The Columbia University College of Dental Medicine (CDM) will use a $3.2 million grant from the Health Resources and Services Administration (HRSA) to develop and implement a postdoctoral program focused on oral healthcare for special needs patients of all ages.
The funds are the latest in a series of HRSA grants to support educational and service initiatives at CDM focused on underserved patient populations, with $14.4 million awarded since 2007.
Professor Burton Edelstein, DDS, will lead the efforts to build upon those prior projects, modify existing programming, and integrate it with new components to develop the special care program, titled “Building Future Capacity for Special Care Dentistry Across the Lifespan.”
Two courses dedicated to special care dentistry, one didactic and the other experiential, will be the backbone of the program, CDM said. They will instruct CDM postdoctoral primary care trainees in general dentistry, pediatrics, and public health specialties on special care considerations and approaches.
The program will be coordinated by social worker Emily Byington and nutritionist June Levine, and it will be guided by Mach Marc Michalowicz, DDS, assistant professor of dental medicine and chief of dental medicine at the Helen Hayes Rehabilitation Hospital.
Working closely with the residency program directors, Byington and Levine are identifying relevant materials, which the group will package into a coherent curriculum with the help of an instructional designer, CDM said.
“There’s a vast amount of expertise that exists in bits and pieces around the dental school. We’re consolidating it into something that makes sense and is readily accessible to the residents,” said Edelstein.
Byington and Levine also are analyzing CDM’s strengths and opportunities in special care. That assessment will inform didactic and clinical course content, allowing the team to leverage the resources available and address unmet needs at different clinics, CDM said.
Involving clinical rounds and rotations as well as online education, the clinical course will emphasize multidisciplinary collaborations in the treatment of special needs patients, including the use of electronic health records.
“We’re trying to incorporate what kind of information is being collected about this patient population and how the electronic health record could be potentially utilized in the treatment planning and education,” said Levine.
To prepare the primary care trainees for an evolving healthcare climate, an additional course on population oral health management developed by Edelstein and assistant clinical professor Marcie Rubin, DrPH, will supplement the special care curriculum. A self-paced, online course will cover fundamentals of new healthcare models and systems reform, with connections to special needs populations and integrated throughout.
In a population-based model of care, provider groups are reimbursed, at least in part, according to the health outcomes of a defined patient population rather than only for provision of dental services.
“You’re paid based on how well the patients do as opposed to how many teeth you cleaned or repaired or extracted. It’s looking at health, rather than the lack of it,” said Byington.
According to Edelstein, this shift is “a dramatic change already underway in medicine” that could benefit disadvantaged populations by rewarding health improvements among those with the greatest needs.
For 12 years, Edelstein and his team have organized the annual Regional Primary Care Dentistry Training Convocation centered on underserved and vulnerable populations. It gathers primary care dentistry trainees and program directors from around the tristate area for an evening of learning and networking.
The new HRSA grant will sustain the convocation for another five years. Each year, the convocation will spotlight a type of disability, such as developmental and intellectual, sensory, physical, mental and cognitive, or behavioral and emotional.
Spearheaded by assistant professor Hosam Alraqiq, BDS, EdD, the next convocation will take place online this spring. He and his colleagues are enthusiastic about the opportunities afforded by a virtual platform, namely the ease of meeting and interacting with other attendees and the potential to expand participation to primary care programs in other regions, CDM said.
The 2021 convocation will include screenings of short day-in-the-life documentaries featuring people with special healthcare needs, such as a deaf New York City actress. Alraqiq, who is working with the producer to create the videos, said they are intended to provide a window into the experience of individuals with disabilities and anchor breakout room discussions.
The grant also will support the Public Health Scholars Program, which provides three pediatric or general dentists in New York City with a stipend to pursue an advanced degree in public health or healthcare administration each year.
As part of the initiative, scholars conduct and present research that will focus on topics linked to special care for this year’s cohort and upcoming cohorts as well. Edelstein’s team takes an active role in the program by facilitating conversations to connect past and present scholars, discuss their progress, and collaborate on projects, CDM said.
Finally, reporting and assessment have a key role in the special care program, CDM said. Data collection already has begun via surveys of the primary care postdocs and public health scholars, regular feedback from the planning team, and other sources, said Mari Millery, PhD, an evaluation expert and collaborator on the grant.
During the program, the team will use an iterative process called the plan-do-study-act (PSDA) cycle to make improvements rapidly and thoughtfully, CDM said.
Taken together, the many components of the new program strengthen the school’s commitment to special care patients and will prepare today’s trainees to deliver and manage future care for people with a wide range of differences and disabilities, CDM said.
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