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A Practice Report From the Northern Dental Access Center

Offering Wraparound Services at a Community Dental Access Clinic to Improve Treatment Outcomes Among Rural Populations in Poverty

Larson, Jeanne E. MS; Leider, Jonathon P. PhD; Knudson, Alana PhD

Journal of Public Health Management and Practice: September/October 2019 - Volume 25 - Issue 5 - p E22–E29
doi: 10.1097/PHH.0000000000000767
Research Reports: Practice Full Report

Context: Rural populations suffer significant adverse health outcomes without reliable access to dental care, including increased emergency department use for oral health. The Northern Dental Access Program (Northern Dental) serves more than 20 counties in Greater Minnesota and bordering states. Its population is generally poor and less healthy than the rest of the state, with high rates of Medicaid.

Approach: Evaluation of Northern Dental focused primarily on utilization of dental and nondental wraparound/support services. First, descriptive analyses were conducted, including assessing the patient population, visit, and client counts over time. Measures include procedures performed, visits, unique clients, active client base (based on previous visits in 12, 18, or 24 months), treatment plan completion, and use of wraparound services.

Results: Between 2009 and 2016, Northern Dental saw 20 367 unique clients. The staff performed more than 307 000 prevention and screening procedures, more than 55 000 fillings and restorations, and 20 000 oral surgery/endodontic procedures. Overall, 32% of patients (n = 6 626) completed their treatment plans. Bivariate comparisons suggested that those who were provided transportation assistance (5% of all patients) were more likely to complete their treatment than the overall patient population. Overall, in 2016, a total of 1 748 unduplicated clients worked with the staff more than 3 800 times to receive referrals and wraparound services. This represented about 27% of all clients seen in 2016 who had at least 1 clinical visit.

Discussion: Evaluation of Northern Dental's practice and approach shows sustained growth over time in service provision to the Medicaid population in Greater Minnesota, high need for transportation assistance, and significant interest in wraparound services. Transportation assistance involved substantial outlays from Northern Dental but resulted in substantially higher reimbursement, billing, and treatment completion for patients.

Implications for Practice: Wraparound services are typically supported through grants and charitable giving. Evidence like this can inform policy makers and insurance companies, making the case for reimbursing nonprofits that provide them.

Northern Dental Access Center, Bemidji, Minnesota (Ms Larson); JP Leider Research & Consulting LLC, Minneapolis, Minnesota (Dr Leider); and Walsh Center for Rural Health Analysis, National Opinion Research Center at the University of Chicago, Bethesda, Maryland (Dr Knudson).

Correspondence: Jonathon P. Leider, PhD, JP Leider Research & Consulting LLC, Minneapolis, MN 55414 (

This project was supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS). The authors thank Erin Tanenbaum and the article's peer reviewers for their thoughtful comments; these helped improve the quality of the final manuscript.

This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the US Government.

The authors declare no conflicts of interest.

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