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
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.
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.
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.
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;
○ 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,
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.
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