Legal Name of Applicant Organization:
Fulton-DeKalb Hospital Authority – The Grady Health System – Infectious Disease Program
Address (include Street, City, County, State, and Zip Code):
341 Ponce de Leon Avenue, Atlanta, Georgia 30308
Contact Person (Person to Be Contacted on Matters Involving this Application):
Name: David A. Reznik, D.D.S., Director Oral Health Center, Infectious Disease Program
Phone Number: 404/616-9770 Fax Number: 404/616-0592
E-Mail Address:
Proposed Priority Service Areas And Funding Amount Requested Per Service Priority Area
(See Addendum A for Priority Area Definitions):
Part A Funds Requested
Primary Care: $
AIDS Pharmaceutical Assistance: $
Oral Health: $1,087,731.42
Case Management: $
Mental Health: $
Substance Abuse: $
Support Services: $
TOTAL: $1,087,731.42
*Note: These totals should equal the requests on Attachment H.
Typed Name and Title of Individual Authorized to Enter into Contracts on Agency’s Behalf:
Otis L. Story Sr., FACHE, President and CEO, Grady Health System (Fulton-DeKalb Hospital Authority)
Signature of Above-Listed Authorized Representative and Date Signed:
Insert the “Application Checklist” immediately after the “Cover Page” of your proposal.
Attachment B: APPLICATION CHECKLIST
After completing the application, the individual authorized to enter into contracts on behalf of the applicant agency should place his/her initials in the first column. This certifies that you have reviewed your application for completeness and accuracy. Enter the page numbers for each section.
INITIALSÑ / PART/SECTION / PAGE #
Ñ / REQUIREMENT
I. INTRODUCTION/OVERVIEW
A. Cover Page / Use standardized form provided.
Attachment B / Application Checklist
B. Table of Contents / 1
C. Agency Overview / 4 / No More than 2 Pages
D. Project Abstract / 6 / No More than 2 Pages
II. NARRATIVE / 8
E. Project Description / 8
F. Access and Retention in Primary Care / 20
G. Impact of Proposed Services / 22
H. Program Goals and Objectives / 24 / Attachment E, page 36
I. Quality Management and Evaluation Activities / 24
J. Coordination and Collaboration / 27
K. Payment Policies / 30
III. BUDGET INFORMATION
L. Current Funding Sources / 72 / Attachments G-1 through G-3
M. Budget Summary by Priority Category / 75 / Attachment H
N. Budget and Budget Justification / 76 / Attachment I
ATTACHMENTS:
Attachment C / 33 / Evidence of Agency’s 501(c)(3) status
Attachment D / 35 / List of Board of Directors with Demographics
Attachment E / 36 / Goals and Objectives by Priority Area
Attachment F / 37 / Letters of Agreement
Spreadsheet: Attachment G / 72 / Table G-1: Federal Funds
73 / Table G-2: Non-Federal Funds
74 / Table G-3: Federal & Non-Federal Funds
Spreadsheet: Attachment H / 75 / Table H: Budget Summary Form by Priority Category
Spreadsheet: Attachment I-2 / 76 / Table I-2: Budget
Attachment I-3 / 78 / Budget Justification
Attachment J
**Certification of Receipt of Application / DO NOT ATTACH. Bring this with you when delivering your application.
INITIALS
Ñ / These initials certify that you have reviewed your application for compliance with the following: / .
Applicants are requested to submit one complete original, ink-signed application along with a diskette or CD Rom which includes the application in WORD format and the spreadsheets in EXCEL format and three (3) additional printed copies with budgets. The original should be submitted UNBOUND; copies may be BOUND.
Number all pages of the application clearly and in order, including attachments.
INITIALS
Ñ / These initials certify that you have reviewed your application for compliance with the following:
Narrative text must be either typed double-space or 1.5-space using either Arial or Times New Roman with a font size of 12 with 1" margins on 8½ by 11 inch paper that can be photocopied. Do not use photo reduction.
Do not include required application information in a cover letter; all cover letters will be discarded without benefit of review.
Do not include photos or over-sized documents.
The application should be well-organized and follow the required format as outlined in this section. The narrative section shall be no longer than 25 pages (excluding the cover page, table of contents, Agency Overview, Project Abstract, and required attachments).
Do not include information that is not requested in this guidance. Do not attach additional information about your agency, the services your agency provides, or the number of clients served unless so requested by the application guidance. Information requested by this guidance should be included in the appropriate section and not attached as an appendix.
