Oral Health Disparities Collaborative Update

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Transcript of Oral Health Disparities Collaborative Update

  • Oral Health Disparities

    Collaborative PilotColleen Lampron, MPHOral Health Pilot Co-chairExecutive Director, National Network Oral Health Access

  • Overview

    Review of Oral Health Collaborative modelDiscuss Oral Health Disparities Collaborative

    Implementation ManualDiscuss how you can use this informationReview next steps

  • AcknowledgmentIrene Hilton, DDS, MPH Oral Health Collaborative Pilot Co-ChairJay Anderson, DDS, MS Faculty and VisionaryMarty Lieberman, DDS FacultyFrancisco Ramos-Gomez, DDS, MPH FacultyJim Sutherland, DDS, MPHPioneering Teams:Community Health Partners, Livingston MTHigh Plains Community Health Center, Lamar, COSalud Family Health Centers, Fort Lupton, COSunrise Community Health Center, Greeley, COTracy Jacobs, BSN IHI Collaborative DirectorKevin Little, PHD , Data Guru

  • QuestionsHow many of you have participated in a Health Disparities Collaborative?How many of your Health Centers have participated in a Collaborative?How many of you were at the sessions on the Oral Health Collaborative last year?

  • A New Era of Best PracticesProviding value-added preventive dental visitsProviding ECC risk assessment and disease management to very young children in the medical and dental settingsProviding comprehensive dental services to perinatal patientsRedesigning dental service delivery

  • Collaborative AimsDevelop comprehensive primary oral health care system change interventions that generate major improvements in process and outcome measures for:

    Early childhood caries prevention and treatmentPerinatal oral healthConcurrent emphasis on practice redesign and office efficiencies that support improvements in the targeted areas

  • Informed,

    Activated

    Patient

    Productive

    Interactions

    Prepared,

    Proactive

    Practice Team

    Functional and Clinical Outcomes

    Delivery

    System

    Design

    Decision

    Support

    Clinical

    Information

    Systems

    Self-

    Management

    Support

    Health System

    Resources and Policies

    Community

    Health Care Organization

    Care Model

  • SuccessesImproved access to oral health care for young children and pregnant womenParadigm shift to approach clinical dentistry from a prevention standpointDeveloped oral health measures in PECS 3Medical and dental working together to improve patient outcomes

  • ResultsFocusing on the preventive approach rather than surgical or end-stage treatmentIntegration of oral health in PECS 3Implementation and standardized referral mechanisms from medical to dental.Greater collaboration and communication between medical and dentalIncreased oral health knowledge of medical staff

  • Team Results Scheduling 8 days out vs. 4 months out5% no-show vs. 12% no-show 40% Medicaid vs. 20% Medicaid 18.3pts/day vs.12pts/day (based on 8 hour day)Dentist billed $51,281 Aug 2006 vs. $16,205 Aug 2005The OHDPC made dentistry relevant to the delivery of health care within a Community Health Center. The dental department is at the table and no longer a sideshow.At Sunrise, we are a completely different department than we were 18 months ago and it shows in how we now practice dentistry.

