Medical Oral Expanded Care (MORE Care)
What is MORE Care?
MORE Care (Medical Oral Expanded Care) is an initiative of the DentaQuest Institute (DQI) with an aim of providing primary and secondary preventive oral health services in primary care medical offices to underserved populations, as well as testing optimal patient-centered referral systems between primary care and dental care teams.
Addressing Rural Disparities through MORE Care
Millions of Americans lack access to basic oral health care. Children and adults living in rural communities, however, face additional challenges including higher rates of poverty, dental provider shortages, and a lack of dependable transportation.
Although rural primary care providers have the potential to play a pivotal role in the oral health of their patients, several key elements needed for successful integration of oral health into primary care are currently lacking, including:
- Medical education training on oral health competencies needed for primary care providers to provide primary and secondary oral health prevention
- A sustainable, systemic model for collaborative practice with dental providers
- Practice systems that support oral health care delivery and coordination with dental providers
DQI is partnering with state offices of rural health to begin testing strategies to overcome these barriers and develop the systems in the primary care practices to support the delivery of oral health care as well as develop infrastructure to create a dental delivery system for patients who need dental treatment of disease.
Phase 1 Pilot: The South Carolina Experience
In 2015, DQI partnered with the South Carolina Office of Rural Health and Medical University of South Carolina to pilot test models of integration of oral health into primary care and build dental care referral networks. 7 rural primary care practices (including both family medicine and pediatric practices) are participating in a 12-month learning collaborative to test strategies for optimizing systems in their practices to support the delivery of oral health preventive services and coordinate care to dental providers for treatment. Populations of focus for the pilot collaborative were adults >18 yrs old with a primary diagnosis of diabetes and children ages 0-12. Beginning in August 2015, teams gather for three meetings to learn and plan changes to test, and then return to their practices to test those changes in their clinical settings. They submit monthly data showing their progress, and they participate in regular conference calls and the online listserv to share what they have learned with other teams. They also receive one-on-one support from Quality Improvement Coaches.
Each team is working together to test, develop, and implement selected promising interventions to improve the dental health of their patients. They are re-designing their care delivery systems to include an oral health risk assessment (for pediatrics and diabetic adults), an intraoral exam, and additional primary and secondary prevention activities such as fluoride varnish. Teams are also working to develop and track effective referrals to dental providers for dental disease treatment for those that need it. DQI and MUSC are working to identify and develop relationship agreements with local dental providers to ensure that patients from primary care offices who are in need of dental treatment have sufficient access.
Phase 2 Pilot: 2016 MORE Care Expansion
Using learnings gleaned from the 2015 experience in South Carolina, we will be expanding MORE Care into up to 4 additional states in 2016. Phase 2 of MORE Care will involve a multi-state learning collaborative of at least 5-7 rural primary care practices from each participating state, supported by their State Office of Rural Health. The goal of Phase 2 will be to further test oral health integration strategies and the development of dental referral networks in new environments of care to determine feasibility, challenges and successes.