HCM 491 Module 7 Project Two Example

Project Two: Dental Bridge, a Proposal to Connect Marlow Regional Hospital's Emergency Department With Community Dental Care

[Student Name]

Southern New Hampshire University

HCM 491: Health Sciences Capstone

Project Two

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Project Two: Dental Bridge, a Proposal to Connect Marlow Regional Hospital's Emergency Department With Community Dental Care

Executive Summary

Each year about 1,450 adults come to Marlow Regional Hospital's emergency department with dental pain the ED cannot cure, and more than a third come back. Most are uninsured or on Medicaid, and most leave without a dental appointment. Dental Bridge would change that by placing a navigator in the ED, reserving urgent appointments at Riverside Community Health's dental clinic, standardizing ED pain care and reaching out to frequent visitors. The program costs about $138,000 a year and should earn back the bulk of it because fewer patients will need ED treatment or a hospital bed. This proposal asks the board for twelve months of funding, with a decision on continuation based on results.

The Problem

In fiscal 2025 the ED recorded 1,452 visits for nontraumatic dental conditions, 3.1% of its volume. Seven in ten patients were between 18 and 44, 64% were uninsured or on Medicaid and 54% arrived in the evening, overnight or on a weekend. Thirty-six percent returned for a dental problem within a year, and 112 people accounted for 410 visits. The hospital spent roughly $840,000 on these visits and related admissions and recovered about 38%. These patterns mirror national findings by Sun et al. (2015), who reported similar insurance patterns and heavy antibiotic and opioid prescribing among ED dental visitors in Oregon.

Why It Happens

Root cause analysis with ED and clinic staff found that patients leave with generic advice and no appointment, that the only affordable dental clinic has a wait of two to three weeks for new patients, that pain often peaks when dental offices are closed, that ED clinicians rarely use local nerve blocks and that adult Medicaid in this state pays for little beyond pulling a tooth in an emergency. Singhal et al. (2015) showed that removing adult Medicaid dental benefits in California increased ED dental visits, which helps explain why coverage limits keep patients returning.

What the Evidence Supports

Elani et al. (2020) and Giannouchos et al. (2023) saw emergency dental use drop in expansion states only when adult Medicaid also paid for genuine dental treatment, but not in emergency-only states like Marlow's. Hospital action must therefore focus on what it controls. Jiang et al. (2022) showed that an ED navigator program reduced return visits and improved follow-up adherence. Fox et al. (2013) found an ED prescribing guideline reduced opioid prescriptions for dental pain. Dental Bridge combines these approaches and adds advocacy for broader coverage.

Objectives

In the first year after launch, the program aims to have 60% of eligible adults seen during navigator hours leave with a dental appointment, half of whom attend within a week; to lower the share of dental patients returning within twelve months from 36% to 25%; and to raise nerve block use from 6% to 30%. By the end of the second year, it aims to reduce total ED dental visits by a fifth, to about 1,160.

The Pathway

A community health worker working the ED's weekday afternoon and evening shift meets dental patients, books an appointment in one of twelve weekly slots Riverside holds for the program and calls two days before the visit. Patients seen overnight or on weekends receive a morning callback. Clinicians follow a dental pain protocol that favors nerve blocks, reserves antibiotics for signs of infection and ends with a one-page packet naming the clinic and appointment. Frequent visitors are contacted proactively, and summary data go to the state hospital association to support coverage advocacy.

Implementation Timeline

Implementation unfolds in four phases over twelve months. Preparation includes hiring the navigator, signing a memorandum of understanding with Riverside and building the referral order in the ED record. Testing uses the PDSA cycles designed in Module Six. Full operation follows once the cycles stabilize, and a review at month twelve informs the board's decision on continuation.

Table 1. Implementation Timeline

Note. Timeline agreed with the ED nurse manager and Riverside's clinic director.

The Partnership Agreement

The memorandum of understanding with Riverside will specify twelve reserved slots a week, the $35 fee per slot, the rule releasing unbooked slots at noon the day before, a patient assistance payment for uninsured patients' minimum charges and biweekly sharing of attendance data. Because both organizations handle patient information, the agreement will define what data are shared, how they are protected and who may see them, consistent with federal privacy rules.

Roles and Responsibilities

Clear ownership prevents the drift that affects many pilot programs. Table 2 assigns each major responsibility to one role.

Table 2. Roles

Note. Roles confirmed with each named department.

Stakeholder Commitments

The stakeholder analysis, guided by Brugha and Varvasovszky (2000), identified ED physicians and Riverside's team as the groups whose support mattered most and was least certain. Both have now made conditional commitments. The ED medical director will support nerve block training delivered during shifts, two physicians have volunteered as champions and Riverside's director has agreed to a six-month test of the slot arrangement. Community benefit leaders have signed on as co-sponsors, and two former ED dental patients will advise on the discharge packet and outreach scripts.

