TeleSMILE: Implementing teledentistry through School-Based Health Centers (SBHCs) in Coffee County, GA to expand access to oral health care to rural children Open Access

Lyles, Faith (Spring 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/dr26xx37v?locale=en
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Abstract

Rural child health status remains a public health concern.  Child oral health status is often influenced by where they live. Research has found that living in a rural or remote area can increase a child’s risk of experiencing oral health disparities. Rural children experience more difficulties in accessing oral health care services because of barriers to access attributed to geographical location, lack of transportation, and the limited availability of dental providers. In 2012, approximately 60 percent of the total designated dental health professional shortage areas were located in rural areas. Lack of providers has resulted in rural residents having to travel long distances to locate the nearest clinic or private practice. Traditional practice settings also influence barriers to accessing oral health care in rural areas because of a current medical system designed around face-to-face interaction that has impacted rural health.  Increases in health disparities among rural children have prompted health care and public health providers to seek alternative strategies to remove barriers to access.

 

 

School-Based Health Clinics (SBHCs) are located in or near a school and serve as alternative strategies to meeting the health needs of school children outside of traditional settings to provide healthcare and dental care access to rural schoolchildren experiencing health disparities.  Also, advances in telecommunication technology (e.g., telephone, internet, computers) have resulted in new technologies such as telemedicine and telehealth (terms used interchangeably) and have, in many cases, eliminated the need for face-to-face interaction between provider and patient. Telehealth technologies (e.g., remote patient monitoring, mobile health, live video-conferencing, etc.) can be used to reach patients outside of office settings while maintaining some form of interaction. Telehealth’s success in improving health outcomes has led to its use in other medical fields where rural patients are facing barriers to access. Teledentistry, a subset of telehealth, does not provide clinic service but uses similar technology (live video-conferencing, laptops, mobile devices) to expand access to care, which include different delivery models, such as portable and mobile clinics, fixed clinics or a combination.  Teledentistry programs have become an important strategy to addressing dental provider shortages, particularly in rural areas.

 

 

 

            Coffee County, GA, which is 67 percent rural, is designated as a health provider shortage area (HPSA) in primary care, mental health, and dental care.  In 2010, 26.2 percent of the population was aged 18 and under.  The expected outcomes of this proposal for the implementation of teledentistry services through existing Coffee Telehealth SBHCs include expanded access to dental cares, referrals to a dental home, and outreach activities that prevent dental disease and reduce oral health disparities among rural and minority children in Coffee County where significant dental provider shortages exist.  If successful, the program also expects that this pilot program will serve as a model to integrate similar teledentistry services into the other seven Coffee Telehealth SBHCs sites.

 

 

Table of Contents

TABLE OF CONTENTS

 

Definitions.................................................................................................................................................................................... 1

Abbreviations............................................................................................................................................................................... 4

CHAPTER 1    INTRODUCTION................................................................................................................................. 6

Introduction................................................................................................................................................................................. 6

Telecommunication Technology and Access........................................................................................................... 7

            Telehealth.................................................................................................................................................................... 8

            Telemedicine............................................................................................................................................................. 9

            Teledentistry.............................................................................................................................................................. 9

Teledentistry Challenges....................................................................................................................................................... 10

Benefits of Teledentistry...................................................................................................................................................... 11

U.S. Teledentistry Networks................................................................................................................................................ 11

Problem Statement.................................................................................................................................................................... 14

Purpose Statement..................................................................................................................................................................... 15

Project Goals................................................................................................................................................................................ 15

Significance Statement............................................................................................................................................................ 15

CHAPTER 2    REVIEW OF LITERATURE........................................................................................................... 17

Introduction................................................................................................................................................................................. 17

Review of Literature................................................................................................................................................................. 18

Burden of Children Oral Health Disease.................................................................................................................... 18

Rural Child Oral Health Status........................................................................................................................................... 19

Access Challenges in Rural Areas..................................................................................................................................... 20

         Geographical Location.............................................................................................................................................. 21

         Dental Provider Shortages...................................................................................................................................... 21

Telemedicine and Telehealth............................................................................................................................................. 24

Teledentistry and Access...................................................................................................................................................... 24

CHAPTER 3    METHODOLOGY OF THE REVIEW PROCESS............................................................ 26

Description of Grant Announcement........................................................................................................................... 26

