OBJECTIVE: This study completed the development of a standardized patient-centered dental home (PCDH) framework to align and integrate with the patient-centered medical home. This study identified measure concepts and specific measures and standards to complete the 4-level measurement framework to implement and evaluate a PCDH. This study built on prior model development, which identified the PCDH definition and characteristics and the components nested within those characteristics.

METHODS: An environmental scan identified existing oral health care quality measure concepts, measures, and standards for rating by the project's National Advisory Committee (NAC). A modified Delphi process, adapted from the RAND appropriateness method, was used to obtain structured feedback from the NAC. NAC members rated measure concepts on importance and, subsequently, specific measures and standards on feasibility, validity, and actionability using a 1 to 9 rating scale. Criteria for model inclusion were based on median ratings and rating dispersion. Open-ended comments were elicited to inform model inclusion as well as identify additional concepts.

RESULTS: We identified more than 500 existing oral health care measures and standards. A structured process was used to identify a subset that best aligned with a PCDH for rating by the NAC. Four Delphi rounds were completed, with 2 rounds to rate measure concepts and 2 rounds to rate measures and standards. NAC quantitative ratings and qualitative comments resulted in a total of 61 measure concepts and 47 measures and standards retained for inclusion in the framework.

CONCLUSIONS: The NAC ratings of measure concepts, and specific measures and standards nested within those concepts, completed the 4-level PCDH measurement framework. The resulting framework allows for the development and implementation of core measure sets to identify and evaluate a PCDH, facilitating quality improvement and dental-medical integration.

KNOWLEDGE TRANSFER STATEMENT: Clinicians, payers, health care systems, and policy makers can use the results of this study to guide and assess implementation of the various components of a patient-centered dental home and to support dental-medical integration.

OBJECTIVES: The Rocky Mountain Network for Oral Health (RoMoNOH) promotes the delivery of preventive oral health services (POHS) to children receiving care at community health centers (CHCs) in Arizona, Colorado, Montana, and Wyoming. One POHS is oral health goal setting (OHGS). This study aimed to evaluate the effect of OHGS during medical visits on parent/caregiver-reported oral health behaviors (OHBs). METHODS: The RoMoNOH implementation team trained CHC healthcare providers in POHS, including caries risk assessment, oral health education, fluoride varnish application, dental referrals, and parent/caregiver oral health engagement. To promote parents' oral health engagement, healthcare providers were trained in motivational interviewing (MI) with OHGS at medical visits. To evaluate the impact of MI with OHGS on parent/caregiver OHBs, a healthcare team member invited parents/caregivers to complete a baseline survey after their medical visits. The evaluation team sent a follow-up survey after 10-14 days. The surveys measured parents/caregivers' goals, confidence in goal attainment, OHBs, and sociodemographics; the follow-up survey also measured OHGS attainment. Improvement in parent/caregiver-reported OHBs was tested with a paired t-test and unadjusted and adjusted multiple linear regression. RESULTS: In total, 426 parents/caregivers completed the baseline survey; 184 completed both surveys. OHBs, including toothbrushing frequency, stopping bed bottles, drinking tap water, and brushing with fluoride toothpaste improved over the evaluation interval. After adjusting for covariates, brushing with fluoride toothpaste (p = 0.01), drinking tap water (p = 0.03), and removing bed bottles (p = 0.03) improved significantly. CONCLUSION: MI with OHGS with parents/caregivers during medical visits has potential to improve OHBs on behalf of their children.

Cross-sector collaborations are alliances among partners from various sectors, including health, education, and business, working together to address complex issues. These alliances are key to addressing inequities in maternal health outcomes. The seven chapters in this section outline examples of successful collaborations, provide information on barriers to, and facilitators of, successful collaboration, or describe opportunities to engage with traditional or nontraditional stakeholders invested in maternal health. Community engagement is also important in building cross-sector collaborations aimed at addressing inequities. The chapters of this section will give readers a better understanding of models for collaborations and community engagement that can be adapted and employed to address inequities in maternal health.

Introduction : This is the first study to use the Common-Sense Model of Self-Regulation (CSM) theory for oral health (OH) interventions in pediatric practices. The objective of this qualitative study was to assess adoption and implementation of theory-based multi-level OH interventions, by clinicians (pediatricians and nurse practitioners) participating in a cluster-randomized clinical trial (cRCT), to create an OH toolkit for widespread dissemination into pediatric practices. Methods : Semi-structured interviews were conducted at the conclusion of the cRCT with 21 clinicians from 9 practices participating in the intervention arm. Clinicians in this arm received CSM theory-based education and resources to deliver OH interventions to parents/caregivers and document in EMR. Semi-structured interview questions were based on the Diffusion of Innovations Theory, assessing adoption and implementation. The interviews were coded using NVivo (QRS International) software. Main themes were identified using a thematic analysis approach. Results : Five themes identified from the interviews included: strengths of theory-based OH training for clinicians, OH resources to improve quality of care, considerations for efficient future implementation, financial considerations, and parent benefits and challenges. Clinicians found that the theory-based training and resources increased knowledge and confidence when addressing OH with parents and required only ≤ 2 minutes in their workflow with no financial consequences. Clinicians reported an increase in OH awareness among parents but suggested an overall need for more pediatric dentists. Conclusions : The CSM theory-based education and resources were well received by clinicians and perceived to be beneficial without adverse impact on workflow or practice finances. An online toolkit is planned, as these OH interventions can be successfully implemented and delivered in medical settings.

Dental caries affect 97% of the world's population during their lifetime. Early childhood caries are the number one chronic disease affecting young children, and it disproportionately affects children of low-income families. American Academy of Pediatrics recommends fluoridated toothpaste to all children starting at tooth eruption, regardless of caries risk. In addition, fluoride varnish is recommended in all children every 3 to 6 months from tooth emergence until they have an established dental home. The health disparities that are most apparent in the rural communities are inadequate prenatal care, low birth weight, cancer, chronic respiratory disease, heart disease, unintentional injury, and stroke. When it comes to oral health, water fluoridation is one of the most cost-effective strategies in preventing dental caries. The need for oral health education in physician assistant/associate (PA) programs is well documented. Implementation has largely been performed using interprofessional education. This article describes an interprofessional education program that teaches PA students to apply fluoride varnish so that they are practice-ready when they graduate and practice medicine.