Budget and Financial Case

Annual operating costs total about $138,000, with the navigator at $58,000, slot fees at $21,000, the patient assistance fund at $20,000, transportation at $12,000 and oversight, evaluation, training and materials making up the rest. One-time start-up costs of about $8,000 come from the community benefit budget. Net of payments the hospital would forgo, avoided visits and admissions are projected to save about $124,000 in year two, leaving a net cost of about $14,000. A possible $30,000 contribution from the largest Medicaid plan would make the program modestly positive, and a smaller-than-expected effect would raise the net cost, which is why continuation depends on results.

Evaluation

The evaluation tracks outcome measures, including repeat visits, total dental visits and attendance; process measures, including navigator reach, bookings, slot fill and nerve block use; and balancing measures, including ED length of stay, how long Riverside's regular patients wait and the extra load on staff. Following the lessons of Taylor et al. (2014), each change will be tested in small, documented cycles with written predictions and weekly data, and results will appear on a monthly executive dashboard.

Risks and Mitigation

Table 3 names the five threats stakeholders judged most likely, each paired with the response already agreed.

Table 3. Risks and Responses

Note. Risks identified with stakeholders.

Sustainability and Equity

If results are positive, the program can be sustained through the hospital's community benefit budget, a Medicaid plan contribution and possible state oral health grants, and the navigator role can be written into the ED staffing plan. Equity is built into the design: materials and calls will be available in Spanish, patients may decline referral without any effect on their ED care, uninsured patients receive help with clinic charges and outreach will not share clinical details by text. Results will be reported by payer and language to show whether gaps narrow.

Request to the Board

The proposal asks the board to approve $146,000 for the first twelve months, covering operating and start-up costs, to authorize the memorandum of understanding with Riverside Community Health and to receive a results report at month twelve. Continuation beyond the first year would depend on meeting at least three of the five objectives and on the financial review.

Conclusion

Dental Bridge responds to a problem the ED sees every night with a solution built from local data, published evidence and the ideas of the people who will run it. It will not fix the state's coverage gap, but it can give patients a real appointment instead of a piece of paper and give the hospital back hundreds of hours of ED capacity. The request is modest, time-limited and tied to measurable results.

References

Brugha, R., & Varvasovszky, Z. (2000). Stakeholder analysis: A review. Health Policy and Planning, 15(3), 239-246. https://doi.org/10.1093/heapol/15.3.239

Elani, H. W., Kawachi, I., & Sommers, B. D. (2020). Changes in emergency department dental visits after Medicaid expansion. Health Services Research, 55(3), 367-374. https://doi.org/10.1111/1475-6773.13261

Fox, T. R., Li, J., Stevens, S., & Tippie, T. (2013). A performance improvement prescribing guideline reduces opioid prescriptions for emergency department dental pain patients. Annals of Emergency Medicine, 62(3), 237-240. https://doi.org/10.1016/j.annemergmed.2012.11.020

Giannouchos, T. V., Reynolds, J., Damiano, P., & Wright, B. (2023). Association of Medicaid expansion with dental emergency department visits overall and by states' Medicaid dental benefits provision. BMC Health Services Research, 23, Article 625. https://doi.org/10.1186/s12913-023-09488-3

Jiang, L. G., Zhang, Y., Greca, E., Bodnar, D., Gogia, K., Wang, Y., Peretz, P., & Steel, P. A. (2022). Emergency department patient navigator program demonstrates reduction in emergency department return visits and increase in follow-up appointment adherence. The American Journal of Emergency Medicine, 53, 173-179. https://doi.org/10.1016/j.ajem.2022.01.009

Singhal, A., Caplan, D. J., Jones, M. P., Momany, E. T., Kuthy, R. A., Buresh, C. T., Isman, R., & Damiano, P. C. (2015). Eliminating Medicaid adult dental coverage in California led to increased dental emergency visits and associated costs. Health Affairs, 34(5), 749-756. https://doi.org/10.1377/hlthaff.2014.1358

Sun, B. C., Chi, D. L., Schwarz, E., Milgrom, P., Yagapen, A., Malveau, S., Chen, Z., Chan, B., Danner, S., Owen, E., Morton, V., & Lowe, R. A. (2015). Emergency department visits for nontraumatic dental problems: A mixed-methods study. American Journal of Public Health, 105(5), 947-955. https://doi.org/10.2105/AJPH.2014.302398

Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Quality & Safety, 23(4), 290-298. https://doi.org/10.1136/bmjqs-2013-001862