Oral Health Disparities

Collaborative Pilot

Colleen Lampron, MPHColleen Lampron, MPHOral Health Pilot Co-chairOral Health Pilot Co-chair

Executive Director, National Executive Director, National Network Oral Health AccessNetwork Oral Health Access

Overview

Review of Oral Health Collaborative model Discuss Oral Health Disparities CollaborativeImplementation Manual Discuss how you can use this information Review next steps

Acknowledgment

Irene Hilton, DDS, MPH Oral Health Collaborative Pilot Co-Chair Jay Anderson, DDS, MS – Faculty and Visionary Marty Lieberman, DDS – Faculty Francisco Ramos-Gomez, DDS, MPH – Faculty Jim Sutherland, DDS, MPH Pioneering Teams: Community Health Partners, Livingston MT High Plains Community Health Center, Lamar, CO Salud Family Health Centers, Fort Lupton, CO Sunrise Community Health Center, Greeley, CO Tracy Jacobs, BSN IHI Collaborative Director Kevin Little, PHD , Data Guru

Questions

How 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 Practices

Providing value-added preventive dental visits Providing ECC risk assessment and disease

management to very young children in the medical and dental settings

Providing comprehensive dental services to perinatal patients

Redesigning dental service delivery

Collaborative Aims

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

– Early childhood caries prevention and treatment– Perinatal oral health– Concurrent emphasis on practice redesign and office

efficiencies that support improvements in the targeted areas

Informed,ActivatedPati ent

ProductiveInteractions

Prepared,ProactivePractice Team

Functional and Clinical Outcomes

DeliverySystemDesign

DecisionSupport

ClinicalInformation

Systems

Self-Management

Support

Health SystemResources and Policies

Community Health Care Organization

Care Model

Model for Improvement What are we trying

to accomplish? How will we know that a

change is an improvement?

Act Plan

Do Study

Successes

Improved access to oral health care for young children and pregnant women

Paradigm shift to approach clinical dentistry from a prevention standpoint

Developed oral health measures in PECS 3 Medical and dental working together to

improve patient outcomes

Results

Focusing on the preventive approach rather than surgical or end-stage treatment

Integration of oral health in PECS 3 Implementation and standardized referral

mechanisms from medical to dental. Greater collaboration and communication

between medical and dental Increased oral health knowledge of medical staff

Team Results

Scheduling 8 days out vs. 4 months out

5% “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 2005 The 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

0

50

100

150

200

250

300

Jan-05 Apr-05 Jul-05 Oct-05 Jan-06 Apr-06 Jul-06

# Dental Medicaid Visits

Fort LuptonMedicaid

Goal

Upper ControlLimit since10/04Lower ControlLimit since10/04Average

Start of OHC

Pioneering National Leadership

1st organized oral health initiative in the county that has a protocol for treating pregnant women

1st national entity that has a protocol for treating kids at age 1

1st national oral health quality improvement effort for Health Center dental programs

We have the technology, change package, and desire to do this

How do we get there?

Oral Health Disparities CollaborativeImplementation Manual

A 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 resources CAMBRA 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 Materials

OHDP 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 Partners

High 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 Articles

Research Articles on pregnancy, early childhood oral health, and infant oral care

Oral 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, California

ECC AG-6 step visit – Six steps for the child dental exam including Anticipatory Guidance

Resources – Power Point

Perinatal 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 analysis

Improving 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 - Tools

Cycle 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 Improvement

Oral 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 Manual

A step-by-step guide to implementing your own oral health collaborative

Includes professionally developed and tested measures

Examples of high leverage changes Explanation of what full integration looks like The tools you need to get there.

Be Aware of Challenges

Extensive training needed for dental staff Competing organizational priorities may limit

commitment MIS/IT/data challenges Capacity issues in dental Prioritization of certain populations an issue Doing this alone may be hazardous to your

mental health

Do Try This at Home

1) Talk to your Medical and Executive Directors about their experience of the oral health collaborative

2) Host a grand round/brown bag learning forum/learning opportunity for medical team about transmissibility, importance of early prevention

3) Build partnerships with medical for referrals and clinical protocols

Next Steps

NNOHA 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 rapidly Growing recognition of oral systemic

connection Widening gap between oral health of rich

and poor Prevention strategies exist that benefit

the most vulnerable populations – the oral health collaborative implements these

Thank you

More information:

Colleen Lampron: 720-838-7739 colleenlampron@gmail.com

Irene Hilton: 415-657-1708 ivhilton@ix.netcom.comJay Anderson: 301-594-4295 janderson@hrsa.gov