FY2008 Fulton-DeKalb Hospital Authority (Grady IDP) - Oral Health Care
C. AGENCY OVERVIEW
1. Agency mission statement: The Infectious Disease Program (IDP) is the out-patient HIV/AIDS facility of the Grady Health System (GHS) of the Fulton-Dekalb Hospital Authority, which includes Grady Memorial Hospital and several other hospital and neighborhood-based outpatient clinics. The mission statement of the Oral Health Center (OHC) of the IDP mirrors that of the GHS, which includes the commitment to “improve the health of the community by providing quality, comprehensive health care in a compassionate, culturally competent, ethical and fiscally responsible manner.” Within the Atlanta Eligible Metropolitan Area’s (EMA) triage system, the IDP is committed to providing a comprehensive continuum of ambulatory health care specifically for clients living with advanced HIV/AIDS. The OHC is committed to offering routine and urgent oral health care for IDP clients and medically complex HIV+ clients in the EMA system of care.
2. Year agency was founded: GHS was founded in 1892 and the IDP began in 1986. The OHC opened in 1993, when the IDP relocated to 341 Ponce de Leon Avenue.
3. Number of employees: The IDP employs 174 people (165.15 FTE); 111 (103.15 FTE) are funded by Ryan White Part A funds. The OHC employs 14 people (13.6 FTE); 11 (10.6 FTE) are funded by Ryan White Part A funds under the Oral Health priority category.
4. General description of services provided:
The above schematic depicts the IDP’s comprehensive, interdisciplinary model of care and services. The facility allows provision of a “one-stop-shopping” environment, a framework for productive interactions between empowered, adherent patients and an expert, cohesive, interdisciplinary practice team, which ideally lead to decreased viral load, increased T cell counts and an improved quality of life for clients.
Under the medical direction of Emory University School of Medicine physicians, the IDP provides an array of services including primary care; medications; oral health care; mental health care; substance abuse treatment; education; on-site childcare; laboratory services; radiology services; nutritional evaluation/counseling; and subspecialty services (e.g. Dermatology, Neurology, Oncology, and Ophthalmology). Services offered at the OHC are designed to eliminate oral pain and infection and to restore oral health and function. Services are provided in a client-centered manner that reduces barriers and promotes the continuum of care.
Essential components of the IDP’s interdisciplinary approach include on-site service provision by partner agencies such as AID Atlanta (case management), Atlanta Legal AID (legal counseling), Living Room (housing placement) and Project Open Hand (food pantry and emergency nutrition services including soft meals for OHC clients with oral pain). The Georgia Department of Family and Children’s Services also provides on-site assistance with enrollment and evaluation for Food Stamps and disability adjudication. The IDP has received several awards for its program design and services.
5. Client base served: In calendar year (CY) 2007, 1,635 clients were served in the OHC.1 Based on the Part A EMA triage system, OHC clients are generally those who have the most advanced disease (AIDS) and are thus at the most critical level of illness on the HIV/AIDS continuum and present with the most complicated oral health conditions. 96% were below 100% of the federal poverty level and all are considered uninsured by the Atlanta EMA grantee’s office as Medicare does not have a dental benefit, Georgia Adult Medicaid only covers extractions, and the few clients with private insurance had medical coverage only. African-Americans represented 75.4% of the population served, Caucasians 17.2%, Native American/Asian Pacific Islander 1.6% clients self-identified as multiracial 1.8%, and 5.8% identified as Hispanic. Females represented 26.1% of the population served.1
6. See Attachment C (page 33) for GHS 501(c)(3) documentation
D. PROJECT ABSTRACT
This application addresses the Oral Health priority category and will serve approximately 1,800 clients in FY2008. The Oral Health Center (OHC) of the Grady Health System (GHS) Infectious Disease Program (IDP) proposes to continue provision of high quality, client-centered, routine and emergency dental care for persons living with advanced HIV disease (AIDS) within the Atlanta Eligible Metropolitan Area (EMA). The OHC, an eight chair (operatory) state-of-the art facility, provided 5,403 oral health clinic visits to 1,635 individuals in CY2007.[1] The OHC served 275 new clients in CY2007.1 During CY2006, the latest EMA-wide CARE Act Data Report (CADR) available, 73% of the individuals accessing oral health care via Part A (Title I) of the Ryan White Program in the Atlanta EMA obtained care in the OHC.[2] Over 4,900 clinic visits were provided during CY2006 accounting for about 70% of all EMA dental encounters.2 The OHC has consistently provided exceptional care to the vast majority of clients accessing oral health care services in the Atlanta EMA since 1993.
