Despite efforts to improve access to oral health services in the US, oral health disparities persist for many vulnerable population groups, including children. Children are especially vulnerable to not receiving health or oral health services because they are dependent on others to arrange appointments and provide transportation to services. Researchers at the OHWRC collaborated with the Health Workforce Research Center at the Association of American Medical Colleges (AAMC) to survey parents about the factors that affect access to oral health services for their children. This report highlights unique access barriers for specific high-need children (racial/ethnic minorities, low-income parents, uninsured families, Medicaid beneficiaries, rural individuals) or geographic regions.
Oral health providers across the country that work in the safety net have used a variety of innovative strategies to expand access to oral health services in community-based settings, including federally qualified health centers, schools and nursing homes, among others. This compendium summarizes best practices in innovative oral health service delivery programs drawn from over 40 case studies conducted by the OHWRC in recent years. Organizations included were early initiators of service integration, mobile/portable dentistry, and/or teledentistry. Brief summaries of each organization include infographics as well as detail the problem, solution, facilitators, barriers, and benefits that the organization encountered in its efforts to expand access to care for underserved populations.
The Health Resources and Service Administration (HRSA) mission is “To improve health outcomes and address health disparities through access to quality services, a skilled health workforce, and innovative, high-value programs.” To support this mission, HRSA supports primary care postgraduate dental (PGD) training programs through competitive grant funding. Primary dental care fields include Advanced Education in General Dentistry (AEGD), General Practice Residency (GPR), Pediatrics, and Dental Public Health (DPH). Researchers at OHWRC assessed the impacts of this HRSA-funded training experience on current practice patterns of completers of these programs, and subsequent patient access to care. This study also aims to measure the long-term impact of these programs on improving the capacity of dentists to meet the needs of the underserved.
Demographic changes within the dental profession including aging and gender distribution are affecting dental practice characteristics and practice locations. OHWRC collaborated with the American Dental Association (ADA) to conduct secondary data analyses to assess the impact of demographic changes in dentistry on access to oral health services, particularly in rural areas and for underserved populations.
Despite efforts over the past decade to improve access to oral health services in the US, oral health disparities persist for many high need populations. To better understand the factors that contribute to these disparities from the patient perspective, OHWRC partnered with the Workforce Studies unit at the Association of American Medical Colleges (AAMC) to include a series of questions on oral health care access in AAMC’s biannual Consumer Survey of Health Care Access.
There is growing recognition of the relationship between mental illness and behavioral health disorders with oral and physical health status. Safety net provider organizations are key to providing integrated care for many of their patients with mental health or substance use disorders. OHWRC will conduct 6 case studies of Federally Qualified Health Centers or other safety net providers that have successfully integrated oral health and substance abuse/behavioral health services.
Federally qualified health centers (FQHCs) are increasingly providing oral health services directly to patients in fixed clinics and mobile and portable oral health programs. However, some continue to offer only referrals or vouchers for services from community dentists. This study examines factors that impact the decision of an FQHC to provide oral health services directly, including state Medicaid and reimbursement policies for oral health. The study used a variety of data sources including HRSA’s Uniform Data System and primary data.
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.
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.
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 examines the variety of DSO models, who they serve, their workforce needs and practices, career pathways provided, and evolving models of workforce deployment.
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 Academy 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.
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.
OHWRC analyzed and summarized their findings of Medicaid dental claims over a 2-year period in New York State, which has 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.
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. The report also explores the impact of residencies in ambulatory care settings, particularly for FQHCs, on service capacity and access for patients.
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.
As part of its Year 1 research projects, staff at OHWRC conducted an extensive review of state legislation and regulation governing RDHs in order to describe the current regulatory environment and quantify it using the 2001 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 has diminished. In 2016, OHWRC updated and modified the DHPPI scale by adding new variables to better quantify current practice for RDHs and allow comparisons of change over time for dental hygiene practice in each state.
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.
OHWRC updated the scope of practice index for registered dental hygienists (RDHs) that was originally created in 2001. This report provides an objective quantification of current practices for RDHs and a comparison of changes over time for dental hygiene practice in each state.
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. This report describes the findings from case studies conducted for the project.
OHWRC analyzed and summarized their findings of Medicaid dental claims over a 2-year period in Oklahoma, where the Medicaid program provides only a limited emergency dental benefit for eligible adults. The objective of this research is to understand the impact of Medicaid dental benefits and availability of providers on utilization of dental services.
The Dental Assistant Workforce in the United States, 2015 (Report)
OHWRC conducted a comprehensive examination of the dental assisting profession to understand the contributions of dental assistants to oral health services. This study discusses demographic and educational characteristics of dental assistants and identifies gaps in data about this workforce that should be addressed.
Case Studies of 8 Federally Qualified Health Centers: Strategies to Integrate Oral Health with Primary Care (Report)
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 is to better understand the use of new or alternative workforce models in oral health services delivery and to understand their contributions to patient care.