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Improving Access to Oral Health Care for Vulnerable and Underserved Populations (2011)

Chapter: Appendix D: Summary of *Advancing Oral Health in America:* A Report of the IOM Committee on an Oral Health Initiative

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Suggested Citation:"Appendix D: Summary of *Advancing Oral Health in America:* A Report of the IOM Committee on an Oral Health Initiative." Institute of Medicine and National Research Council. 2011. Improving Access to Oral Health Care for Vulnerable and Underserved Populations. Washington, DC: The National Academies Press. doi: 10.17226/13116.
×

Appendix D


Summary of Advancing Oral Health in America: A Report of the IOM Committee on an Oral Health Initiative

In February 2010, with support from the Health Resources and Services Administration (HRSA), the Institute of Medicine (IOM) formed the Committee on an Oral Health Initiative to assess the current oral health care system and to advise the Department of Health and Human Services (HHS) on actions that should be taken for an HHS oral health initiative (see Box D-1). This study was conducted at the same time that the IOM’s Committee on Oral Health Access to Services study was under way. While

BOX D-1

The Committee on an Oral Health Initiative Statement of Task

The IOM Board on Health Care Services, in collaboration with the Board on Children, Youth, and Families, will undertake a study to

Assess the current oral health care system for the entire U.S. population;

Examine preventive oral care interventions, their use and promotion;

Explore ways of improving health literacy for oral health;

Review elements of a potential HHS oral health initiative, including possible or current regulations, statutes, programs, research, data, financing, and policy; and

Recommend strategic actions for HHS agencies and, if relevant and important, other actors, as well as ways to evaluate this initiative.

Suggested Citation:"Appendix D: Summary of *Advancing Oral Health in America:* A Report of the IOM Committee on an Oral Health Initiative." Institute of Medicine and National Research Council. 2011. Improving Access to Oral Health Care for Vulnerable and Underserved Populations. Washington, DC: The National Academies Press. doi: 10.17226/13116.
×

the two studies had related statements of task, the two projects had separate committees, meetings, and report review processes. The two committees were not made aware of the other’s conclusions or recommendations.

The IOM Committee on an Oral Health Initiative’s report, Advancing Oral Health in America, released in April 2011, summarizes the state of oral health today, underscores the important oral-systemic connection, describes the current role of HHS, and provides lessons learned from previous related efforts. The committee made seven recommendations in six key areas, including establishing and evaluating an oral health initiative; focusing on prevention; improving oral health literacy; enhancing the delivery of oral health care; expanding research; and measuring progress. Finally, the committee identified three key areas needed to ensure success: strong leadership, sustained interest, and the involvement of multiple stakeholders. This appendix provides an overview of the report, Advancing Oral Health in America. Full text of the report can be found online at http://www.iom.edu/oralhealthinitiative.

ORGANIZING PRINCIPLES FOR AN HHS ORAL HEALTH INITIATIVE

The Committee on an Oral Health Initiative developed a set of organizing principles based on the areas in greatest need of attention as well as approaches that have the most potential for creating improvements:

1. Establish high-level accountability.

2. Emphasize disease prevention and oral health promotion.

3. Improve oral health literacy and cultural competence.

4. Reduce oral health disparities.

5. Explore new models for payment and delivery of care.

6. Enhance the role of nondental health care professionals.1

7. Expand oral health research, and improve data collection.

8. Promote collaboration among private and public stakeholders.

9. Measure progress toward short-term and long-term goals and objectives.

10. Advance the goals and objectives of Healthy People 2020.

RECOMMENDATIONS

Based on these principles, the Committee on an Oral Health Initiative recommended several approaches that HHS could take to help improve the

______________

1 Nondental health care professionals includes, but is not limited to, nurses, pharmacists, physician assistants, and physicians.

Suggested Citation:"Appendix D: Summary of *Advancing Oral Health in America:* A Report of the IOM Committee on an Oral Health Initiative." Institute of Medicine and National Research Council. 2011. Improving Access to Oral Health Care for Vulnerable and Underserved Populations. Washington, DC: The National Academies Press. doi: 10.17226/13116.
×

oral health of the nation. The committee referred to this set of recommendations as the New Oral Health Initiative (NOHI), to distinguish it from and build upon HHS’ existing Oral Health Initiative.