“Those who suffer the worst oral health include poor Americans…Members of racial and ethnic groups also experience a disproportionate level of oral health problems. People with disabilities and complex health conditions are at greater risk for oral diseases that, in turn, further complicate their health.”[3] Approximately 85% of the clients followed in the OHC are racial or ethnic minorities, 96% are within 100% of the federal poverty level, all have complex medical conditions, and the majority present with severe dental disease.1 It is the goal of the OHC to improve health outcomes by enabling clients to achieve and maintain oral health.
1. Priority Service Area proposed for funding and what will be accomplished through the use of these funds.
Oral Health Care (Total request: 1,087,731.42)
Personnel: $843,427.62 will continue to support the salaries (including a market adjustment and an anticipated 3% annual salary increase) for the 10.6 full time equivalent (FTE) staff positions funded in FY07 (2.6 FTE dentists, 3 FTE dental hygienists, 4 FTE dental assistants including the clinic supervisor, 1 FTE sterilization technician) allowing the program to continue to provide high quality, client-centered, routine and emergency dental care and oral medicine services for approximately 1,600 clients. This proposal requests additional resources to maximize existing OHC facility capacity in order to achieve two goals: 1) a reduction in the 3 month wait time for appointments for new and existing clients; and 2) increased access for an additional 200 medically complex clients throughout the EMA-funded system of primary care. The OHC has eight dental chairs but only seven are fully utilized. $56,733.53 in additional funding is requested for a FTE dental hygienist that will create 160 new preventive, diagnostic and periodontal (deep cleaning) appointments per month. $56,380.42 in additional funding is requested for a 0.4 FTE dentist that will create 72 new appointments for general dental care per month. Both of these positions were approved in the FY07 grant process, but funded at levels inadequate to recruit staff. This proposal seeks to address the unmet oral health care needs for people living advanced HIV disease in the EMA by providing 1,800 clients with 6,500 clinic visits. Total personnel request: $956,541.57
Supplies: $131,189.85 total: $48,000 is requested to continue the provision of dental supplies used in general dental procedures. Dental supplies provided include materials used in restoring teeth such as amalgam and composites; impression materials used in fabricating dentures; materials used in dental hygiene visits such as prophy paste, prophy angles, and dental x-rays; and materials necessary for removing teeth such as dental forceps and suture kits. $3,048 is requested to enable clients of the OHC to have continued access to home care supplies such as toothbrushes, toothpaste and dental floss. $52,421.85 is requested to cover laboratory costs incurred in the fabrication of complete and partial dentures. Partial and complete dentures are offered to clients to replace multiple missing teeth to ensure proper nutrition, function, speech, and esthetics, promoting improved general health. $27,720 is requested to continue support for necessary prescription oral health medications used in the management of oral diseases seen in association with advanced HIV/AIDS. The oral health medications, which include prescription fluoride therapies and mouthrinses, are necessary to prevent dental decay and gum disease and manage oral pain due to infection, ulceration, post surgical discomfort, oral cancer and the oral health consequences of oncology therapies.
2. Support of a comprehensive continuum of care
The OHC is the primary provider of quality oral health care services to eligible persons in the 20-county Atlanta EMA, a key component of a comprehensive system of care. However, addressing the persistent unmet oral health needs of people living with HIV/AIDS in the EMA remains a challenge. Therefore, this year’s application seeks to continue to expand services to all medically complex clients receiving primary care at Ryan White program-funded sites. Medically complex patients are at greatest risk for complications due to oral disease and must have access to timely and expert care to support a true comprehensive system of care. As stated in the Surgeon General’s report, Oral Health in America, “Oral health is integral to general health. You cannot be healthy without oral health.” 3 Therefore, clients who receive care in the OHC should achieve the following benefits: elimination of dental pain and infection; restoration of oral function and esthetics; and improvement in general health and well-being.
The IDP plays a lead role in ensuring that eligible persons in the Atlanta EMA have access to quality primary care and HIV/AIDS specialty care as well as the essential support services needed to remain in care. In addition to primary and subspecialty adult and pediatric medical care, peer counseling, mental health care, substance abuse services, and oral health care the IDP provides space for several partner agencies delivering services on-site including case management, housing assistance, legal counseling, and a food pantry. Several letters of agreement are in place to facilitate referrals of clients from other sites requiring specialty care (i.e. agreements with Fulton and DeKalb County HIV Clinics and St. Joseph’s Mercy Care to accept their Hepatitis C co-infected clients). Several IDP staff members, including the OHC Director, and clients participate in the Metropolitan Atlanta HIV Health Services Planning Council activities in order to understand client needs, assist in the enhancement and quality management of the continuum of care and services available for clients, and to maximize opportunities to collaborate with other service providers. The OHC/IDP staff is committed to ensuring that clients have access to all services, whether on-site or by referral, which would serve to bring them into care, keep them in care, and enhance quality of life.