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Building a Culture for Interprofessional Collaborative Practice
in Oral HealthGeorge E. Thibault, MD Nexus Award
Broad, Multi-System Interprofessional Collaborations For Healthcare Transformation
Anita Duhl Glicken, MSWExecutive Director, NIIOHAssociate Dean and Professor EmeritaUniversity of Colorado School of [email protected]
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InitiativeInitiative activities are made possible as a result of funding from the DentaQuest Partnership and the Arcora Foundation
result of funding from the DentaQuest Foundation and the Arcora Foundation
Why are we here?
A Systems Change Initiative Advancing Interprofessional
Education and Integrated Oral Health Care
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Medicine and Dentistry – Fragmented Delivery SystemsHow Did We Get Here?
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People visit a medical provider but not a dental provider
Visit a dental provider butnot a medical provider
Vujicic, M., H. Israelson, J. Antoon, R. Kiesling, T. Paumier, and M. Zust. 2014. A profession in transi- tion. Guest editorial. Journal of the American Den- tal Association 145(2):118-121.
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Primary Care physician
Diabetes Screening
Diabetes, so endocrinologist
If heart attack, cardiologistIf stroke, neurologist
If chronic kidney disease, nephrologist
General DentistPeriodontal Screening
Periodontal disease, so periodontist
If root canal, endodontist
Communication is tenuous, usually carried out by patient, if at all
?
?
Flow of Oral Health Information in Patient Care
Adapted from Powell and Din 2008
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Health Professional Shortage Areas
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Who, What and Why – NIIOH 2009
Consortium: Funders, health professionals +national organizationsVision: Eradicate dental diseaseMission: Engage primary care teamFocus: Integrate oral health into primary care education +
practice
The Short Answer
NIIOH is a systems change initiative that provides“Backbone Support” and facilitates interprofessional agreement and alignment to ready an
interprofessional oral health workforce for whole person care
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The Opportunity for Change
Collective Impact
Interprofessional Competencies The “What” and
“How”
2020 Surgeon General Report
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InterprofessionalInitiative Activities
National Interprofessional Initiative on Oral HealthTheory of Change
Primary Care Clinicians
Ready• To deliver oral health services
• To work with dentists
Optimal Oral
HealthDEVELOP TOOLS
(e.g., curriculum)June 28, 2012
Oral Health Recognized
Through• Accreditation
• Licensure• Certification
External Factors•Access to Care
•Patient Motivation• Appropriate Reimbursement
CULTIVATELEADERSHIP
Curriculum Endorsements
Health Professional
Education Systems
• Teach Oral Health
• Adopt Interprofessional
CultureFACILITATE
INTER-PROFESSIONAL
LEARNING & AGREEMENT
Theory of Change
Support, align and connect partner efforts to integrate oral health into education and practice.
COLLECTIVE IMPACT
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Smiles For Life
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Facilitate Interprofessional Agreement
20Endorsing organizations
representing
MedicinePA’s
NursingDentistry
Dental HygienePharmacy
Community Health CentersAnd More!
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Smiles for Life Discrete Site Visits1
SMILES FOR LIFE CROSSES THE ONE MILLION MARK FOR DISCRETE SITE VISITS!
Since the site launched in June 2010, there have been:• 102,082 registered users• 299,0412 courses completed for CE credit• 51,872 modules downloaded by educators
Discrete Site Visits2010 - 2018
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Smiles for Life Survey
Key Question:
• How does Smiles for Life influence practice?
Clark M, Quinonez R, Bowser J, Silk H (2017). Curriculum influence on interdisciplinary oral health education and practice. Journal Public Health Dentistry. 2017 Jun; 77(3):272-282. doi: 10.1111/jphd.12215.
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How Does SFL Influence Practice?
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Influence on 6 Key Activities
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Influence on 6 Key Activities
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Oral Health: An Essential Component
of Primary Care
Published
June 2015
© Qualis Health, 2016
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19 diverse healthcare delivery organizations: Private practices, Federally Qualified Health Centers; medical only and on-site dental
Adults with diabetes (12), pediatrics (5), pregnancy (1), adult well visits (1) EHR Platforms: eCW (5), EPIC (8), NextGen (2), Centricity (2), Success EHS (2)
Field-Testing a Conceptual Framework
© Qualis Health, 2016
Population receiving regular medical care
Population receiving regular dental care
Total population at risk for caries and
periodontal diseaseUsing population health to address
“missed opportunities”
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“Oral Health Integration Implementation Guide” Toolkit for primary care teams (Released 10/10/16)
What’s in the Guide?• Workflow maps• Referral agreements• Patient engagement strategies• Patient/family education resources• EHR templates• Case examples• Impact data and more
Field-Testing Results Informed the Creation of the Implementation Guide and Tools
© Qualis Health, 2016
Resources available at: http://www.safetynetmedicalhome.org/change-
concepts/organized-evidence-based-care/oral-health
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Additional Core Partners:PA Leadership Initiative on Oral Health
NYU’s Oral Health Nursing Education and Practice Initiative
PA Leadership Initiative in Oral Health
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Patient Centered Oral Health Care
AAPA
ARC-PA
PAEA
NCCPA
Physician Assistant Leadership Initiative On Oral Health
Collective Impact
Accreditation Review Commission on Educationfor the Physician Assistant, Inc.
Connecting Partners Who Can Make a Difference
PA National Organizations
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A Longitudinal Lens:Growth in PA Program OH Curriculum Integration
1. Jacques PF, Snow C, Dowdle M, Riley N, Mao K, Gonsalves WC. Oral health curricula in physician assistant programs: a survey of physician assistant program directors. J Physician Assist Educ. 2010;21(2):22-30.
2. Langelier M, Glicken AD, Surdu S. Adoption of oral health curriculum by physician assistant programs. J Physician Assist Educ. 2015;26(2):60-69.
3. Glicken AD, Savageau JA, Flicke TA, Lord CB, Harvan RA, Silk H. Integrating oral health: physician assistant education in 2017. J Physician Assist Educ. 2019 June;30(2):93-100.
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2016 PA Practice Outcomes Research
PAs who received education in oral health and disease were ~ 2.79 times more likely (95% CI=1.39-5.59, P=0.0038) to provide oral
health services in their clinical practice, compared to those who did not receive any education in oral health competencies.
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NIIOH: A Recognized Thought Leader forPublic and Private Convenings by Policy Organizations,
Payors, Public and Private Health Systems
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What Have We Learned?
The organizational change process requires system-wide intervention
Having the right people, right place, right reason can change ideas and practice
A key is having the right tools and strategies to impact knowledge, skills and attitudes of providers
We cannot achieve our vision of “oral health for all” unless we change our approach to oral health care
Integration and collaboration is key, we can’t do this alone!
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Many Thanks to Our Legacy Funders
We need to continue to work together to create a shared vision
for interprofessional whole person care, defining shared performance
measures that can catalyze new education and evaluation strategies
with a focus on prevention, value and population health.
Where Do We Go From Here?