying periodontal disease with an additional focus of diabetes and oral cancer screening. Secondarily, doctors will be able to prescribe antibiotics, anti-inflammatories, mouthwash and toothpaste to ward off disease.
The third level of care is perhaps the most important. One of the main components of this pilot is to develop partnerships with oral health providers to be able to refer patients that need oral health treatment. Adams explains, “We are trying to build links with rural dentists so that patients have somewhere to turn to avoid going to ER.”
After the first year, they hope to ramp up the program to work with more practices and determine a set of best practices to help other SORHs interested in providing this type of assistance. They are hopeful this work will provide a framework for other SORHs and turn into a national model.
For more information on the role of the SORH, contact Melinda Merrill.
Does your SORH have a “Promising Practice”? We’re interested in the innovative, effective and valuable work that SORHs are doing. Contact Kassie Clarke, NOSORH’s Communication and Development Coordinator to set up a short email or phone interview in which you can tell your story.
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The growing awareness of the importance of oral health on a person’s overall health juxtaposed with the decreasing number of oral health providers especially in rural areas was spotlighted in 2000 with the release of Oral Health in America: A Report of the U.S. Surgeon General. Since then, many SORHs and rural health organizations have been trying to provide necessary resources to rural health providers to help them combat this growing need. While great strides have been made in this area, the pervasive need continues to exist and will likely continue for some time to come.
To assist SORHs in their efforts, NOSORH has compiled many helpful resources for SORHs on our website, including:
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Back to December Branch
With funding from a Centers for Disease Control and Prevention (CDC) Oral Health Infrastructure Grant, the Hawaii SORH has partnered with the Hawaii State Department of Health (DOH), Family Health Services Division to assist in rebuilding its oral public health program. Other partners include staff from the Primary Care Office and Title V Maternal and Child Health Services Block Grant.
“Hawaii’s oral public health program was shut down in 2009 due to lack of funding,” said Gregg Kishaba, Hawaii SORH Rural Health Coordinator. “The need for the program to be restarted was clear when we received two consecutive “F” grades on our PEW Foundation report card for achieving only one of eight key benchmarks.” Some of the indicators used to measure success included fluoridated water systems, school-based dental sealants programs, expanding dental hygienists scope of work, and Medicaid reimbursement.
Implementing the Hawaii Smiles program is the first step in the rebuilding process. Starting in January 2015, Hawaii Smiles will monitor the dental health of Hawaii’s third graders, gathering important data that will be used to develop dental disease prevention programs for children.
“Good oral health care is critical. Dental problems cause children to miss school and have difficulty eating, speaking, socializing and sleeping,” said Kishaba. “We’ll be asking 64 random schools to take part in Hawaii Smiles during the 2015 school year. Our plan is to repeat Hawaii Smiles every 3-5 years.”
With their parent’s consent, third graders will receive a free, non-invasive dental screening at their school. Screenings will be performed by a dentist or dental hygienist and will take about one minute per child. Children who are determined to be in need of dental care will be referred to their own dentist or a local clinic. “Hawaii Smiles will provide basic services that many rural communities are not getting. We are currently building teams so that every island will have equal resources available to them,” Kishaba said.
Data collected from Hawaii Smiles will be analyzed by the Association of State and Territorial Dental Directors (ASTDD). Kishaba said “the baseline data will be shared with our partners to quantify the oral health burden within Hawaii’s school-age population. Findings will be used for public health strategic planning, policy development, and prevention activities.”
With funding in place and the Hawaii Smiles program starting in 2015, Kishaba is confident they are “establishing a solid foundation in which the core team can leverage and build upon other key oral health efforts in the years to come.”
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Back to July Branch
On April 28-30, I had the opportunity to attend the National Oral Health Conference in Fort Worth, Texas. This meeting was an eye-opening opportunity! I learned a lot about oral health issues and many ways in which State Offices of Rural Health (SORH) and oral health providers can collaborate to improve access to oral health care in rural communities. I highly recommend this conference if you ever have the chance to attend or, better yet, give a presentation about oral health projects that you are working on.
Amy Martin, PhD and Mark Doherty, DMD, MPH, gave an inspiring presentation, “Taming the Frontier: Bringing Oral Health into Rural Health” that I’m hoping to replicate in a webinar for NOSORH members. They talked about how they’ve partnered with the South Carolina Office of Rural Health to improve access to dental care in that state. Their session had many in the
audience asking, “How do I get in touch with my State Office of Rural Health?” As a result, you may be hearing from folks who’d like to partner with you on oral health initiatives.
During the conference, I had the opportunity to address the Board of Directors of the Association of State and Territorial Dental Directors (ASTDD) and to lead a roundtable discussion about partnering with NOSORH and SORHs. I left with a number of ideas for webinars to share with you what I learned. These are some of the areas that we seemed to have common interests: partnering to achieve common goals, including facilitating collaboration with Primary Care Associations (PCAs), and supporting alternative pathways to access through innovative models, including new allied dental health provider models.
If you’re interested in learning more about the event, visit the following website: http://www.nationaloralhealthconference.com.
Stephanie Hansen
Education and Service Director
Medical-Dental Integration – What it Looks Like & How to Achieve It (Dr. Hilton)
Medical-Dental Integration – What it Looks Like & How to Achieve it (M. Smith)