The Surgeon General has called dental caries a “silent epidemic”, disproportionally suffered by the poor, with 80% of all dental decay occurring in low-income, homeless, and/or minority families. Many factors influence the access to and utilization of oral healthcare services in these populations: demographic characteristics and social structure (age, ethnicity, family size), childhood characteristics (victimization, homelessness, substance abuse), lack of understanding of the benefits of good oral health, and competing needs (e.g., housing, food). Pregnant mothers’ health beliefs, dental practices (e.g. diet, use of flouride, dental hygiene practices), and substance abuse history may complicate their fetus’ oral health because of vertical bacteria transmission that produce caries. Similar to oral health service utilization, medical health utilization is lower for children from poor, uninsured, and minority families. A study by Byck et al, shows that collaboration of these safety net organizations with dental safety-net clinics was key to addressing dental access to care barriers in underprivileged communities. The Connecticut Health Foundation, the Community Health Center, Inc., and partners such as Medicaid and DPH all have invested significant resources in increasing access to utilization of oral health services and in devising new and creative strategies to improve oral health and decrease dental decay in children and pregnant women. However, there has been little formal research to study the impact of these interventions on a systemic level. This project will examine specific issues of co-location of primary medical and oral health care services, through a retrospective cohort study. We will analyze dental care outcomes in prenatal patients and children ages birth to 5 years old across our statewide primary care network, and anticipate access and utilization trends for dental services and care between different models of dental care locations (e.g. all services in the same building versus services in different locations). Specifically cohorts of patients who were aged birth to 5 years as of December 31, 2011, and women who both received prenatal care at CHC and delivered their baby during calendar year 2011 will be studied. This project is particularly interested in exploring and clarifying the relationships between utilization of oral health services, at CHC or elsewhere, and the co-location, integration, or organized access to CHC’s own oral health services.
This study has major strategic importance as all partners consider how, where, and at what level to invest in physical co-location of services versus the investment in more virtual models of collaboration and coordination. The new knowledge contributions made from this project should be highly impactful in providing evidence for further action by delivery organizations and further support by the Connecticut Health Foundation for the location/co-location of oral health services and pediatric/obstetric (OB) services.