RECOMMENDATION 1: The secretary of HHS should give the leader(s) of the New Oral Health Initiative (NOHI) the authority and resources needed to successfully integrate oral health into the planning, programming, policies, and research that occur across all HHS programs and agencies:

Each agency within HHS that has a role in oral health should provide an annual plan for how it will integrate oral health into existing programs within the first year.

Each agency should identify specific opportunities for public-private partnerships and collaborating with other agencies inside and outside HHS.

The leader(s) of the NOHI should coordinate, review, and implement these plans.

The leaders(s) of the NOHI should incorporate patient and consumer input into the design and implementation of the NOHI.

RECOMMENDATION 2: All relevant HHS agencies should promote and monitor the use of evidence-based preventive services in oral health (both clinical and community based) and counseling across the life span by

Consulting with the U.S. Preventive Services Task Force and the Task Force on Community Preventive Services to give priority to evidentiary reviews of preventive services in oral health;

Ensuring that HHS-administered health care systems (e.g., Federally Qualified Health Centers, Indian Health Service) provide recommended preventive services and counseling to improve oral health;

Providing guidance and assistance to state and local health systems to implement these same approaches; and

Communicating with other federally administered health care systems to share best practices.

RECOMMENDATION 3: All relevant HHS agencies should undertake oral health literacy and education efforts aimed at individuals, communities, and health care professionals. These efforts should include, but not be limited to,

Community-wide public education on the causes and implications of oral diseases and the effectiveness of preventive interventions;

Suggested Citation:"Appendix D: Summary of *Advancing Oral Health in America:* A Report of the IOM Committee on an Oral Health Initiative." Institute of Medicine and National Research Council. 2011. Improving Access to Oral Health Care for Vulnerable and Underserved Populations. Washington, DC: The National Academies Press. doi: 10.17226/13116.
×

Focus areas should include

The infectious nature of dental caries,

The effectiveness of fluorides and sealants,

The role of diet and nutrition in oral health, and

How oral diseases affect other health conditions.

Community-wide guidance on how to access oral health care; and

Focus areas should include using and promoting websites such as the National Oral Health Clearinghouse and www.healthcare.gov.

Professional education on best practices in patient-provider communication skills that result in improved oral health behaviors.

Focus areas should include how to communicate to an increasingly diverse population about prevention of oral cancers, dental caries, and periodontal disease.

RECOMMENDATION 4: HHS should invest in workforce innovations to improve oral health that focus on

Core competency development, education, and training, to allow for the use of all health care professionals in oral health care;

Interprofessional, team-based approaches to the prevention and treatment of oral diseases;

Best use of new and existing oral health care professionals; and

Increasing the diversity and improving the cultural competence of the workforce providing oral health care.

RECOMMENDATION 5: CMS should explore new delivery and payment models for Medicare, Medicaid, and CHIP to improve access, quality, and coverage of oral health care across the life span.

RECOMMENDATION 6: HHS should place a high priority on efforts to improve open, actionable, and timely information to advance science and improve oral health through research by

Leveraging resources for research to promote a more robust evidence base specific to oral health care, including but not limited to

oral health disparities, and

best practices in oral health care and oral health behavior change;

Working across HHS agencies, in collaboration with other federal departments (e.g., Department of Defense, Veterans Administration) involved in the collection of oral health data, to integrate,

Suggested Citation:"Appendix D: Summary of *Advancing Oral Health in America:* A Report of the IOM Committee on an Oral Health Initiative." Institute of Medicine and National Research Council. 2011. Improving Access to Oral Health Care for Vulnerable and Underserved Populations. Washington, DC: The National Academies Press. doi: 10.17226/13116.
×

   standardize, and promote public availability of relevant databases; and

Promoting the creation and implementation of new, useful, and appropriate measures of quality oral health care practices, cost and efficiency, and oral health outcomes.

RECOMMENDATION 7: To evaluate the NOHI, the leader(s) of the NOHI should convene an annual public meeting of the agency heads to report on the progress of the NOHI, including

Progress of each agency in reaching goals;

New innovations and data;

Dissemination of best practices and data into the community; and

Improvement in health outcomes of populations served by HHS programs, especially as they relate to Healthy People 2020 goals and specific objectives.

