Mobile-Portable Hybrid Apple Tree Dental
f. What are some program operation considerations?

Having multiple mobile offices with multiple units allows the "swapping out" of equipment needing repair or maintenance without affecting the operation. If one piece of equipment is not functioning properly, treatment time is not lost due to waiting for repairs. Because Apple Tree is using a large number of Mobile Dental Offices (12 Adec plus a number of lighter Aseptico units), it is important to have a schedule for regular equipment maintenance. The Lead Dental Assistant is responsible for setting up equipment maintenance schedules and following them, while the Transportation Supervisor is responsible for the maintenance of the MDV and leased automobiles. Equipment sterilization is done on site by Statim sterilizers. It is important to have either a quick turnaround time for sterilization or enough instruments available to not have to wait for equipment. Each mobile unit has a bin that is taken to the mobile office on clinical days and returned to the central clinic each evening. The bins have lab cases and restock items. At the end of each day, the staff assesses the supplies by using a standardized inventory list. The list showing needed supplies is placed in the bin and returned to the central clinic. Needed supplies are placed in the bin to be transported to the mobile office for the next clinical day.

Informed consent is an essential part of the Apple Tree model. Before seeing a patient for an initial exam and prior to carrying out dental treatment, the dentist obtains consent from someone who is capable of fully understanding the plan for treatment, either the patient or a patient representative. HIPAA paperwork is completed by the patient or patient representative at the time consent is obtained. Apple Tree provides a written treatment plan to each patient or their patient representative. This plan uses plain language to describe the dental problems, the treatment recommendations, the risks of undergoing the dental procedures, and the problems that can be expected if treatment is delayed or avoided. The plans also include an estimate of the number of visits needed to complete the plan, and the costs involved based on the patient's insurance coverage. Also, in some cases, prior authorization from the insurance carrier is required before treatment can be started. In this case, a treatment plan letter is also sent to the insurance company for approval. Language translation is provided by staff of the long-term care facility or the Head Start Center. Staff that typically works with the patient will assist with communication at dental appointments. This is an advantage over providing care in a regular dental office, as staff often do not accompany the patient there.

In the event of a dental emergency, the dental liaison provides information to the Apple Tree scheduler for that facility by a "Dental Concern" form. The form indicates what the problem is, what area is involved, any treatment provided up to the time of the report, prescription of antibiotic or pain medication and when the problem occurred. If a trip to the facility is planned within a reasonable time frame to handle the emergency, the resident will be placed on the schedule. If no trip is planned within a reasonable time frame, the Apple Tree scheduler will assist the facility with booking an appointment in the fixed clinic.