Year 3 Projects
Assessing the Impact of DH Scope of Practice on Oral Health Outcomes
In Year 2, the OWHRC completed a study to update the state-specific Dental Hygiene Professional Practice Index (DHPPI) scores to reflect current dental hygiene scope of practice in 2016. The variables in the 2016 DHPPI were factor analyzed to determine validity. This project will use the 2016 data in multi-level regression analysis to examine the impact of state level scope of practice on oral health outcomes for low-income children.
This research resulted in an article that was submitted to a peer-reviewed publication.
The Evolving Pipeline of Hispanic Dentists in the US
The Hispanic/Latino (H/L) dentist population is disproportionately small compared to the rapidly growing and historically underserved H/L population in the US, and current enrollment will not meet the demand. Half of the H/L dentists in the US are foreign-born, and about 1 in 5 were trained outside the US. Changing licensure laws have limited the pathways for non US-trained providers. Using a nationally representative sample survey of H/L dentists and a policy review, this study elucidates trends and challenges in H/L dentists’ pathways to practice, examines the changing patterns of care delivery, and identifies access and care delivery goals for the H/L population.
An Assessment of Mobile and Portable Dentistry Programs to Improve Population Oral Health: Practice and Policy Implications
Mobile and portable oral health service programs continue to gain the attention of policymakers and providers for their ability to bring oral health services into local communities and to reach patients with limited access to oral health services. This study consists of 7 case studies that describe the workforce in mobile dentistry programs, the structure and funding of programs, and the regulation of mobile and portable dentistry by states.
Trends in the Development of the Dental Service Organization Model: Implications for the Oral Health Workforce and Access to Services
The fastest growing segment of the dental delivery system is Dental Service Organizations (DSOs). While DSOs take various forms, as large employers of dental providers, they are changing the landscape of oral health care delivery. OHWRC conducted a survey of a convenience sample of DSOs and compiled case studies of 6 dental support organizations delivering general or specialty dental services to patients. This mixed-methods study examined the variety of DSO models, who they serve, their workforce needs and practices, career pathways provided, and evolving models of workforce deployment.
Developing a Graphic Visualization to Help Policy Makers Understand the Wide Variation in State-level Dental Hygiene Scope of Practice
There is substantial variation in dental hygiene (DH) scope of practice across states, but no user-friendly tools to help policymakers understand these differences. OHWRC produced an infographic on state-specific DH scope of practice. Researchers worked with key stakeholders in dental hygiene (representing education, practice, and research) to identify the variables to include in the graphic to accurately depict key DH responsibilities associated with scope of practice and to display state-to-state variation.
This research resulted in an Infographic.
Further Study of State-Level Policies that Affect Access to Dental Services in LTC Settings
A Year 1 OHWRC project included a 4-state case study of delivery models for dental care services in long-term care (LTC) settings. Since then, a more comprehensive literature review was completed and additional information was compiled on key state-level policy factors that drive the organizational models cited in the study. OHWRC researchers conducted an in-depth analysis of policy factors that serve as barriers to and facilitators of access to dental services in long term care settings. Findings highlighted state level policy factors that influence access to needed services.
This research resulted in an article that was submitted to a peer-reviewed publication.
Generating State and Sub-State Maps of Oral Health Training Sites, Substance Abuse Treatment Centers, and FQHCs and Look-alike Clinics that Provide Comprehensive Oral Health Services
Researchers at the OHWRC used data and information provided by HRSA and the Substance Abuse and Mental Health Services Administration (SAMHSA) to produce a series of maps depicting the following: (1) oral health training and rotation sites, (2) substance abuse treatment centers, and (3) FQHCs and FQHC look-alike clinics (FQHC-LA) that provide comprehensive dental services. These maps integrated information on oral health and substance abuse treatment centers which could potentially encourage possible synergies and resource sharing.
Year 2 Projects
Determinants of Oral Health Assessment and Screening in Physician Assistant Clinical Practice
In 2013, a survey of directors of physician assistant education programs conducted by the Center for Health Workforce Studies (CHWS) found that more than 70% of respondent programs had integrated oral health topics into core content of their physician assistant (PA) curriculum. A 2014 HRSA-sponsored report described core oral health clinical competencies for frontline primary care clinicians, including PAs, and outlined strategies for implementing oral health training in primary care practice and safety net settings. However, whether training in oral health in PA education programs translates to actual screening and assessment of patients’ oral health status in clinical practice remains unclear. OHWRC in cooperation with the American Association of Physician Assistants (AAPA) fielded a survey to a sample of PAs across the US in 2016 to ascertain PA practice characteristics, to describe oral health screening activities for patients, to understand the extent and source of PA education in oral health, and to determine facilitators and barriers to the integration of oral health service in practice.
