Supporting HIV care through education and innovation

Module 3: Organizational Models Studied in the SPNS Oral Health Initiative

Module 3: Organizational Models Studied in the SPNS Oral Health Initiative

November 2013
Author:
IHIP
HRSA HIV/AIDS Bureau

60 minutes

Materials Needed:

  • Computer and compatible LCD projector to play the PowerPoint presentation
  • Internet connection to access the module video
  • Copies of the handout referenced in this module (should be printed out and distributed to each person).

POWERPOINT PRESENTATION

SLIDE 1: Background of the SPNS Innovations in Oral Health Care Initiative

  • Sponsored demonstration projects at 15 sites across the country
  • Provided oral health care to underserved HIV-positive individuals in 12 States and one U.S. Territory
  • Ran from 2006–2011
  • Oral Health Initiative information posted on SPNS site: http://hab.hrsa.gov/abouthab/special/oralhealth.html
  • The Health and Disability Working Group at the Boston University School of Public Health was chosen to lead the multisite evaluation, which occurred under the project Evaluation Center on HIV and Oral Health (ECHO). The initiative evaluation center Website can be accessed at: http://echo.hdwg.org/.

SLIDE 2: Objective of the SPNS Oral Health Initiative and Medical Care Outcomes

  • The overall goal of the initiative was to expand access to comprehensive oral health care provided in accordance with professional standards to improve oral health outcomes of PLWHA.
  • Other important objectives of the SPNS Oral Health Initiative included integrating medical and dental care, and sustaining programs beyond the life of the grant.
  • Initiative outcomes

    – 2,500 PLWHA who had been out of oral health care for 1 year or more were served

    – 14,500 visits occurred

    – 26,000 dental procedures were performed.

SLIDE 3: Patient Testimonial to the Benefits of SPNS Oral Health Care

“[Oral health care has] definitely helped me. Because when [the Harbor Health dental staff] did the top teeth, I guess I had an infection in there probably for about a year and a half. So, my T cells once this was all done jumped 100 points. So yeah, and I feel a lot better. Now that I don’t have any pain, I’ve been in pain for like, I don’t know 8 years. I was used to it, you know.”

— SPNS Grantee Patient at Harbor Health in Provincetown, Massachusetts

Slide 4: Changing Lives Through Good Oral Health Video

  • Video: Watch the video, “Changing Lives Through Good Oral Health”: http://vimeo.com/13917365.

  • After the video, the Trainer should lead the group in discussion of reactions to the video.

    – What was your overall impression of the video?

  • Is there anything you learned about the impact of oral health on PLWHA that you did not know before watching this video?

Slide 5: Organizationa l Models Studied

  • Each demonstration site had to determine which organizational model(s) they would use, how they would recruit and train clinical staff, and how they would recruit and retain patients into care.
  • Six organizational models were used across the sites (many utilized various combinations):

    1. Increasing services at their existing clinics

    2. Building satellite clinics

    3. Collaborating with clinics in dental hygiene schools or community colleges

    4. Fee-for-service dental reimbursement with contracted providers

    5. Leasing space at existing private offices/clinics, and

    6. Purchasing mobile dental units.

 

HANDOUT

The Trainer should distribute the table of organizational model pros and cons shown below as a handout so that participants can take notes on the models during the following discussion of slides. Please read the pros and cons within the table.

OVERVIEW OF THE SIX SPNS ORGANIZATIONAL MODELS STUDIED

ModelGranteeProsCons/Caveats
Increasing
services at their
existing clinics
  • Harbor Health
  • Most expedient model
  • Does not necessarily enable clinic to expand oral health care access to
    new geographic areas or populations
Building satellite
clinics
  • AIDS Care Group
  • AIDS Resource Center
    Wisconsin
  • Special Health Resources for
    Texas
  • Community Health Center, Inc
  • Tenderloin Health Center
  • Reduces travel time for some patients, often reducing a huge
    barrier to care
  • Enables greater patient enrollment
  • Improves likelihood of program
    sustainability
  • Can be costly
  • Can take a lot of time to establish,
    including navigation of regulations
    and completion of construction
Collaborating
with clinics in
dental hygiene
schools or
community
colleges
  • HIV Alliance*
  • High-quality oral health care for PLWHA in a mixed clinic setting
  • Improved training in care of PLWHA
    and reduced perception of HIV
    stigma on part of students
  • Enhanced clinical space and
    equipment
  • Faculty supervision and training
  • Requires careful coordination and flexibility
  • Ensure that expectations for
    participating organizations in
    partnership are clearly and formally
    spelled out and agreed upon prior to
    beginning collaboration
Fee-forservice
dental
reimbursement
with contracted
providers
  • AIDS Resource Center Wisconsin
  • Reduced travel time for patients
  • More cost-effective than establishing
    a formal satellite clinic
  • Important to ensure that dentists recruited are culturally and clinically
    competent to serve PLWHA
  • Funding options for fee-for-service
    varies by State and may be more or
    less attractive to providers as a result
Leasing space at
existing private
offices/clinics
  • Center for Comprehensive Care
  • Increased access to care for patients
  • Less resource-intensive than building
    a satellite clinic
  • Provision of care in private clinics that
    are non-HIV-affiliated may reduce risk
    of stigma for patients
  • Leased office locations may not qualify as Medicaid-certified
    providers, limiting ability to bill for
    dental services in some States
  • Important to ensure that patient
    caseload is manageable so that
    patients can be seen at regular
    intervals for follow-up care to improve
    retention and clinical outcomes
Purchasing
mobile dental
units
  • Sandhills Medical Center
  • University of Miami
  • Louisiana State University
  • Montefiore Medical Center
  • Enables provision of care to patients isolated by geography or with
    challenges traveling to dental services
  • Ability to serve a high volume of
    patients
  • Expensive to purchase**
  • Expensive and time-intensive to
    maintain both the dental equipment
    and the unit itself***
  • Cannot be used anywhere—need
    open, flat area; proper parking
    permits; access to electricity to
    operate van and equipment; etc.
  • Requires research into unique
    State regulations, infection control
    procedures, town and county parking
    ordinances, medical record access
    and storage, and scheduling and
    staffing
  • Requires referral of clients to other
    nonmobile clinics for many dental
    services, including most x-rays
  • Patient confidentiality may be a
    concern when using electronic
    medical records through wireless
    system
  • Difficult to navigate roads with
    sensitive dental equipment on
    board because measures used to
    hold equipment stable were often
    insufficient

*While HIV Alliance was the only grantee to use relationship with dental program as their program model, several other grantees established formal or informal relationships with dental professional schools.

**Mobile dental units used by grantees ranged from $144,000 for a one-chair unit to $330,000 for two-chair unit.

***All grantees who employed a mobile dental unit experienced frequent mechanical, electrical, and  vacuum  system  problems.

 

SLIDES 6–8: Overview of Pros, Cons, and Important Considerations for the Six Organizational Models

The following slides review the pros, cons, and important considerations of each of the six organizational models studied by grantees during the SPNS Oral Health Initiatve.

 

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