Filling a need in North Texas

Dallas residents lacking adequate access to dental care are benefiting from Texas A&M University Baylor College of Dentistry’s community-based clinical training program.

Since January, the dental school has formed partnerships with three area nonprofits: Healing Hands Ministries in Lake Highlands, North Dallas Shared Ministries and Irving Community Clinic.

A trend was apparent at each of the three clinics: Need among patients far surpassed the hours volunteer dentists were available to provide care.

Now, the partnerships have resulted in an influx of fourth-year dental students at two of the three locations, where they perform extractions, fillings and cleanings. Clinical rotations will begin at the Irving location later this summer.

“We’re basically able to do two things at once,” says Dr. Daniel Jones, professor and chair of the dental school’s public health sciences department, which oversees the community-based training program. “We are increasing access to care, because we are expanding the hours that these clinics are open. We’re expanding them by sending the students out there, which means they get more community-based clinical training. That’s going to be a big push for us in the next couple of years.”

Expansion of the college’s clinical rotation sites would not have been possible without utilization of the 1115 Healthcare Transformation waiver.

Established in fall 2011, the waiver works as an incentive for hospitals and other providers to transform their service delivery practices to improve quality, health status, patient experience, coordination and cost effectiveness, according to the Texas Health and Human Services Commission website.

Hospitals and health care providers were given the opportunity to apply for funding from a pool worth $29 billion. Texas A&M Baylor College of Dentistry administrators seized the opportunity, submitting a proposal in 2012 that was met with approval from the commission, making it one of only a handful of dental projects like it across the state.

Now in the third year of a five-year funding period, the waiver has enabled the college to provide new equipment, operatories and electronic health records software at the community clinics, as well as faculty supervision and dental assistants.

“That way, they meet the standards for our students to be there,” says Jones. “This probably would not have happened without the waiver.”

In addition to the community-based clinical training, two other college programs — the senior preceptorship, in which dental students shadow private practitioners and treat patients in community clinics, as well as the school-based sealant program, which provides dental sealants for 10,000 Dallas schoolchildren — opened the door for additional funding through Delivery System Reform Incentive Payments, also a part of the health care waiver.  In total, the value of the college’s three programs approved by the Centers for Medicare & Medicaid Services tops $28 million.

“This federal program came at a really fortunate time because we were looking to expand students’ training, and this gave us the wherewithal to do it,” says Jones. “The waiver is about improving access to care, but it’s also serving our training needs for the students, which is one of the main goals of the school.”

The clinics

While copay amounts vary among the clinics, applicable third-party insurance coverage, Medicare, Medicaid and CHIP will be collected, as the three locations must be sustainable before the healthcare transformation waiver funding ends, so that off-campus patient care and training can continue in perpetuity.

Healing Hands Ministries

Since January 2014, fourth-year dental students have rotated to the site in groups of four for a week at a time, treating approximately 25 patients a day. With five operatories and the potential for another to be added, Paul Hoffmann, TAMBCD’s administrative director for extramural clinics, says the goal is to provide comprehensive dental care for the entire family.

“There’s such a void for adult care. Inevitably what happens is the adult care comes first, and the children follow,” Hoffmann says.

The clinic’s hours are 10 a.m. to 6 p.m., Monday through Friday.

North Dallas Shared Ministries

Fourth-year dental students began clinical rotations at the nonprofit on June 11, treating approximately 25 patients per day in the center’s four operatories. Previously, the all-volunteer clinic was limited to four days a month; now with help from TAMBCD students and faculty, patients are seen Monday through Friday, 10 a.m. to 6 p.m.

Judy Rorrie, executive director of the nonprofit, says the dental school’s presence will expand the clinic’s reach exponentially.

“To be able to have our clinic open for eight hours a day, five days a week, for 40 weeks a year is going to provide dental care for a population that is sorely in need of its services,” Rorrie says.

Irving Community Clinic

Clinical rotations will begin at this site in late summer 2014. Close proximity to the emergency room at Baylor Medical Center at Irving means patients with urgent dental needs can be redirected to Irving Community Clinic. Two dental students will work at the clinic for a week at a time, performing extractions, fillings and cleanings. Plans are in the works to provide additional treatment, such as endodontics and fixed prosthodontics.

“What has happened with all of these locations is the initial surge seems to be adults, particularly adults with chronic disease,” says Hoffmann. “We anticipate over time they will bring children and siblings.”

—Jenny Fuentes

— Jennifer Fuentes