How to improve oral health care capacity at federally qualified health centers

UCLA experts make recommendations based on UCLA-First 5 LA program achievements

Despite efforts to increase dental visits at federally qualified health centers, only 21 percent of people who use those facilities received dental services in 2015, according to an article by researchers at the UCLA School of Dentistry and Fielding School of Public Health.

The article, published in the December issue of Health Affairs, outlines recommendations for closing the gap in oral health services. Strategies for expanding oral health care capacity include adding dental clinics at federally qualified health centers that currently do not provide dental services (co-locating medical and dental services) and providing support for infrastructure enhancements and quality improvement, said Dr. James Crall, lead author of the article and a professor of public health and community dentistry at the UCLA School of Dentistry.

A model of how these strategies can achieve success in improving access and quality of care for young children is the UCLA-First 5 LA Oral Health Program, led by Crall and funded by First 5 LA — an early childhood advocacy organization in Los Angeles County. Data from the oral health program show that the average number of children, ages zero to 5, receiving dental services each month at 12 participating clinics increased by nearly 85 percent in the first two years of the project. Eight additional clinics are now participating in a second phase of the program.

Crall credits this jump in dental services to the program’s support for new oral health care workers known as community dental home coordinators, training clinicians and support staff to provide oral health care for young children, and a quality improvement learning collaborative that teaches clinic teams how to deliver care more effectively by integrating the efforts of dental and medical providers.

 “We are very pleased with the results thus far of our oral health program,” Crall said. “The data show that our model is working. The strategies we’ve implemented could serve as a model for oral health care programs across the country.”

The model is outlined in the Health Affairs article and in a related policy brief released earlier this year by the UCLA Center for Health Policy Research. The issue marks the journal’s first comprehensive look at oral health and today Crall presented the paper at a forum in Washington, D.C.

“Young children are our greatest asset and we cannot improve their overall health without improving their oral health,” said Nadereh Pourat, co-author on the study and the director of research at the UCLA Center for Health Policy Research. “Our study identifies an effective strategy to integrate oral and medical care to improve the health of the most socially vulnerable children, but this strategy can also work for all young children.”

Crall and Pourat, who is also a professor at the UCLA Fielding School of Public Health and the UCLA School of Dentistry, along with fellow researchers, Moira Inkelas, an assistant professor at the Fielding School, and quality improvement advisors Colleen Lampron and Richard Scoville, made the following recommendations for policy makers and program officials to increase access to high-quality primary oral health care services for underserved people:

  • Policies could be updated to define oral health care as an essential, integral part of health centers’ primary health care services, with a clear expectation that comprehensive primary health care services be provided in all federally qualified health centers.
  • Congress and the Health Resources and Services Administration could give greater priority to expanding dental care service delivery within existing federally qualified health centers by providing additional funding for facilities, personnel and critical infrastructure elements to address obstacles.
  • Government agencies could help develop more effective strategies for expanding access to dental services through partnerships among eligible health centers and community-based dental providers, especially in clinics that do not provide co-located medical and dental services.
  • The Health Resources and Services Administration could expand the use of quality improvement methods and collaboratives to redesign the care delivery processes at federally qualified health centers to achieve greater medical and dental integration within health center delivery systems and improve oral health care access, quality and performance.

A related brief, focused on California, will be issued Dec. 8 by Children Now, First 5 LA and the UCLA School of Dentistry.

This research and the Los Angeles-based oral health program featured in the Health Affairs article was supported by First 5 LA.

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