Oral health is associated with many common systemic diseases. Medicare age-eligible patients (i.e., adults age 65+ years) represent a population at high risk for both types of disease, as well as a high prevalence of unmet social and economic needs (e.g., food insecurity or social isolation) which may contribute to poor health outcomes. As the population ages and a larger proportion of patients require dental services and chronic disease prevention and management, a clinically integrated model that coordinates care across clinical functions (e.g., dental and medical), activities, and sites may maximize the value of health services for older patients. The dental setting is an ideal location in which to conduct medical care interventions, such as chronic disease screening, by collaborating with other health care professionals. The Kaiser Permanente Northwest (KPNW) health plan and Permanente Dental Associates implemented a novel program that integrated dental and medical care, the Dental-Medical Integration Program (DMIP), in 2018. The DMIP provides enhanced preventive and disease management services with the goal of closing critical evidence-based medical care gaps to improve longer term health outcomes. The DMIP presents an ideal opportunity to evaluate a natural experiment, which will be conducted using a retrospective cohort design of Medicare patients age ?65 who received dental care between 7/1/2018-12/31/2019 and had 1 or more medical care gaps at time of their visit. The proposed specific aims are:
Aim 1. Evaluate the association between dental-medical integration and closure of evidence- based medical care gaps among Medicare patients aged ?65 years;
Aim 2. Characterize the frequency and type of unmet social and economic needs among Medicare patients aged ?65 years seen for dental care in DMIP clinics and assess whether having social or economic needs are associated with closure of evidence-based medical care gaps. This study will provide valuable information on the relationship between DMIP and medical care gap closure and improve our understanding of the extent to which unmet social and economic needs affect this relationship. Study findings may serve as initial evidence of the benefit of a comprehensive population-based approach to identifying and resolving medical care gaps in the dental setting. Moreover, results will have policy significance, addressing prior calls by stakeholder groups including the National Academy of Medicine, Cigna, and Aetna, for further investment in more robust dental-medical integration programs across the U.S. to expand access to recommended treatments and promote better overall health. Ultimately, this study will inform the development of hypotheses and research questions about the effect of DMIP on long-term health outcomes to be tested in a future R01.
Medicare-aged adults in the U.S. are at high risk of poor dental health, chronic diseases, and social needs such as isolation and hunger. In this study, we will evaluate an innovative program designed to address these problems by placing medical staff in dental clinics to provide preventive care and help manage chronic diseases. Our study will test whether this program increases the use of medical services needed by patients and will provide new information about the social needs of older Americans.