HHS should provide a forum for public response and comment and make the final proceedings of each meeting available to the public.

The recommendations in Advancing Oral Health in America highlight the vital role that HHS can play in improving oral health and oral health care in the United States. The committee concluded that an HHS oral health initiative could be successful if it had clearly articulated goals, effective coordination, and adequate funding. The committee stressed that three key areas were needed to successfully maintain oral health as a priority issue for HHS: strong leadership, sustained interest, and the involvement of multiple stakeholders.

Suggested Citation:"Appendix D: Summary of *Advancing Oral Health in America:* A Report of the IOM Committee on an Oral Health Initiative." Institute of Medicine and National Research Council. 2011. Improving Access to Oral Health Care for Vulnerable and Underserved Populations. Washington, DC: The National Academies Press. doi: 10.17226/13116.
×

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Suggested Citation:"Appendix D: Summary of *Advancing Oral Health in America:* A Report of the IOM Committee on an Oral Health Initiative." Institute of Medicine and National Research Council. 2011. Improving Access to Oral Health Care for Vulnerable and Underserved Populations. Washington, DC: The National Academies Press. doi: 10.17226/13116.
×
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Suggested Citation:"Appendix D: Summary of *Advancing Oral Health in America:* A Report of the IOM Committee on an Oral Health Initiative." Institute of Medicine and National Research Council. 2011. Improving Access to Oral Health Care for Vulnerable and Underserved Populations. Washington, DC: The National Academies Press. doi: 10.17226/13116.
×
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Suggested Citation:"Appendix D: Summary of *Advancing Oral Health in America:* A Report of the IOM Committee on an Oral Health Initiative." Institute of Medicine and National Research Council. 2011. Improving Access to Oral Health Care for Vulnerable and Underserved Populations. Washington, DC: The National Academies Press. doi: 10.17226/13116.
×
Page 267
Suggested Citation:"Appendix D: Summary of *Advancing Oral Health in America:* A Report of the IOM Committee on an Oral Health Initiative." Institute of Medicine and National Research Council. 2011. Improving Access to Oral Health Care for Vulnerable and Underserved Populations. Washington, DC: The National Academies Press. doi: 10.17226/13116.
×
Page 268
Suggested Citation:"Appendix D: Summary of *Advancing Oral Health in America:* A Report of the IOM Committee on an Oral Health Initiative." Institute of Medicine and National Research Council. 2011. Improving Access to Oral Health Care for Vulnerable and Underserved Populations. Washington, DC: The National Academies Press. doi: 10.17226/13116.
×
Page 269
Suggested Citation:"Appendix D: Summary of *Advancing Oral Health in America:* A Report of the IOM Committee on an Oral Health Initiative." Institute of Medicine and National Research Council. 2011. Improving Access to Oral Health Care for Vulnerable and Underserved Populations. Washington, DC: The National Academies Press. doi: 10.17226/13116.
×
Page 270
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Access to oral health care is essential to promoting and maintaining overall health and well-being, yet only half of the population visits a dentist each year. Poor and minority children are less likely to have access to oral health care than are their nonpoor and nonminority peers. Older adults, people who live in rural areas, and disabled individuals, uniformly confront access barriers, regardless of their financial resources. The consequences of these disparities in access to oral health care can lead to a number of conditions including malnutrition, childhood speech problems, infections, diabetes, heart disease, and premature births.

Improving Access to Oral Health Care for Vulnerable and Underserved Populations examines the scope and consequences of inadequate access to oral health services in the United States and recommends ways to combat the economic, structural, geographic, and cultural factors that prevent access to regular, quality care. The report suggests changing funding and reimbursement for dental care; expanding the oral health work force by training doctors, nurses, and other nondental professionals to recognize risk for oral diseases; and revamping regulatory, educational, and administrative practices. It also recommends changes to incorporate oral health care into overall health care. These recommendations support the creation of a diverse workforce that is competent, compensated, and authorized to serve vulnerable and underserved populations across the life cycle.

The recommendations provided in Improving Access to Oral Health Care for Vulnerable and Underserved Populations will help direct the efforts of federal, state, and local government agencies; policy makers; health professionals in all fields; private and public health organizations; licensing and accreditation bodies; educational institutions; health care researchers; and philanthropic and advocacy organizations.

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