Maria Dolce, PhD, RN, CNE, Shares Insight on Innovating Integrated Care Models

November 25, 2020
Headshot of Maria Dolce
Maria Dolce, PhD, RN, CNE, is a long-time collaborator with the Harvard School of Dental Medicine (HSDM), first joining HSDM’s Oral Health and Primary Care Task Force in 2013. When the Initiative to Integrate Oral Health and Medicine was launched in 2015, Dolce was a founding member. As an associate professor at University of Massachusetts Dartmouth and subject matter expert lead in the Department of Oral Health Policy at HSDM, Dolce boasts valuable experience working to improve health care systems through interprofessional education and clinical practice.  

Much of your professional career has focused on integration within health care systems. Can you share some information on the different roles you’ve held?

I was born and raised in Brooklyn, New York. I earned a Bachelor of Science and a Master’s degree from New York University and started my career at NYU Medical Center as a critical care nurse. My professional practice experience includes clinical, education, and administrative roles in large academic health systems, including New York-Presbyterian Hospital/Weill Cornell Medical Center, Northwell Health, NYU Langone Health. In 2009, I earned a PhD in research and theory development from NYU and joined the faculty at NYU College of Nursing as clinical assistant professor and director for the Nursing Education Graduate Programs. While at NYU, I was the director of the Oral Health Nursing Education and Practice initiative, a national program to integrate oral health in nursing curriculum and clinical practice. I transitioned to Northeastern University Bouvé College of Health Sciences and received external funding to advance oral health integration through interprofessional education across health profession fields, including nursing, pharmacy, physical therapy, and dentistry.

How did you initially become involved in working with various HSDM initiatives centered around integration?

In 2013, Dr. Bruce Donoff, who was dean at Harvard School of Dental Medicine at the time, invited me to join the Oral Health and Primary Care Task Force at HSDM. This initial involvement led to many collaborative opportunities to advance interprofessional education and practice in dentistry.

You have been involved in a variety of projects that prioritize integration of oral health and primary care, including HSDM’s Initiative to Integrate Oral Health and Medicine, the Center for Integration of Primary Care and Oral Health, and the National Center for Equitable Care for Elders. What attracted you to this work specifically?

My past experiences as an ICU nurse and critical care administrator imparted the value of interprofessional collaboration to improve health outcomes. In my practice, I recognized the link between oral health and general health, and the need to integrate oral health in comprehensive health care. My teaching, learning, and research experiences at New York University College of Nursing and College of Dentistry fortified my commitment to advance interprofessional education and oral health integration.

Much of your work, like the Nurse Practitioner-Dentist Model for Primary Care, focuses on clinical care models and interprofessional education and practice. What role do you see interprofessional education and practice playing in the future of integrating oral health and systemic health?

Interprofessional education and practice are foundational to integrated care - the building blocks for integrating oral health as an essential component of comprehensive health care. We need to strengthen our efforts of innovating integrated care delivery models to improve health and wellness.

How can collaborative team-based care increase the value of patient care, expand care delivery, and improve patient health outcomes?

Health care systems are moving ahead with designing value-based care models to address the Triple Aim to improve patient experience of care, patient and population health outcomes, and reduce the cost of care.  Collaborative, team-based care is the linchpin for value-based models. Academic dentistry is shifting toward person-centered care and evidence-based practice approaches and gradually adopting a value-based care orientation for improving oral health quality and outcomes.

Why do you think the integration of oral health and medicine is important in the changing landscape of healthcare?

Innovating integrated care models is imperative to addressing the changing landscape of health care. The integration of oral health and medicine is particularly important in attending to the high chronic disease burden in the United States. For example, the Nurse Practitioner-Dentist Model emphasized chronic disease management, and was designed to improve health for older adults living with diabetes and hypertension. Our team asserts the dental office can serve as a gateway or bridge to comprehensive health care, with a focus on wellness, health promotion, and disease prevention.

Fully integrating oral health and primary care can seem daunting to healthcare professionals. What are some first steps that professionals can take to learn more about the benefits of this care model?

The Nurse Practitioner-Dentist Model for Primary Care is a replicable model for integrating oral health and primary care in a dental practice setting.  First steps for implementing any integrated care model should include identifying champions, establishing partnerships across health professions, presenting the case for integration, determining necessary resources, selecting evaluation measures, and planning ahead.  Our team published a roadmap with steps for implementing collaborative care in dental schools and clinics.