  • The Business Case: Dental Medicaid Visits Salud Case Study

    DFL CAID

    159175256.950526315849.4705263158153.2105263158

    194202256.950526315849.4705263158153.2105263158

    171202256.950526315849.4705263158153.2105263158

    200202256.950526315849.4705263158153.2105263158

    156202256.950526315849.4705263158153.2105263158

    111202256.950526315849.4705263158153.2105263158

    161202256.950526315849.4705263158153.2105263158

    103202256.950526315849.4705263158153.2105263158

    151202256.950526315849.4705263158153.2105263158

    121202256.950526315849.4705263158153.2105263158

    112202256.950526315849.4705263158153.2105263158

    115202256.950526315849.4705263158153.2105263158

    151202256.950526315849.4705263158153.2105263158

    242202256.950526315849.4705263158153.2105263158

    170202256.950526315849.4705263158153.2105263158

    227202256.950526315849.4705263158153.2105263158

    38838202256.950526315849.4705263158153.2105263158

    38869202256.950526315849.4705263158153.2105263158

    38899202256.950526315849.4705263158153.2105263158

    38930202256.950526315849.4705263158153.2105263158

    Start of OHC

    Fort Lupton Medicaid

    Goal

    Upper Control Limit since 10/04

    Lower Control Limit since 10/04

    Average

    # Dental Medicaid Visits

    DFL Total

    522617.57894736841032.834502924202.3233918129

    573617.57894736841032.834502924202.3233918129

    619617.57894736841032.834502924202.3233918129

    1161617.57894736841032.834502924202.3233918129

    563617.57894736841032.834502924202.3233918129

    441617.57894736841032.834502924202.3233918129

    543617.57894736841032.834502924202.3233918129

    655617.57894736841032.834502924202.3233918129

    603617.57894736841032.834502924202.3233918129

    575617.57894736841032.834502924202.3233918129

    578617.57894736841032.834502924202.3233918129

    476617.57894736841032.834502924202.3233918129

    582617.57894736841032.834502924202.3233918129

    920617.57894736841032.834502924202.3233918129

    631617.57894736841032.834502924202.3233918129

    859617.57894736841032.834502924202.3233918129

    38838617.57894736841032.834502924202.3233918129

    38869617.57894736841032.834502924202.3233918129

    38899617.57894736841032.834502924202.3233918129

    38930617.57894736841032.834502924202.3233918129

    Notes 12/20/05: The high point in April '05 has been explained by the active dental outreach program (Smile-a-bration) in Fort Lupton that month.

    There are at least 2 discreet processes to get dental appointmente over this time period. Betty

    Start of OHC

    Smile-a-bration

    Fort Lupton Total

    Average

    Upper Control Limit

    Lower Control Limit

    # Total Visits

    Fort Lupton Total Dental Visits

    Summary

    522159175617.5789473684153.2105263158

    573194202617.5789473684153.2105263158

    619171202617.5789473684153.2105263158

    1161200202617.5789473684153.2105263158

    563156202617.5789473684153.2105263158

    441111202617.5789473684153.2105263158

    543161202617.5789473684153.2105263158

    655103202617.5789473684153.2105263158

    603151202617.5789473684153.2105263158

    575121202617.5789473684153.2105263158

    578112202617.5789473684153.2105263158

    476115202617.5789473684153.2105263158

    582151202617.5789473684153.2105263158

    920242202617.5789473684153.2105263158

    631170202617.5789473684153.2105263158

    859227202617.5789473684153.2105263158

    3883838838202617.5789473684153.2105263158

    3886938869202617.5789473684153.2105263158

    3889938899202617.5789473684153.2105263158

    3893038930202617.5789473684153.2105263158

    Start of OHC

    Total Dental Visits

    Medicaid Dental Visits

    Medicaid Goal

    Average Total Dental

    Average CAID Dental

    # Dental Visits

    Fort Lupton Dental MAP Progress

    Fort Lupton

    Number of Visits per Month for M.A.P. Progress AnalysisMFL CAIDGoal CAID

    Time PeriodFort Lupton TotalFort Lupton MedicaidM.A.P. GoalCAID UCLCAID LCLCAID averageCAID Moving RangeCAID SigmaTotal SigmaTotal UCLTotal LCLTotal AverageMFL Total MRMFL CAID MRas % totalas % totalTotal MedianCAID Median

