Addressing Oral Health Disparities in Urban Settings
Oral Health America Webinar Series J U LY 2 0 , 2 0 1 8
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/Oral Health America
@Smile4Health
/Oral Health America
@Smile4Health
2018
HOUSEKEEPING INFORMATION • •
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Please remember to MUTE your phone. Questions are welcome! We’ll allow 10-15 minutes after the presentation for questions. • Questions will be accepted in writing through the control panel on the upper right hand of your screen. • Submit questions at any time; we will address them at the end of the presentation. Webinar is being recorded; for rebroadcast on OHA’s website – OralHealthAmerica.org Your feedback is important to us. Please take our brief webinar evaluation after this session; link will be sent via email.
2018
CE Credit Available
2018
ABOUT ORAL HEALTH AMERICA America’s leading national oral health nonprofit focused on the nation’s oral and overall health for 63 years, with particular emphasis on children and youth, older adults and Americans whose voices are not wellrepresented in oral healthcare conversations. OHA employs strategic partnerships and communications to connect the dots between oral and overall health
SMILES ACROSS AMERICA®
CAMPAIGN FOR ORAL HEALTH EQUITY
WISDOM TOOTH PROJECT®
2018
Early Childhood Caries Prevention Project
School-Based Prevention Programs
Demonstration Projects
Product Donation
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2018
toothwisdom.org
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Professional Symposia
Demonstration Projects
2018
Addresses oral health inequities in our society and identifies possibilities for closing the oral health divide in America. The campaign strives to: Educate and engage the public, including policymakers, about the importance of oral health for overall health Emphasize the need to prioritize oral disease alongside other chronic health conditions Lead, participate and observe on legislative issues impacting oral health policies critical to OHA, our programs and stakeholders 2018
Pierre Cartier, DMD, MPH Comprehensive General Dentist Population Health Expert
2018
Implementing a Clinical Quality Evaluation System in Your Oral Health Practice Pierre M. Cartier, DMD, MPH July 20, 2018
Learning Objectives
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Discuss the importance of collecting and analyzing population health data.
Describe the process for planning, implementing, and evaluating a clinical quality evaluation program in an oral healthcare environment.
Identify three principal data categories collected during the clinical quality evaluation processes.
Identify key process evaluation metrics that might be incorporated into a clinical program’s evaluation process.
Why Do We Need Clinical Quality Assessment? • Identify areas for process improvement. • Identify differences in care and outcomes between populations. • Improve care coordination. • Demonstrate “best practices.”
Planning A Quality Evaluation System 1) Examine clinic processes and existing data. 2) Identify outcomes and problems that seem to be important. 3) Identify stakeholders and assemble working group. 4) Identify processes and outcomes that influence all stakeholders (e.g. �common themes�). 5) Develop metrics to evaluate those from #4. 6) Draft and finalize written evaluation plan.
Three Principal Types of Data Used to Evaluate and Monitor Clinical Programs • Number of children linked to dental home from sealant program. • Percentage of broken appointments. • Number of sentinel events per unit of time.
• Prevalence of patients with urgent dental care needs. • Prevalence of high caries risk patients. • Incidence of advanced edentulism (≥ 6 teeth).
• Percentage of patients experiencing seating delays of 10 minutes or more. • Percentage of patients able to be seen for emergency in same day.
ProcessOriented
Population Health
Patient Experience
Factors to Consider When Designing Metrics
• Process Metrics evaluate goals that occur in the delivery of care or interventions. • “How well are we getting from A to B?” • ”B” is usually some sort of population health outcome.
Process-Oriented Versus Population Health Metrics
Scheduling Priority
Example Metrics: Dental Treatment Urgency Class 3
Deep cavities, teeth requiring root canals, conditions causing severe pain or disruption in oral functioning, abscesses, acute gum infections, etc.
Class 2
Routine fillings, periodontal maintenance cleanings, deep cleanings, partial dentures, etc.
Class 1
Routine preventive care in absence of other treatment needs
Follow-Up Intensity
Example Metrics: Recall Compliance Class A Class B
Class C Class D
Currently has had recall appointment within 1 month of recommended interval Has had recall appointment with 2-3 months of recommended interval Has had recall appointment within 4-6 months of interval Has not had recall appointment or appeared at >6 months
Creating Dummy Codes
Go to “Lists” in toolbar, select ”Service Codes,” and “Edit”
Dummy Codes Will Now Appear in “Walkout” Options
Code Type
Examples
Dental Urgency
Class 1 Class 2 Class 3
Recall Compliance
Class A Class B Class C Class D
Caries Risk
Low Moderate High
Dental ED Visit in Past 6 months
EDVY EDVN
Edentulous without Prosthesis
REMY REMN REMNA (Not Applicable)
New Dental Medicine Patient Examination (From Larger Panel)
NEWY NEWN
What About Systemic Conditions? Condition
Codes
Descriptor
Diabetes
DIANOEX DIASRP DIAEX
Diabetic without comprehensive periodontal examination Diabetic with at least one quadrant of scaling and root planing Diabetic with at least one tooth that was lost to periodontal disease
Depression
DEPNOEX
Individual with depression that hasn’t had comprehensive examination Individual with depression that has not been recalled for preventive care
DEPNORCL
Ensuring Complete Data • A key challenge will be getting the complete data you want. • May need to develop your own spreadsheets to collect data. • Important to develop “case definitions” and train staff regarding these. • Also important to keep metrics and indicators ”focused” to ~510 important ones.
Implementing Patient Surveys • Determine your sampling strategy. • Make surveys a ”matter of fixed routine” based on sampling strategy you select. • Should be limited to 1-3 simple, focused questions. • Recommended to do a ”pilot run” to determine response rate if you aren’t sending survey after every visit.
Reporting Frequency • Reporting is primarily driven by 1) How much “control” you have over the outcome being measured. 2) How critical it is to clinical operations. • Grant and statutory requirements should be considered as well.
How Should We Report Data? • Generally recommend using some type of “visual” mechanism that allows you and stakeholders to see trends. • “Actionable” data should be reported at least on a monthly basis. • Infographics are great for summarizing points to stakeholders.
General Advice 1) Identify and document priorities. 2) ”Keep it Simple!” Align metrics and indicators with logic model. “Bundle” multiple purposes into one metric. 3) Ensure all staff are trained on ascertainment and assessed for compliance. 4) Talk about aggregate data to staff, management, and stakeholders!
Recommended Resources: http://adentmag.com/datamining-for-dentists/
Recommended Resources: www.dentalclinicmanual.com
Recommended Resources: www.mobileportabledentalmanual.com
Contact Information Pierre M. Cartier, DMD, MPH pierrecartierdmdmph@outlook.com (202) 790-7863
Question and Answer Session • Questions are welcome! This session may last for 10-15 minutes. • Write your questions in your control panel on the upper right hand of your screen. • Submit questions at any time.
2018
CE Credit Available
2018
Contact Information
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Dr. Pierre Cartier pierrecartierdmdmph@outlook.com
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David Martin David.Martin@OHA-Chi.org
2018
THANK YOU! Let’s improve the oral and overall health of all Americans together.
2018