title: State policy environment and the dental safety net: a case study of professional practice environments' effect on dental service availability in Federally Qualified Health Centers.
abstract: To determine whether and to what extent the state policy environment for the dental hygiene workforce affects the availability of dental services at Federally Qualified Health Centers (FQHCs).
  
  
  
  We examined data drawn from the Uniform Data System on 1,135 unique FQHC grantees receiving community health center funding from the U.S. Health Center program between 2004 and 2012. The Dental Hygiene Professional Practice Index was used to quantify variations in state policy environment. We then examined the influence of state policy environment on the availability of dental care through generalized linear mixed-effects models.
  
  
  
  Approximately 80% of FQHCs reported delivering dental services. We consistently observed that FQHCs with favorable levels of state support had the highest proportion of FQHCs that delivered dental services, even more so than FQHCs with extremely high support. FQHCs located in the most restrictive states had 0.28 the odds of delivering dental services as did those located in the most supportive states.
  
  
  
  The state policy environment for the dental hygiene workforce is likely associated with the availability of dental services at FQHCs. The greatest proportion of FQHCs delivering dental services was found in states with policy provisions supporting professional independence in public health settings. Nevertheless, additional research is needed to understand the specific mechanism by which these policies affect FQHCs.
authors.affiliation: Department of Family Medicine, Bowen Center for Health Workforce Research and Policy, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Hannah L
authors.initials: HL
authors.lastname: Maxey
authors.affiliation: Department of Family Medicine, Bowen Center for Health Workforce Research and Policy, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Connor W
authors.initials: CW
authors.lastname: Norwood
authors.affiliation: Department of Biostatistics, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA.
authors.forename: Ziyue
authors.initials: Z
authors.lastname: Liu
mesh_terms: D000554:Ambulatory Care Facilities; D003729:Dental Care; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D011320:Primary Health Care; D011364:Professional Practice; D064876:Safety-net Providers; D013219:State Government; D014481:United States
keywords: Health policy; community health centers; delivery of dental care; dental hygiene; health workforce; oral health; safety-net providers