    9/1/03509832329749616.3%45.6%48983

    10/1/03641162232236-419779521137971964961327925.3%36.2%48983

    11/1/0340568232236-419794521137971964962369416.8%57.3%48983

    12/1/0343792232236-41972452113797196496322421.1%53.1%48983

    1/1/0448981232236-41971152113797196496521116.6%47.4%48983

    2/1/0493512823217177413.7%24.8%740163

    3/1/0473220223228359171744213111234257742037427.6%31.7%740163

    4/1/047471732322835917129521311123425774152923.2%31.1%740163

    5/1/047811922322835917119521311123425774341924.6%29.7%740163

    6/1/0465813017528359171625213111234257741236219.8%26.6%740163

    7/1/0493915317528359171235213111234257742812316.3%18.6%740163

    8/1/04723152175283591711521311123425774216121.0%24.2%740163

    9/1/046772381752835917186521311123425774468635.2%25.8%740163

    10/1/0448711717515361824.0%35.9%575151

    11/1/044591021752574915315391561033202618281522.2%38.1%575151

    12/1/044871481752574915346391561033202618284630.4%35.9%575151

    1/1/055221591752574915311391561033202618351130.5%33.5%575151

    2/1/055731942022574915335391561033202618513533.9%35.3%575151

    3/1/056191712022574915323391561033202618462327.6%32.6%575151

    4/1/05116120020225749153293915610332026185422917.2%17.4%575151

    5/1/0556315620225749153443915610332026185984427.7%35.9%575151

    6/1/0544111120225749153453915610332026181224525.2%45.8%575151

    7/1/0554316120225749153503915610332026181025029.7%37.2%575151

    8/1/0565510320225749153583915610332026181125815.7%30.8%575151

    9/1/056031512022574915348391561033202618524825.0%33.5%575151

    10/1/055751212022574915330391561033202618283021.0%35.1%575151

    11/1/055781122022574915393915610332026183919.4%34.9%575151

    12/1/05476115202257491533391561033202618102324.2%42.4%575151

    1/1/0658215120225749153363915610332026181063625.9%34.7%575151

    2/1/0692024220225749153913915610332026183389126.3%22.0%575151

    3/1/0663117020225749153723915610332026182897226.9%32.0%575151

    4/1/0685922720225749153573915610332026182285726.4%23.5%575151

    5/1/0620225749153391561033202618575151

    6/1/0620225749153391561033202618575151

    7/1/0620225749153391561033202618575151

    8/1/0620225749153391561033202618575151

    Total Visits

    28023605.37772307692105.77612307692855.5769230769

    27373605.37772307692105.77612307692855.5769230769

    31803605.37772307692105.77612307692855.5769230769

    35153605.37772307692105.77612307692855.5769230769

    25543605.37772307692105.77612307692855.5769230769

    23763605.37772307692105.77612307692855.5769230769

    31423605.37772307692105.77612307692855.5769230769

    28423605.37772307692105.77612307692855.5769230769

    25923605.37772307692105.77612307692855.5769230769

    27563605.37772307692105.77612307692855.5769230769

    28953605.37772307692105.77612307692855.5769230769

    25023605.37772307692105.77612307692855.5769230769

    30563605.37772307692105.77612307692855.5769230769

    32143605.37772307692105.77612307692855.5769230769

    29173605.37772307692105.77612307692855.5769230769

    33123605.37772307692105.77612307692855.5769230769

    388383605.37772307692105.77612307692855.5769230769

    388693605.37772307692105.77612307692855.5769230769

    388993605.37772307692105.77612307692855.5769230769

    389303605.37772307692105.77612307692855.5769230769

    Note 9/21/05: The high point in April '05 is due to the dental outreach program during that month. Betty