Proposal Review Criteria....................................................................................................................................................... 27

Review of Funding Agencies.............................................................................................................................................. 30

Grant Review Process............................................................................................................................................................. 35

Grant Proposal Reviewers.................................................................................................................................................... 35

Protection of Human Subjects .......................................................................................................................................... 37

CHAPTER 4    REVIEWER COMMENTS................................................................................................................ 40

Reviewer 1 Comments............................................................................................................................................................ 40

Reviewer 2 Comments............................................................................................................................................................ 40

Reviewer 3 Comments............................................................................................................................................................ 44

Reviewer 4 Comments............................................................................................................................................................ 45

Reviewer 5 Comments............................................................................................................................................................ 47

CHAPTER 5    FINAL VERSION OF THE GRANT PROPOSAL............................................................. 50

Project Abstract ......................................................................................................................................................................... 50

Introduction................................................................................................................................................................................. 52

Project Narrative........................................................................................................................................................................ 55

         Overview of Telehealth Network....................................................................................................................... 55

         Members............................................................................................................................................................................ 57

         Needs Assessment........................................................................................................................................................ 58

                  Health Care Needs......................................................................................................................................... 60

                  Target Population........................................................................................................................................... 63

         Methodology.................................................................................................................................................................. 65

         Work Plan......................................................................................................................................................................... 66

         Resolution of Challenges........................................................................................................................................ 66

         Evaluation and Technical Support Capacity................................................................................................. 67

         Organizational Information ..................................................................................................................................  69

         Support Requested....................................................................................................................................................... 71

ATTACHMENTS ..................................................................................................................................................................... 73

        Attachment 1         Rural ID Eligibility............................................................................................................. 73

        Attachment 2         Proposed Budget Information..................................................................................... 74

        Attachment 3         Work Plan................................................................................................................................ 76

        Attachment 4         Proposed Memorandum of Agreements and Contracts ............................... 78

        Attachment 5         Biographical Sketches of Key Personnel ............................................................. 94

        Attachment 6         Organizational Chart.......................................................................................................... 98

        Attachment 7         Other Documents................................................................................................................ 99

        Attachment 7.1    Proposed Patient Consent and Medical Information Release Forms........ 99

        Attachment 7.2    Proposed Dental Provider Referral Process............................................................ 101 

        Attachment 7.3    Proposed Surveys..................................................................................................................... 102

        Attachment 7.4    Proposed Summary Report of Dental Services....................................................... 109

REFERENCES .......................................................................................................................................................................... 110

APPENDICES  .......................................................................................................................................................................... 116

     Appendix 1 Distribution of U.S. Health Care Providers Residing in Rural and Urban Areas     116

     Appendix 2  HRSA Funding Opportunity Announcement .................................................................... 119

     Appendix 3 Grant Reviewer Form..........................................................................................................................  154

     Appendix 4  HIPAA and Telehealth Compliance Guide............................................................................ 156

     Appendix 5 TeleSMILE Pilot Program Planning Logic Model ............................................................ 158

 

List of Figures

Figure 1   Georgia School-Based Health Center Map ......................................................................................... 53

Figure 2   Map of Telehealth Networks in Georgia that Provide Teledentistry Services................ 54

Figure 3   Illustration of Rural Landscape of Coffee County, GA and Location of Municipalities................................................................................................................... 59

Figure 4   Coffee Regional Medical Center Service Areas................................................................................ 61

List of Tables

Table 1    Four Categories of Telehealth Technology........................................................................................ 8

Table 2    U.S Teledentistry Networks.......................................................................................................................... 13

Table 3    Distribution of U.S. Health Care Providers Residing in Rural and Urban

               Areas Health, 2008-2010 by Dental Occupation................................................................................. 22

Table 4    Review Criteria for TNGP Proposal Evaluation Process............................................................. 29

Table 5    Human Resources and Services Administration’s Goals and Objectives............................ 31

Table 6    Patient Privacy Risks and Controls in Telehealth............................................................................ 39

Table 7    Proposed Project Program Activities...................................................................................................... 56

Table 8    Comparison of Clinical Care Providers in Coffee County, GA ............................................. 60

Table 9    2016 Comparison of Health Outcomes in Coffee County, GA................................................ 61

Table 10  Target Population................................................................................................................................................ 63  

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