G-2212-17675

Tufts University School of Dental Medicine (TUSDM) is a private dental school located in Boston, Massachusetts, and is connected to Tufts Medical Center. TUSDM serves more than 30,000 patients annually and, through Tufts Dental Facilities, a public-private partnership between Tufts and the state, provides comprehensive dental care to more than 6,500 adults and children with intellectual and/or developmental disabilities (I/DD) across seven sites, two of which will participate in this pilot project.

TUSDM has received grant funding from CareQuest Institute in the past, with the most recent grant award made in 2016. That grant and some prior CareQuest Institute funding also supported TUSDM’s work to improve the oral health care experience for the I/DD patient community and their families, but focused primarily on education, training, and exposure for dental and medical residents to working with patients with medical complexity and/or I/DD. The results of the project included a toolkit and educational framework design based on the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF), which will also be leveraged for the proposed project.

This proposal outlines a pilot to test a model of oral health care for adults with medical complexity and/or intellectual or developmental disability (I/DD). TUSDM is proposing to:

Develop a patient/family-centered approach to care, based on principles of the WHO International Classification for Function, Disability and Health, that views patients and their caregivers as full partners,

Test principles of care coordination with a team of experts including a hygienist and social worker equipped with tele-dentistry to support families at home and care facilities, and

Evaluate an integrated dental team (Advanced Response for Complex Treatment and Integrated Care - ARCTIC) with representations from all TUSDM clinical departments. 

With respect to community engagement, TUSDM will establish a parent/caregiver panel of up to 20 participants to provide input, information, and support to the coordination team of a social worker and dental hygienist, who will both serve as connection points between dentists, families, and patients. The organization will also leverage its previous CareQuest Institute supported Functional Assessment Manual (FAM), which will allow caregivers to share impressions and information about the patient's social context, environmental needs, and/or family beliefs that may support more responsive care. Finally, the interdisciplinary dental team will be trained in cultural, behavioral, and linguistic responsiveness to promote improved care outcomes.

To test and promote new principles of care coordination for people with I/DD, TUSDM will pilot a model of coordination based around a social worker and a hygienist. The social worker role will be responsible for situational awareness, family support, and communication while the dental hygienist will support care coordination between different dental specialists and the dental home as well as provide preventive care and functional assessments using FAM. Beyond care provided at Tufts Dental Facilities, the dental hygienist will also offer home care and leverage teledentistry for patient evaluations prior to clinical visits for care. Finally, to respond to the unique healthcare needs of this patient population, TUSDM will establish the ARCTIC team, which represents all TUSDM clinical departments and will support behavioral and technical care needs that may emerge throughout this pilot.

This request was originally submitted in early 2023 for $350,000. Following a successful Concept submission, the recommendation among reviewers was to pursue a reduced grant amount and scope of work, given that this is a demonstration project and matching funds were not indicated beyond one project role. The updated proposal reflects participation of fewer Tufts Dental Facilities; however, it maintains the care coordination team and support for intentional evaluation and dissemination efforts at several points in the project. TUSDM’s work to effectively test and evaluate this model of care present CareQuest Institute with an opportunity to support the creation of a more responsive care model for patients and families/caregivers with I/DD that can be adapted and scaled at similarly positioned institutions in the future.