Understanding the Impact of Dental Residents and Student Externs on Oral Health Service Delivery Capacity in the Safety Net
Demand for dental residency and dental student externship opportunities has grown in recent years, driven by the economy for dental employment and the desire of students for increased market competitiveness. In addition to specialty residencies, some states now also require that general dentists complete a year of advanced education in general dentistry before licensure. The Teaching Health Center program, a feature of the ACA, has contributed to increased capacity in dental residency programs, has impacted new dentist preparedness for practice, has increased opportunities for recruitment and retention of dentists in community clinics, and has increased access to oral health services for safety net populations. OHWRC examined trends in demand for advanced training by students and how this aligns with current policy supporting this training and practice. Researchers also explored the impact of residencies in ambulatory care settings, particularly for FQHCs, on service capacity and access for patients.
Case Studies of 6 Innovative Oral Health Service Delivery Programs Using Teledentistry
Teledentistry is an emerging strategy with the potential to improve oral health outcomes for underserved populations, particularly those living in rural communities. OHWRC conducted 6 case studies of innovative oral health programs in different states that employed teledentistry. The case studies entailed site visits and in-depth interviews with both administrative, HIT, and clinical staff at selected sites where teledentistry services are provided. In addition, OHWRC reviewed current state statutes and regulations in dentistry with a specific focus on regulation of teledentistry and state-level reimbursement policies for oral health providers accepting Medicaid and/or commercial insurance for services provided using teledentistry. The findings provide a better understanding of teledentistry program applications, workforce strategies, impacts on access to care, the organizational structure in which services are provided, and the barriers and facilitators of teledentistry services.
Development of a New Scope of Practice Index for Dental Hygienists
As part of its Year 1 research projects, staff at OHWRC conducted an extensive review of state legislation and regulation governing registered dental hygienists in order to describe the current regulatory environment and quantify it using the 2001 dental hygiene professional practice index (DHPPI). However, much has changed for the dental hygiene profession in the decade since the DHPPI was constructed and the utility of the 2001 DHPPI for analysis had diminished. In 2016, OHWRC updated and modified the DHPPI scale by adding new variables to better quantify current practice for dental hygienists and allow comparisons of change over time for dental hygiene practice in each state.
Underrepresented Minority Dentists’ Contribution to Health Equity in the US
Black, Hispanic, and American Indian/Alaska Native dentists are substantially underrepresented relative to their proportion in the general population. HRSA has a strong commitment to improve health workforce diversity. OHWRC examined nationally representative sample survey data of underrepresented minority (URM) dentists in the US to determine the supply, distribution, and practice patterns of URM dentists, current contributions to dental care for minority populations, and future supply and impact on the access to care for minority populations based on cohort practice patterns and projected inflows through US schools as well as immigration flows over time.
Year 1 Projects
A Comparison of Medicaid Dental Claims Data in 2 States With Different Adult Dental Benefits, 2012-2013
OHWRC conducted a comparative analysis of Medicaid dental claims over a 2-year period in New York and Oklahoma. Oklahoma Medicaid provides only a limited dental benefit for adult enrollees 21 years of age and older, including emergency exams and extractions of diseased teeth. In contrast, adult Medicaid beneficiaries
in New York State have a comprehensive dental benefit that includes preventive services, restorative services, periodontal services, dentures, and oral surgery services. The objective of this research was to understand the impact of Medicaid dental benefits and availability of providers on utilization of dental services.
This research resulted in:
- A Comparison Report, Policy Brief, and Abstract;
- A Oklahoma-specific Report, Policy Brief, and Abstract; and
- A New York-specific Report, Policy Brief, and Abstract
Updating the Professional Practice Index for Dental Hygienists in the 50 US States and the District of Columbia
OHWRC updated the scope of practice index for registered dental hygienists (RDHs) that was originally created in 2001. Researchers provided an objective quantification of current practices for RDHs and a comparison of changes over time for dental hygiene practice in each state of the US.
Case Studies of Oral Health Service Delivery Models Used in Long-Term Care Settings
OHWRC examined the current and changing practice models utilized in providing dental services in long-term care, residential care, and for homebound individuals through 4 state case studies. A secondary objective was to determine policy variables that may impact the availability of these services within a state or community and describe these impacts.
A Study of the Dental Assistant Workforce in the United States
OHWRC conducted a comprehensive examination of the dental assisting profession to understand the contributions of dental assistants to oral health services. Researchers examined demographic and educational characteristics of dental assistants and identified gaps in data about this workforce that should be addressed.
Case Studies of 8 Federally Qualified Health Centers to Describe Oral Health Services Delivery and Oral Health Workforce Innovation
OHWRC developed 8 case studies of federally qualified health centers (FQHCs) that use various oral health and/or medical workforce in their care delivery models to provide oral health services to high-need populations. One goal of the study was to better understand the use of new or alternative workforce models in oral health services delivery and to understand their contributions to patient care.