MOLAR: Mapping Oral health and Local Area Resources

Abstract Despite the importance of optimizing oral health as a public health goal, there remain significant disparities in access to oral health care and in health outcomes. Although there have been multiple studies showing similar risk factors for unmet oral health needs and emergency department (ED) utilization, and a high frequency of ED utilization for oral health conditions, the optimal strategy for leveraging an ED visit to connect patients to oral health care remains to be defined. Previous efforts to reduce ED utilization for oral health problems have focused on improving access to insurance and have not been successful in reducing ED visits. This project would use a hybrid effectiveness-implementation study to perform a randomized controlled trial of an intervention to reduce unmet oral health and social needs in the ED, while collecting information to inform subsequent implementation strategies. We will assess individual, health system and community level impacts of an intervention to identify and address adverse social determinants of health (aSDoH) along with unmet oral health needs among ED patients. ED patients randomized to (1) standard of care handout of regional dental clinics, (2) geographically-matched Medicaid-accepting dental clinics or (3) aSDoH screening + geographically- matched resources for oral health and aSDoH and phone navigation as necessary to access resources. For Aim 1, the primary outcome will be individual successful linkage to oral health care at 1 month; for Aim 2, the primary outcome will be return visits for oral health concerns. In Aim 3, we assess the spatial association of (a) dental clinics and (b) social resources with intervention efficacy to understand the community and policy needs underlying successful intervention of linkage interventions. The proposed work builds on our team’s strong track record in development of ED-based screening, with feasibility demonstrated by our pilot work and successful enrollment. This work provides the baseline information to develop a patient-centered, technology- driven strategy to integrate oral health and aSDoH into the emergency care workflow in a sustainable and scalable way. In doing so, we fulfill two of the primary goals of the NIDCR Strategic Plan: (1) Enabling “precise and personalized oral health care” by developing a model to identify patients at risk in the ED and facilitating their connection to local, accessible, community oral health care; and (2) Using “multidisciplinary research approaches to overcome disparities and inequalities” by using the ED to enroll patients who do not otherwise have access to oral health care and ensure that they are connected to appropriate community resources for their social needs and oral health care. By doing so, we address the potential drivers of poor oral health and the challenges around accessibility of oral health care. Our long-term goal is to reduce the burden of untreated oral disease in vulnerable populations by integrating screening and referral for oral health and aSDoH into ED care, and thereby reduce potentially preventable ED visits, particularly for oral health conditions.