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Oral Health Disparities Collaborative Update

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  • 1. Oral Health Disparities Collaborative Pilot Colleen Lampron, MPH Oral Health Pilot Co-chair Executive Director, National Network Oral Health Access
  • 2. Overview
    • Review of Oral Health Collaborative model
    • Discuss Oral Health Disparities Collaborative
    • Implementation Manual
    • Discuss how you can use this information
    • Review next steps
  • 3. 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
  • 4. 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?
  • 5. 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
  • 6. 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
  • 7.  
  • 8.  
  • 9. 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
  • 10. 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
  • 11. 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.
  • 12. The Business Case: Dental Medicaid Visits Salud Case Study
  • 13. Pioneering National Leadership
    • 1 st organized oral health initiative in the county that has a protocol for treating pregnant women
    • 1 st national entity that has a protocol for treating kids at age 1
    • 1 st 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?
  • 14. Oral Health Disparities Collaborative Implementation 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
  • 15. 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
  • 16. 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
  • 17. 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
  • 18. 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
  • 19. 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
  • 20. 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.
  • 21. 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
  • 22. Do Try This at Home
    • Talk to your Medical and Executive Directors about their experience of the oral health collaborative
    • Host a grand round/brown bag learning forum/learning opportunity for medical team about transmissibility, importance of early prevention
    • Build partnerships with medical for referrals and clinical protocols
  • 23. 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
  • 24. 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
  • 25. Thank you
    • More information:
    • Colleen Lampron: 720-838-7739 [email_address]
    • Irene Hilton: 415-657-1708 [email_address]
    • Jay Anderson: 301-594-4295 [email_address]