The Case for Integration
Oral health is inextricably linked to overall health - yet, it is often a separate and sometimes undervalued aspect of health care. An individual's health improves when oral health services, education, and referrals are integrated into a wide variety of health care settings.
The Coalition works with clinical and social support partners to provide the framework, tools, and education necessary to integrate oral health education, referrals, and services into primary and behavioral health care as well as pharmacy services, home visiting, and other outreach programs.
Our vision is a care system that provides comprehensive health care that is inclusive of oral health that also addresses the unique needs of each patient.
To realize this vision, the Coalition:
- Provides technical assistance to clinics to assess integration readiness and aid with implementation of patient-centered integration programs;
- Offers education for a wide variety of providers and family educators; and,
- Synthesizes and shares best practices to encourage replication.
To learn more, check out the resources below or contact us to schedule an integration training.
Integrating Across Disciplines for Continuous Care
Oral Health Integration Toolkit
How to use the integration toolkit
The Oral Health Integration Toolkit is intended to serve as a guide to help medical and dental teams integrate their care processes. First, take a look at Opportunities to Address Community Health Needs and consider the prompt questions within Core Components of Integration to begin identifying your integration approach. Use Community Health Solutions' Integration Model Checklist to design an integration model for your workplace. The Clinical Practice Tools section offers helpful resources you can download and use in your practice today.
1. Opportunities to Address Community Health Needs
- Emergency Room Diversion: Reduce unnecessary use of emergency room for dental issues and related costs; direct patients to appropriate primary health care services in the community. Related resource: Integrated Care Model for Emergency Department Diversion
- Ventilator-Associated Pneumonia in the ICU: Reduce risk of ventilator-associated pneumonia (VAP) and related respiratory issues; reduce hospital stay and in-hospital adverse events and mortality. Related resource: Integrated Care Model for VAP in the ICU
- Maternal and Child Health and Wellness: Improve perinatal health; improve birth outcomes; increase use of preventive oral health care for young children and access to a dental home. Related resource: Integrated Care Model for Pregnancy and Childhood
- Chronic Disease and Wellness: Improve overall health; address and manage oral and overall health of individuals with chronic disease (e.g. diabetes, heart disease, chronic inflammatory conditions) and ensure appropriate and timely use of the health care system and services. Related resource: Integrated Care Model for Chronic Disease
- Behavioral Health and Wellness: Improve overall health; behavioral health providers address oral health issues that may arise due to prescription and medication use/abuse or issues with self-care. Related resource: Integrated Care Model for Serious Mental Illness
Learn more about the State Innovation Model (or "SIM") initiative in Virginia.
2. Core Components of Integration
- Leadership: Who are the administrative and clinical leaders that will champion this initiative?
- Education: What are the oral health educational needs of your clinical and administrative staff?
- Patient Population: What are some of the most significant health issues in your community? What are your patients' needs? What questions have your patients asked regarding oral health and chronic disease? Do you provide care that fits with a patient's cultural background?
- Health Care Services: What services are available onsite and what requires a referral? What services can you introduce (e.g. fluoride varnish, diabetes testing, health education)? Who will provide these services?
- Communication and Information Sharing: How will you share patient information and coordinate care?
- Measures and Assessment: How will you determine, collect, and evaluate process and outcome measures that assess access to care, utilization of services, and health outcomes? How will you measure clinical performance and patient/family experience to monitor the care system?
- Financing: What payment models and funding streams can your patient utilize?
- Infrastructure: What staff, information-technology (including certified electronic health record technology), capacity or support changes are necessary to support integration efforts? How will you manage referrals and cross-disciplinary care transitions? Can you utilize team members differently to integrate care?
- Community Support: What types of clinical or social support activities are happening in your community systems (e.g. diabetes education groups, centering programs, transportation, or job training)? Is there potential for partnership?
3. Integration Model Checklist
The resources below were developed by Community Health Solutions. Use the Integration Model Checklist to walk through the core components of your integration strategy (note: the checklist was originally developed for clinics seeking Patient-Centered Medical Home Certification). The Leadership Assessment and Development guide will help you assess and build team readiness for integration work.
4. Clinical Practice Tools
- Educational Video: Integrating Oral Health into Patient-Centered Primary Care - View Part 1 | View Part 2
- Blood Pressure Screening in the Dental Office (PDF) full-text article from the Annals of Family Medicine
- Dental Referral Form (Word)
- Diabetes Self-Management Education (DSME) Programs for Patients (Diabetes Local) search for a local DSME program for patient referrals
- Developing Community-based Programs for People with Diabetes (Web-based Course) from the Centers for Disease Control and Prevention
- Dry Mouth Overview (PDF)
- Electronic Medical Record (EMR) Integration Guide: Pediatric Oral Health in Primary Care Practices, EPIC (PDF)
from The First Tooth and MaineHealth
- Fluoride Varnish: A Resource Guide, 2nd Edition (PDF) from OHRC
- Fluoride Varnish Billing Instructions (PDF)
- Fluoride Varnish Suppliers List (PDF)
- National Diabetes Education Program (Website) from the Centers for Disease Control and Prevention
- Oral Health Risk Assessment Tool (AAP) (PDF)
- Pediatric Oral Health and Varnish EMR Documentation, EPIC (PDF) from The First Tooth and MaineHealth
- Pediatric Oral Screening, Assessment and Varnish EMR Documentation, EPIC (PDF) from The First Tooth and MaineHealth
- Primary Care Screenings and Interventions in the Dental Office (PDF)
- Search Medicaid Dental Providers (Website)
- Standards of Medical Care in Diabetes (PDF) from the American Diabetes Association
- Using Electronic Medical Records: A Case Study in Dental Practice (PDF)
If you have additional Clinical Practices Tools that you'd like to share in this section, please send them to Samantha Dorr.
Continuing Education Opportunities
- Smiles for Life: A National Oral Health Curriculum
- Cultural Competency Program for Oral Health Professionals (Office of Minority Health)
- Learning Modules: Oral Health Across the Lifespan (APTR)
- The Dental Team's Role in Identifying and Preventing Family Violence (Procter & Gamble Company)
- Diabetes Mellitus and the Dental Professional (ADA)
Thank you to the Richmond Memorial Health Foundation, Daily Planet Health Services, and Community Health Solutions for their contributions to the integration toolkit.