Thesis
A national study of dental care delivery and utilization at programs of all-inclusive care for the elderly (PACE)
University of Iowa
Master of Science (MS), University of Iowa
Summer 2018
DOI: 10.17077/etd.zssv8lyq
Abstract
<p>Background: The Program of All-inclusive Care for the Elderly (PACE) is a program of care that enrolls nursing home eligible and offers them community-based long-term services and supports (LTSS). Many PACE enrollees are “dual eligibles” (DEs) meaning they qualify for Medicare and Medicaid services. Dental care is a unique feature of PACE among LTSS, as many LTSS do not include dental care, even though this population has difficulty in accessing these services. However, little is known about the delivery of dental care at PACE and how dental care and oral health promotion and prevention is being integrated into PACE. Thus, the purpose of this study is to describe the delivery and integration of dental care at PACE.</p>
<p>Methods: Based on ten preliminary interviews and the PACE manual from the Centers for Medicare and Medicaid Services (CMS), a 56-question survey was developed to describe the delivery and integration of dental care at PACE across the country. In addition, the survey asked programs to rank their focus among five specialties (dentistry, mental health, optometry, audiology, podiatry), to determine if a program’s focus on dental care would influence the delivery and integration of dental services at PACE, and if this would lead the program to have a very high percentage of new and continuous enrollees with regular dental examinations. A publicly available contact list was obtained from CMS and the survey was distributed to all 124 PACE programs via email.</p>
<p>Results: Respondents in this study represented 35 programs (28.2%) in 23 states (74.2%). Most programs had no limits for dental care, minimal waitlists, and provide most dental services without exclusions. This is evident by the 51.4% of programs that have no dental budget, 100% of programs providing preventive and basic restorative dental care, and nearly 100% offering advanced restorative services. Many programs also did not have a waitlist for non-emergent dental care. Few programs include a dentist in the routine operations of the PACE program, as evidenced by few programs having dentists conduct the dental assessment for the initial comprehensive assessment or having a dental director.</p>
<p>A statistically significant association with a high percentage of reported utilization of dental examinations was detected with programs having a system for quality assurance for dental care (t=0.358, p=0.024), a protocol for a dental cleaning every 6-12 months (t=0.595, p<0.001), mandating a comprehensive dental examination (t=0.390, p=0.007), and providing preventive dental services onsite with built-in equipment (t=0.454, p=0.001). No factors were statistically associated with the focus ranking for dentistry among the other specialties.</p>
<p>Conclusion: This study suggests that compared to nursing homes, PACE enrollees may have greater ability to receive dental care without limitations of the state adult Medicaid dental benefit. Dentistry also appears to be a high focus for some PACE programs. This study has begun to identify structures that support positive outcomes that can be used to develop best practices and guidelines for the delivery of dental care in PACE and other LTSS. Future studies are needed to better understand barriers and facilitators to the delivery of dental care and other specialty services.</p>
Details
- Title: Subtitle
- A national study of dental care delivery and utilization at programs of all-inclusive care for the elderly (PACE)
- Creators
- Matthew Masayoshi Oishi - University of Iowa
- Contributors
- Leonardo Marchini (Advisor)Elizabeth T. Momany (Advisor)Pamela Z. Cacchione (Committee Member)Joan I. Gluch (Committee Member)Robert J. Collins (Committee Member)Howard Cowen (Committee Member)Peter Damiano (Committee Member)
- Resource Type
- Thesis
- Degree Awarded
- Master of Science (MS), University of Iowa
- Degree in
- Dental Public Health
- Date degree season
- Summer 2018
- DOI
- 10.17077/etd.zssv8lyq
- Publisher
- University of Iowa
- Number of pages
- xiii, 95 pages
- Copyright
- Copyright © 2018 Matthew Masayoshi Oishi
- Language
- English
- Date submitted
- 11/19/2018
- Description illustrations
- color illustrations
- Description bibliographic
- Includes bibliographical references (pages 91-95).
- Public Abstract (ETD)
The Program of All-inclusive Care for the Elderly (PACE) is a program of care under Medicare and Medicaid for people who may otherwise go to a nursing home and offers them home and community-based care. PACE is a comprehensive, interdisciplinary, and capitated model of care that coordinates and provides enrollees with all the necessary health and social services for maintaining independent living in the community, including those not traditionally covered by Medicare or Medicaid. Dental care is a unique feature of PACE among long term care options. The purpose of this study is to describe the delivery and integration of dental care at PACE. A 56-question survey was developed to describe the delivery and integration of dental care at PACE across the country, and distributed to all 124 programs in 31 states.
Respondents represented 35 programs (28.2% response rate) in 23 states (74.2% response rate). Most programs have no limits for dental care, minimal waitlists, and provide most dental services without exclusions. Few programs include a dentist in the routine operations of the PACE program. However, dentistry also appears to be a high focus for some PACE programs. This study has begun to identify structures that support positive outcomes that can be used to develop best practices and guidelines for the delivery of dental care in PACE and other LTSS. Future studies are needed to better understand barriers and facilitators to the delivery of dental care and other specialty services.
- Academic Unit
- Preventive and Community Dentistry
- Record Identifier
- 9983777115302771
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