Notes

Predictors in the result of physiotherapy using a meniscus tear: A planned out evaluation.
Chronic disease management models in primary care have demonstrated significant benefits to the patient experience and patient health outcomes. In trying to prepare for the future, with or without COVID-19 implications, dental providers and clinics are facing opportunities to add value, consider alternative payment models, and to incorporate risk stratification and population health management along with medical systems. RMC-4550 purchase However, as alternative payment models emerge in dentistry, stand-alone dental clinics may face unique challenges in trying to prepare for the future while still providing patient care in the fee for service environment. This article focuses on a 6-months pilot project of how implementing a comprehensive caries disease management care model, evaluating caries risk, and implementing risk stratification strategies can prepare dental offices for future payment models and inclusion in the greater health system. There are two overall goals for this pilot. First, applying a caries disease management protocol to every patient visit, regardless of reimbursement. Second, applying quality improvement (QI) principles to change how a dental office approaches care delivery. The Institute of Medicine defines quality in healthcare as a direct correlation between the level of improved health services and the desired health outcomes of individuals and populations.The U.S. healthcare sector is a paradox - achieving comparatively poor population health outcomes despite outspending the world - and the current paradigm is a dichotomy - pursuing value definition consisting of quality, outcome, and cost, but failing to act in aligned and informed manner. In 2018, U.S. dental spending was $136 billion, accounting for 3.7 percent of total healthcare spending, a relatively nominal amount when considering oral diseases are among the most prevalent and have serious health and economic burdens, greatly reducing quality of life for those affected. Consistent and growing evidence shows that primary care-oriented systems achieve better health outcomes, more health equity, and lower costs; however, to date, there is little means to structuralize the role of oral health and quantify the value provided. To understand the reasons behind the abstract nature of value-based care requires an in-depth understanding of the drivers impeding the transition to a value based oral health system of care. One large clinically integrated network will provide detail of their experience.The upheaval of providers and their patients has led to many changes in the way people live and work. In addition to the changes in Personal Protective Equipment (PPE) guidelines, there has been evidence of rapid adoption of telehealth services. In April of 2020, the American Dental Association's Health Policy Institute released a report stating that 1 in 4 dentists nationally were utilizing teledentistry to perform limited evaluations. Many of these dentists are new to teledentistry, and unfortunately, direct-to-patient consultations yield limited clinical outcomes. The more traditional methods of using teledentistry have been extending the reach of dental care for over a decade, using an allied team member such as a dental hygienist or expanded-function dental assistant. As dentistry adapts to this new environment, it is important that there be adequate awareness of the diverse uses of teledentistry to meet the needs of the population. This brief, outlines one dental clinic's attempt at providing a broad use of teledentistry.Dental professionals and consumer advocates can work together toward oral health integration in a value-based care environment. This provides examples from California and Massachusetts of successful advocacy partnerships.
The United States health system is challenged to improve patient and population health, enhance patients' experience of care, and reduce health care costs. Value-based health care (VBHC) models are proposed to address these issues. Medical health systems are making strides toward VBHC, whereas dental care systems lag behind. The aims of this paper are to a) present study findings of an interprofessional practice model integrating oral health and primary care in a dental practice setting, and b) discuss practice and research implications for advancing VBHC approaches in oral health.

A nonexperimental research method was employed to evaluate the Nurse Practitioner-Dentist Model for Primary Care (NPD Model) at the Harvard Dental Center. Pretest/post-test design was used to assess clinical patient outcomes for a convenience cohort of Medicare beneficiaries (n = 31) with a reported diagnosis of hypertension and/or type 2 diabetes. Clinical outcome measures included blood pressure, weight, body mass index (BMI), and Hemoglobin A1c.

Positive and significant improvements in biometrics (blood pressure, body weight, BMI, HbA1c) were found.

The NPD Model is an early prototype for interprofessional VBHC in oral health and holds promise for improving patient and population health outcomes. Integration of interprofessional VBHC in oral health is an imperative for achieving the Triple Aim to improve the overall health of our nation.
The NPD Model is an early prototype for interprofessional VBHC in oral health and holds promise for improving patient and population health outcomes. Integration of interprofessional VBHC in oral health is an imperative for achieving the Triple Aim to improve the overall health of our nation.Dental caries are the most common chronic disease of childhood. Untreated caries can result in severe pain and infection; and in some cases, difficulties in eating, speech, and education. Hospitalization and general anesthesia are often necessary for treating extensive disease in young children, which adds significant risk and expense. Interventions, such as community-based preventative care, utilization of pre-authorizations for treatment, and at-risk contracts, have been deployed as innovative strategies to reduce the incidence of caries and the cost of treatment. Value-based payment structures give payors flexibility to design a multipronged system to impact the health of consumers. This practice brief will identify interventions at a systems level that reduced the utilization of general anesthesia treating dental caries in children under the age of six. Dental claims data from the period of Q1 2011 to Q2 2020 were utilized to analyze the trends in utilization of the operating room (OR) to treat dental conditions among children under 6 years.
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