P2.205: Redesigning a System: How Integrated Care Helped Patients in Ohio

Purpose/Objectives: MORE Care® is a medical-dental integration (MDI) framework that uses quality improvement (QI) methods to integrate oral health primary care offices while building patient-centered referral networks with dental providers. CareQuest Institute for Oral Health and Oral Health Ohio (OHO) piloted MORE Care in Ohio (2022-24) where participants focused on three key drivers to improve patient oral health: 1) increase access to quality care through workforce capacity building 2) reduce tooth decay by increasing preventive care services 3) establishing interdisciplinary referral relationships.

Design/Methods: The MORE Care framework employs a mixed-methods approach to evaluate its impact on the oral health outcomes of pediatric patients aged 0 - 18. CareQuest Institute and OHO paired each pediatrician with a dental provider in their area as their referral partner.

Participants engaged in an active online learning curriculum featuring peer-to-peer learning, self-paced courses, and hands-on training. After this training phase, participants entered a period of observation where CareQuest Institute and OHO gathered insights to help determine the sustainability of changes introduced through the program. These changes included adding oral health assessments, fluoride varnish applications, and patient-self-assessment goals to well-child visits.

Insights were gathered by analyzing quantitative and qualitative data collected during the project. Qualitative data was collected through interviews with participants and stakeholders throughout the program. Quantitative data was collected via monthly patient encounter data reports submitted to CareQuest Institute to track progress against their benchmarks.

Results: By program conclusion, MORE Care Ohio had reached the lives of over 19,000 children. Pediatric offices demonstrated marked growth in oral health services delivered compared to baseline (November 2021 – October 2022). These included an increase in oral health risk assessments (1,502%), self-management goals (1,069%), and fluoride varnish applications (1,375%).

The number of cross disciplinary referrals also showed a 100% growth from baseline (n=0) to program end (n = 407).

Participants also successfully shared and implemented what they learned with affiliated satellite locations, allowing a spillover effect outside the direct participant cohort.

Conclusion/Discussion: MDI in pediatric settings is often challenging due to variables such as competing priorities, incompatible electronic health records, barriers in communication, and general lack of resources. It is also more commonplace in public health settings. However, participants in MORE Care Ohio, representing diverse operating models, including health systems, private practice, and affiliates of accountable care organizations, successfully established referral networks and provided high quality, comprehensive care to patients. Use of QI principles and tools such as driver diagrams, Plan-Do-Study-Act cycles, and data visualization set these participants up for success. This demonstrates that with the proper tools and resources, MDI can be viable in and across diverse practice settings. Additionally, the organic spread of MDI to non-affiliated locations further affirms its sustainability beyond the program.