    SALUD-wide Total Visits

    Upper Control Limit

    Lower Control Limit

    Average

    # Pt Visits

    SALUD-wide Total Dental Visits

    Salud-wide CAID

    8398351057.1574769231520.6886769231788.9230769231

    7829661057.1574769231520.6886769231788.9230769231

    9689661057.1574769231520.6886769231788.9230769231

    9419661057.1574769231520.6886769231788.9230769231

    8179661057.1574769231520.6886769231788.9230769231

    6259661057.1574769231520.6886769231788.9230769231

    7579661057.1574769231520.6886769231788.9230769231

    7019661057.1574769231520.6886769231788.9230769231

    8219661057.1574769231520.6886769231788.9230769231

    8229661057.1574769231520.6886769231788.9230769231

    7299661057.1574769231520.6886769231788.9230769231

    6609661057.1574769231520.6886769231788.9230769231

    8519671057.1574769231520.6886769231788.9230769231

    9089681057.1574769231520.6886769231788.9230769231

    7769691057.1574769231520.6886769231788.9230769231

    8799701057.1574769231520.6886769231788.9230769231

    388389711057.1574769231520.6886769231788.9230769231

    388699721057.1574769231520.6886769231788.9230769231

    388999731057.1574769231520.6886769231788.9230769231

    389309741057.1574769231520.6886769231788.9230769231

    Note 9/21/05: The volume of CAID is highly correlated with the overall dental clinic volume (r=0.84). Betty

    SALUD-wide Medicaid

    M.A.P. Goal

    CAID Upper Control Limit

    CAID Lower Control Limit

    Average

    # Medicaid visits

    SALUD-Wide Dental Medicaid Visits

    Salud-wide

    Number of Visits per Month for M.A.P. Progress AnalysisNumber of Visits per Month for M.A.P. Progress AnalysisYear over year medians

    Time PeriodSALUD-wide Total VisitsSALUD-wide MedicaidM.A.P. GoalCAID UCLCaidLCLCAID AverageCAID SigmaTotal Sigma (Median MR)Total UCLTotal LCLTotal averageSALUD-wide total MRSALUD-wide CAID MRTotalCAID

    9/1/03218951672248121562085483

    10/1/032360592722756205481104349308312292156171762085483

    11/1/0318133967227562054811043493083122921565471962085483

    12/1/031980449757756205481104349308312292156167532085483

    1/1/04190539675775620548110434930831229215675532085483

    2/1/0426885367577562054811043493083122921567831402085483

    3/1/04261371698278928562822779

    4/1/042777713982105752178910128236052106285616432822779

    5/1/042779829982105752178910128236052106285621162822779

    6/1/0431017668351057521789101282360521062856322632822779

    7/1/04317377283510575217891012823605210628567262822779

    8/1/0429157538351057521789101282360521062856258192822779

    9/1/0428779678351057521789101282360521062856382142822779

    10/1/04254571383510575217891012823605210628563322542822779

    11/1/0424436238351057521789101282360521062856102902822779

    12/1/04263078483510575217891012823605210628561871612822779

    1/1/0528028398351057521789101282360521062856172552822779

    2/1/052737782966105752178910128236052106285665572822779

    3/1/05318096896610575217891012823605210628564431862822779

    4/1/0535159419661057521789101282360521062856335272822779

    5/1/05255481796610575217891012823605210628569611242822779

    6/1/05237662596610575217891012823605210628561781922822779

    7/1/05314275796610575217891012823605210628567661322822779

    8/1/0528427019661057521789101282360521062856300562822779

    9/1/05259282196610575217891012823605210628562501202822779

    10/1/052756822966105752178910128236052106285616412822779

    11/1/0528957299661057521789101282360521062856139932822779

    12/1/0525026609661057521789101282360521062856393692822779

    1/1/06305685196710575217891012823605210628565541912822779

    2/1/0632149089681057521789101282360521062856158572822779

    3/1/06291777696910575217891012823605210628562971322822779

    4/1/06331287997010575217891012823605210628563951032822779

    5/1/0697110575217891012823605210628562822779

    6/1/0697210575217891012823605210628562822779

    7/1/0697310575217891012823605210628562822779

    8/1/0697410575217891012823605210628562822779

    correlation0.8480921886

  • Pioneering National Leadership1st organized oral health initiative in the county that has a protocol for treating pregnant women1st national entity that has a protocol for treating kids at age 11st national oral health quality improvement effort for Health Center dental programsWe have the technology, change package, and desire to do thisHow do we get there?

