Abstract：
BACKGROUND: US health care delivery and financing arrangements are changing rapidly as payers and providers seek greater efficiency, effectiveness, and safety. The Centers for Medicare & Medicaid Services uses grants and technical assistance to drive such development through innovative demonstration programs, including for oral health care. The authors reviewed these dental demonstrations to identify common themes and identify barriers to and facilitators of implementation.
METHODS: The authors compared 12 identified demonstrations across 6 domains: grant and technical assistance, stakeholders, inner care settings, outer contextual settings, interventions, and outcomes. They developed program summaries for each demonstration and interviewed key informants using a semistructured guide to review, correct, clarify, and expand on program summaries.
RESULTS: Common across all programs were engagement of nontraditional providers, care in nontraditional settings, payment as a critical externality for program adoption, interventions that integrate medical and oral health care, use of alternative payment models, and tracking process measures. Adoption facilitators included an engaged oral health champion and obtaining mission support and alignment among stakeholders. Common barriers included unanticipated organizational disruptions, poor information technology infrastructure, cultural resistance to nontraditional care models, and lack of providers in high-need areas.
CONCLUSIONS: Descriptive findings suggest that oral health care may evolve as a more accountable, integrated, and accessible health service with an expanded workforce; collaboration between providers and payers will remain key to creating innovative, sustainable models of oral health care.
CONCLUSIONS: The Centers for Medicare & Medicaid Services\' efforts to advance health equity, expand coverage, and improve health outcomes will continue to drive similar initiatives in oral health care.
METHODS: The authors compared 12 identified demonstrations across 6 domains: grant and technical assistance, stakeholders, inner care settings, outer contextual settings, interventions, and outcomes. They developed program summaries for each demonstration and interviewed key informants using a semistructured guide to review, correct, clarify, and expand on program summaries.
RESULTS: Common across all programs were engagement of nontraditional providers, care in nontraditional settings, payment as a critical externality for program adoption, interventions that integrate medical and oral health care, use of alternative payment models, and tracking process measures. Adoption facilitators included an engaged oral health champion and obtaining mission support and alignment among stakeholders. Common barriers included unanticipated organizational disruptions, poor information technology infrastructure, cultural resistance to nontraditional care models, and lack of providers in high-need areas.
CONCLUSIONS: Descriptive findings suggest that oral health care may evolve as a more accountable, integrated, and accessible health service with an expanded workforce; collaboration between providers and payers will remain key to creating innovative, sustainable models of oral health care.
CONCLUSIONS: The Centers for Medicare & Medicaid Services\' efforts to advance health equity, expand coverage, and improve health outcomes will continue to drive similar initiatives in oral health care.
摘要：
背景：随着付款人和提供者寻求更高的效率，美国的医疗保健提供和融资安排正在迅速变化，有效性,和安全。医疗保险和医疗补助服务中心使用赠款和技术援助通过创新的示范计划来推动这种发展，包括口腔保健。作者回顾了这些牙科演示，以确定共同的主题，并确定实施的障碍和促进者。
方法：作者比较了6个领域的12个确定的演示：赠款和技术援助，利益相关者，内部护理设置，外部上下文设置，干预措施，和结果。他们为每个演示制定了计划摘要，并使用半结构化指南进行了审查，正确,澄清，并扩展计划摘要。
结果：所有计划的共同点是非传统提供商的参与，在非传统环境中的护理，支付作为项目采用的关键外部性，整合医疗和口腔保健的干预措施，使用替代支付模式，和跟踪过程措施。收养促进者包括一名参与的口腔健康倡导者，并获得使命支持和利益相关者之间的协调。常见的障碍包括意外的组织中断，信息技术基础设施差，文化对非传统护理模式的抵制，以及在高需求领域缺乏提供者。
结论：描述性研究结果表明，口腔保健可能会演变为更负责任的，集成,和可获得的医疗服务，扩大劳动力；提供者和付款人之间的合作将仍然是创造创新的关键，口腔保健的可持续模式。
结论：医疗保险和医疗补助服务中心努力推进健康公平，扩大覆盖范围，和改善健康结果将继续推动口腔保健方面的类似举措。
方法：作者比较了6个领域的12个确定的演示：赠款和技术援助，利益相关者，内部护理设置，外部上下文设置，干预措施，和结果。他们为每个演示制定了计划摘要，并使用半结构化指南进行了审查，正确,澄清，并扩展计划摘要。
结果：所有计划的共同点是非传统提供商的参与，在非传统环境中的护理，支付作为项目采用的关键外部性，整合医疗和口腔保健的干预措施，使用替代支付模式，和跟踪过程措施。收养促进者包括一名参与的口腔健康倡导者，并获得使命支持和利益相关者之间的协调。常见的障碍包括意外的组织中断，信息技术基础设施差，文化对非传统护理模式的抵制，以及在高需求领域缺乏提供者。
结论：描述性研究结果表明，口腔保健可能会演变为更负责任的，集成,和可获得的医疗服务，扩大劳动力；提供者和付款人之间的合作将仍然是创造创新的关键，口腔保健的可持续模式。
结论：医疗保险和医疗补助服务中心努力推进健康公平，扩大覆盖范围，和改善健康结果将继续推动口腔保健方面的类似举措。
