The role of electronic records in the integration of oral health and primary care services in community health centers
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BACKGROUND: Medical-Dental integration involves the provision of fluoride varnish application, caries risk assessment, anticipatory guidance, and provision of dental referrals by pediatricians during well-child visits. Integration has been recommended as a means to increase access to quality dental care for patients from racial and ethnic minority groups who are at an increased risk of developing oral health problems. METHODS: Guided by the RE-AIM framework (Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance), this case study explored the barriers and facilitators for the incorporation of a medical-dental integration program at two community health centers in Massachusetts. Specifically, this study explored the degree to which electronic records were instrumental in the provision and documentation of oral health preventive services during pediatric primary care at the study sites. Data sources included analysis of records from 2014–2015 (before integration) to those from 2016-2018 (post integration), interviews with staff, clinicians, and administrators and direct observations of the workflow at dental and pediatric medicine departments in the study sites. A General Estimating Equation Analysis was conducted to estimate the odds of application of oral health preventive measures before and after electronic dental and medical electronic records were integrated at one of the sites. FINDINGS: During the years post-record integration, children were 40.3 times more likely to receive dental screenings, 2.7 times more likely to receive fluoride varnish during well child visits and 1.6 times more likely to receive fluoride in the dental department within six months of their well child visits compared to the period prior to integration. Respondents identified the complexity, ease of use and accessibility of tools within the electronic medical records as significant factors in success of integration efforts. CONCLUSIONS: Community health centers interested in successfully implementing a medical-dental integration model should invest in sufficient workflow and training resources for the transition to the new records system, develop a simplified protocol for the application of dental preventive services, design accessible electronic tools for documentation of services, and establish accurate reporting systems for both internal program monitoring and external surveillance purposes.