  • Oral Health Disparities CollaborativeImplementation ManualA tool to give Health Centers the opportunity to replace episodic, reactive care with comprehensive and proactive care, the Oral Health Disparities Collaborative offers the same for health center dental practices

  • Examples of Resources in the Library

    More than 30 resourcesCAMBRA Risk Assessment Caries Management by Risk Assessment Caries risk assessment tool for children 0-5 years of age. Example of Flow Child - An example of a process map of the flow of a young child visit. Author: Kevin Little, Ph.D., Martin Lieberman, DDS

  • Resources in the Library Team MaterialsOHDP Patient Satisfaction Survey Satisfaction survey for dental patients Author: Developed by the Oral Health Disparities Pilot CHP Dental Balanced Scorecard A dashboard of measures to assess program improvement and vitality. Author: Community Health PartnersHigh Plains CHC: Pedo Caries Risk Assessment Sticker used for children ages 0-5 during initial exam and prevention visit. We print this onto a full page sticker then cut out so it will fit onto our progress note page. There are 2 entries per page. Self Management Goal Setting forms

  • Resources Research ArticlesResearch Articles on pregnancy, early childhood oral health, and infant oral careOral Health and Pregnancy: A Review Author: Sangeeta Gajendra, B.D.S., M.P.H.;Jayanth V. Kumar, D.D.S., M.P.H.Clinical Considerations for an Infant Oral Care Program Author: Francisco J. Ramos-Gomez, DDS, MS, MPH, Associate Professor of Pediatric Dentistry, University of California, San Francisco, San Francisco, CaliforniaECC AG-6 step visit Six steps for the child dental exam including Anticipatory Guidance

  • Resources Power PointPerinatal Oral Health A powerpoint presentation about oral health in pregnant women. Author: Jay R. Anderson, DMD, MHSA, Redesign Tools Exercises Power Point describing how to measure demand and capacity, work analysis, process mapping, waste analysisImproving Access and Efficiency Dental A presentation describing the principles behind improving access and practice efficiency in the dental setting. Author: Christine St. Andre, CSI LLC

  • Resources - ToolsCycle Time Tool - a tool used to measure the time of a patient visit (from when the patient enters the clinic to departure from clinic). Author: 2001, Trustees of Dartmouth College, Godfrey, Nelson, Batalden, Institute for Healthcare ImprovementOral Health DSD Indicators A set of 6 Delivery System Design (also called redesign) measures to assess practice efficiency and patient care effectiveness. Author: Christine St. Andre, Colleen Lampron

  • The ManualA step-by-step guide to implementing your own oral health collaborativeIncludes professionally developed and tested measuresExamples of high leverage changesExplanation of what full integration looks likeThe tools you need to get there.

  • Be Aware of ChallengesExtensive training needed for dental staffCompeting organizational priorities may limit commitmentMIS/IT/data challengesCapacity issues in dentalPrioritization of certain populations an issueDoing this alone may be hazardous to your mental health

  • Do Try This at HomeTalk to your Medical and Executive Directors about their experience of the oral health collaborativeHost a grand round/brown bag learning forum/learning opportunity for medical team about transmissibility, importance of early preventionBuild partnerships with medical for referrals and clinical protocols

  • Next StepsNNOHA will host conference calls on Thursday, March 13, 2008 at 1:00 Eastern (noon Central, 11:00 mtn, 10:00 pacific)Manual will be posted on www.nnoha.org Email notification will take place via listserve and postcard

  • The need Oral medicine is changing rapidlyGrowing recognition of oral systemic connectionWidening gap between oral health of rich and poorPrevention strategies exist that benefit the most vulnerable populations the oral health collaborative implements these

  • Thank youMore information:

    Colleen Lampron: 720-838-7739 [email protected] Hilton: 415-657-1708 [email protected] Anderson: 301-594-4295 [email protected]