SMILES Dental Project
Project Director
In October 2016, grantees of the SMILES Dental Project® launched their first implementation year. Along the way, we developed a learning community to support project implementation across grantee sites, hosting our fourth learning session in August with five grantee teams and other key stakeholders. During the Learning Session, we celebrated initial implementation accomplishments, and reflected on how far the project has come:
Accomplishments:
- Launched a new system of care in four organizations, spanning across 11 communities; the fifth grantee is ready to launch this month!
- Passed the Interim Therapeutic Restorations (ITR) billto expand dental hygienists’ scope of practice to better meet the needs of their communities;
- Worked with the Department of Regulatory Agencies (DORA) and other partners to develop the process and training curriculum for dental hygienists to obtain ITR permits;
- Worked with the Community College of Denver (CCD) to develop the first ITR course, which trained 19 Registered Dental Hygienists (RDHs); as of September 15, 11 SMILES dental hygienists have received ITR permits!
- Worked with the Colorado Department of Health Care Policy & Financing (HCPF) and the Colorado Community Health Network (CCHN) to define a process to compensate care delivered via teledentistry;
- Defined a virtual exam, as well as protocols for ITR, and operational flow;
- More than 1,000 patients have received care since February!
While the first implementation year of the SMILES Dental Project® was challenging in unexpected ways, we’re more successful today as a result of our innovations to address obstacles as they occur.
In January – after SMILES teams had experienced a few months’ project implementation – we conducted site visits to support each grantees’ efforts and provide feedback, including these recommendations for all sites to consider:
Recommendations:
- Develop clinical expertise: Review evidence-based care and best practices to better meet the needs of patients.
- Practice ITRs in the clinic to strengthen skills and teamwork: we recommend that the dentist/dental hygienist team practice ITRs together in the clinic before performing them in a community setting.
- Team calibration: When working with multiple providers in the virtual dental home, develop a plan to calibrate all providers in your care protocols to support consistent implementation.
- Utilize the learning community and lean on each other: Travel to other grantee sites, and observe, or call or email – and learn from – other SMILES programs in action.
- Infection control expertise in mobile/portable dental model: While the principles of infection control are the same regardless of setting, we recommended that each team review infection control policy, emphasizing what extra details need to be in place in a mobile/portable setting.
Following the site visits, grantees applied what they learned, in addition to the above recommendations. The four sites to date that actively implemented the SMILES model submitted progress reports in June, indicating these shared findings:
Challenges:
- IT: Getting IT up and running in remote areas.
- Virtual communication: Teams have been working to build the partnership among the dentists and dental hygienists to provide the communication and information each needs to most effectively serve their patients. Refining the communication among the care team is an ongoing process.
- Performing ITRs: Many care teams were initially very hesitant to do ITRs, even with training. Much communication, practice, and patience was required to support the implementation of this new scope of work among dentist/dental hygienist care teams.
- Developing treatment plans: There has been some resistance from dentists to develop complete treatment plans without seeing patients in person. Teams have been working to develop partnerships with dentists and dental hygienists to provide dentists the information and images they need to confidently create full treatment plans.
Keys to Success:
- Community engagement and support: Because SMILES is a new model, education and collaboration with the community are essential to receiving buy-in, and ultimately ensuring project success.
- Internal testing and modeling: Dentists and RDHs practiced doing ITRs, and working with the telehealth software at the clinic before implementing the SMILES model at community sites. Such testing and modeling also helped ensure positive teamwork and necessary team calibration.
- Patient navigator: Including a patient navigator in each SMILES team is a great asset, and is necessary for success. While patient navigators may fulfill somewhat different roles, depending on the unique needs of each community and each grantee care team, they are a support system for both patients and RDHs in the field.
Despite Year 1 implementation challenges, all sites are poised to make great strides in Year 2. We are looking forward to learning what new ideas and innovations our grantees are implementing!
