title: Effect of a person-centered mouth care intervention on care processes and outcomes in three nursing homes.
abstract: OBJECTIVE
  To develop and test a person-centered, evidence-based mouth care program in nursing homes.
  
  
  METHODS
  Pre-post assessment, with an 8-week intervention period and a pilot 6-month extension at one site.
  
  
  METHODS
  Three North Carolina nursing homes.
  
  
  METHODS
  Ninety-seven residents and six certified nursing assistants (CNAs).
  
  
  METHODS
  CNAs already working in the facilities were trained as dedicated mouth care aides. A psychologist and dental hygienist provided didactic and hands-on training in evidence-based mouth care products and techniques and in person-centered behavioral care.
  
  
  METHODS
  Primary outcome measures for natural teeth were the Plaque Index for Long-Term Care (PI-LTC) and Gingival Index for Long-Term Care(GI-LTC) and for dentures the Denture Plaque Index (DPI); a dentist unmasked to study design obtained measures. Secondary outcomes included quantity and quality of care provided.
  
  
  RESULTS
  Outcome scores significantly improved (P < .001 for PI-LTC and GI-LTC; P = .04 for DPI). Coding of videotaped care episodes indicated that care was more thorough (P < .001-P = .03) but took more time (P < .001) after training. Consistency of care appeared to be more important for natural teeth than dentures.
  
  
  CONCLUSIONS
  As little as 8 weeks of mouth care can significantly improve oral hygiene outcomes. Given the consequences of poor oral hygiene, greater attention to mouth care education and provision are merited. The dedicated worker model is controversial, and future work should assess whether other models of care are equally beneficial.
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA. psloane@med.unc.edu
authors.forename: Philip D
authors.initials: PD
authors.lastname: Sloane
authors.forename: Sheryl
authors.initials: S
authors.lastname: Zimmerman
authors.forename: Xi
authors.initials: X
authors.lastname: Chen
authors.forename: Ann L
authors.initials: AL
authors.lastname: Barrick
authors.forename: Patricia
authors.initials: P
authors.lastname: Poole
authors.forename: David
authors.initials: D
authors.lastname: Reed
authors.forename: Madeline
authors.initials: M
authors.lastname: Mitchell
authors.forename: Lauren W
authors.initials: LW
authors.lastname: Cohen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D009657:North Carolina; D009728:Nursing Assistants; D009735:Nursing Homes; D009910:Oral Hygiene / Q000379:methods* / Q000451:nursing*; D010043:Outcome and Process Assessment, Health Care; D018802:Patient-Centered Care / Q000379:methods*; D011787:Quality of Health Care
keywords: culture change; mouth care; nursing home; oral hygiene; person-centered