Training Dentists To Address Diabetes In An Urban Population

The crisis in diabetes in urban populations mandates an enhanced approach to improve overall health outcomes. Objectives: Train dentists practicing in urban community health center-based dental clinics/hospital settings to use the Wagner's Chronic Care Model (CCM) for patients in dental care with diabetes. Methods: Residents dentists received training: to perform Community Health Assessment using NYCDOH Community Health Profiles EpiQuery for diabetes prevalence in the Bronx, NYC; to determine diabetes prevalence observed in the Montefiore Medical Center Dental Clinics using electronic dental/medical records. Practice Teams were administered the MacColl Institute for Healthcare Innovation (IHI) Assessment of Chronic Illness Care (ACIC) survey. Dental patients were administered Patient Assessment of Chronic Illness Care (PACIC) survey. Results: 1) T2DM rates in the Bronx are as high as 12% in the borough overall and 14-18 % in the South Bronx. The approximate ethnic/racial makeup of the Bronx for the year 2009 was 52% Hispanic, 43% Black or African American, 12.4% Caucasian. MMC Dental clinics with locations in all five Bronx neighborhoods, include all 7 United Hospital Fund codes. Dental clinic data for diabetes prevalence ≈37% (over 6 months, <66,000 patient visits). 2) ACIC/PACIC: The respondents rated the degree to care using a scale range: 0 (not at all) to 11 (fully). At baseline, only 15% of scores > 2, whereas at 12 months, 27% of scores > 2: "0" - "2" = limited support for chronic illness care (CIC); 12 month average moved to between "3" and "5" = basic support for CIC. Conclusion: To address the crisis in diabetes, we will need Systems-Based Practice (SBP) and Practice-Based Learning and Improvement (PBL&I) training for the Dental Team to achieve between "6" and "8" = reasonably good support for CIC; and "9" and "11" = fully developed CIC.