Evaluating the Impact of Dental-Medical Integration among Medicare Beneficiaries: A Population-Based Approach

项目摘要/摘要：口腔健康与许多常见的系统性疾病有关。 符合医疗保险年龄条件的患者(即65岁的成年人)是这两种类型的高危人群 疾病以及未得到满足的社会和经济需求的高度流行(例如，粮食不安全或社会需求 与世隔绝)，这可能会导致不良的健康结果。随着人口老龄化和更大比例的 患者需要牙科服务和慢性病的预防和管理，是临床上综合的 协调跨临床职能(例如，牙科和医疗)、活动和地点的护理的模型可能 最大限度地发挥老年患者健康服务的价值。牙科环境是一个理想的位置，在那里 通过与其他健康机构合作，进行医疗干预，如慢性病筛查 护理专业人士。凯撒永久西北(KPNW)健康计划和永久牙科 联营公司实施了一项将牙科和医疗保健相结合的新计划--牙科-医疗 整合计划(DMIP)，2018年。DMIP提供加强的预防和疾病管理 旨在缩小关键的循证医疗保健差距以改善长期健康状况的服务 结果。DMIP为评估将进行的自然实验提供了理想的机会 对年龄在≥65岁之间接受牙科护理的医疗保险患者进行回溯性队列设计 2018年7月1日至2019年12月31日，并在就诊时有1个或1个以上的医疗保健缺口。拟议的具体目标 目标1.评估牙医结合与证据关闭之间的联系- 基于65岁≥老年医疗保险患者的医疗保健差距；目标2.描述 ≥65岁老年医疗保险患者未得到满足的社会和经济需求的频率和类型 在DMIP诊所进行牙科护理，并评估是否有社会或经济需求 与填补循证医疗保健差距有关。这项研究将提供有价值的 了解DMIP与医疗保健差距缩小的关系，提高我们的认识 未得到满足的社会和经济需求在多大程度上影响这种关系。研究结果可以作为 以人口为基础的综合识别和解决办法的益处的初步证据 牙科环境中的医疗保健缺口。此外，结果将具有政策意义，解决之前的呼吁 由利益相关者团体，包括国家医学科学院、信诺和安泰，进行进一步投资 在全美范围内更强大的牙科-医疗整合计划中，以扩大对建议的 治疗和促进更好的整体健康。最终，这项研究将为 关于DMIP对长期健康结果的影响的假设和研究问题将在一项 未来的R01。

PROJECT SUMMARY/ABSTRACT: Oral health is associated with many common systemic diseases. Medicare age-eligible patients (i.e., adults age 65+ years) represent a population at high risk for both types of disease, as well as a high prevalence of unmet social and economic needs (e.g., food insecurity or social isolation) which may contribute to poor health outcomes. As the population ages and a larger proportion of patients require dental services and chronic disease prevention and management, a clinically integrated model that coordinates care across clinical functions (e.g., dental and medical), activities, and sites may maximize the value of health services for older patients. The dental setting is an ideal location in which to conduct medical care interventions, such as chronic disease screening, by collaborating with other health care professionals. The Kaiser Permanente Northwest (KPNW) health plan and Permanente Dental Associates implemented a novel program that integrated dental and medical care, the Dental-Medical Integration Program (DMIP), in 2018. The DMIP provides enhanced preventive and disease management services with the goal of closing critical evidence-based medical care gaps to improve longer term health outcomes. The DMIP presents an ideal opportunity to evaluate a natural experiment, which will be conducted using a retrospective cohort design of Medicare patients age ≥65 who received dental care between 7/1/2018-12/31/2019 and had 1 or more medical care gaps at time of their visit. The proposed specific aims are: Aim 1. Evaluate the association between dental-medical integration and closure of evidence- based medical care gaps among Medicare patients aged ≥65 years; Aim 2. Characterize the frequency and type of unmet social and economic needs among Medicare patients aged ≥65 years seen for dental care in DMIP clinics and assess whether having social or economic needs are associated with closure of evidence-based medical care gaps. This study will provide valuable information on the relationship between DMIP and medical care gap closure and improve our understanding of the extent to which unmet social and economic needs affect this relationship. Study findings may serve as initial evidence of the benefit of a comprehensive population-based approach to identifying and resolving medical care gaps in the dental setting. Moreover, results will have policy significance, addressing prior calls by stakeholder groups including the National Academy of Medicine, Cigna, and Aetna, for further investment in more robust dental-medical integration programs across the U.S. to expand access to recommended treatments and promote better overall health. Ultimately, this study will inform the development of hypotheses and research questions about the effect of DMIP on long-term health outcomes to be tested in a future R01.