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Regional Oral Health Pathway

Summary 
  • Need: To address the oral health needs of low-income uninsured and underinsured residents in rural Appalachia.
  • Intervention: An oral health education program was implemented in Appalachian Maryland, Pennsylvania, and West Virginia.
  • Results: This program has increased oral health visits in the area and has provided residents with valuable information on oral health resources and services.

Evidence-level

Effective (About evidence-level criteria)

Description

The area of Appalachian Maryland has the highest percentage of adults with total tooth loss and the fewest adults who receive regular dental care in the state. These health issues can be attributed to low health literacy and poor health habits such as high consumption of sugary beverages, use of smokeless tobacco, lack of regular brushing and flossing, and irregular/infrequent visits to a dental provider.

The Regional Oral Health Pathway program serves Allegany County, Maryland; Garrett County, Maryland; Washington County, Maryland; Mineral County, West Virginia; and Bedford County, Pennsylvania, all of which are greatly affected by multi-generational poverty and have less access to healthcare and dental services than more urbanized areas.

Health Right logo

The Regional Oral Health Pathway program was created by Health Right in partnership with the Maryland Area Health Education Center West, Allegany County Health Department, Garrett County Health Department, and Hyndman Area Health Center, to address oral health needs and issues related to neglected oral care in uninsured and underinsured populations.

This program uses a Pathways Model, which uses community health workers (CHWs) to connect at-risk patients to community health and social services. The Pathways Model focuses on three critical action points: finding a target population, treating that population, and measuring progress. The Regional Oral Health Pathway program adapted this model to educate members of the target population in oral health self-care and support them in receiving preventive care. This was done through presentations and by providing information on oral health resources to the community.

Throughout the program, primary care providers and health professions students were trained in how to perform oral health screenings during routine physical exams. Dental providers were also recruited into the program, offering services at greatly reduced rates.

This program received support from a 2012-2015 Federal Office of Rural Health Policy (FORHP) Rural Health Care Services Outreach grant.

Services offered

  • Outreach and education activities
  • Preventive and acute dental treatment
  • Leveraging of treatment funds to provide extensive dental care for very little cost

Results

  • CHWs reached more than 2,000 consumers and more than 500 staff who serve adults with disabilities, with information on oral health self-care and dental services access.
  • Targeted outreach to low-income adults with disabilities resulted in dental treatment referrals for 646 adults with disabilities and 183 caregivers.

In addition, the program:

  • Provided more than 900 urgent dental treatment visits a year and close to $600,000 worth of dental care to those in need
  • Lowered treatment costs by paying a flat hourly rate of $150, resulting in an 80% reduction in actual value of care
  • Reduced emergency department visits by 16%
  • Trained 78 primary care providers and 76 health professions students in how to perform oral health screenings during routine physical exams
  • Recruited and maintained approximately 15 dental providers as part of the network
  • Increased number of low-income adults receiving urgent dental treatment from 177 to 549
  • Increased number of dental treatment visits from 279 to 883
  • Increased value of dental care provided from $162,691 to $590,016

Read more about Regional Oral Health Pathway in the RHIhub Rural Monitor article Community Health Workers Get Trained to Reduce Oral Health Disparities.

For more information about program results:

Rowland, S., Leider, J.P., Davidson, C., Brady, J., & Knudson, A. (2016). Impact of a Community Dental Access Program on Emergency Dental Admissions in Rural Maryland. American Journal of Public Health, 106(12), 2165-2170.

Barriers

Challenges faced by the program include:

  • Changes in personnel
  • Deviation taken from the original plan
  • Partners experiencing financial and personnel difficulties of their own
  • Changes in funding levels severely restricting the program's impact

Replication

In order to create a similar program, it is important to:

  • Try new models of working together
  • Collaborate in ways that maximize the benefit to the community
  • Work with partners to adapt billing practices to accommodate low-income individuals
  • Utilize existing community providers

Contact Information

Susan Stewart, Executive Director
AHEC West
301.777.9150
susan.stewart@ahecwest.org

Topics
Access
Appalachia
Community health workers
Oral health
People with disabilities
Wellness, health promotion, and disease prevention

States served
Maryland, Pennsylvania, West Virginia

Date added
September 2, 2015

Date updated or reviewed
August 6, 2019


Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.