Oral Health Quality for Safety Net Dental Programs
Oral Health Quality For Safety Net Dental Programs Jay R .Anderson, DMD, MHSA Director Practice Improvement DentaQuest Institute
Defining Quality of Care • Care: the services rendered by members of the health professions for the benefit of a patient • Quality of care: the degree to which health services to individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge1. Dorland’s Medical Dictionary2. Medicare: A Strategy for Quality Assurance. IOM, 1990, p.21
Quality Dental Care• The Institute of Medicine (IOM) outlined six aims for changing the health care system. Care must be – safe, – effective, – patient-centered, – timely, – efficient – equitable.
Determinants of Excellence in Dental Health Care• structural adequacy,• access and availability,• technical abilities of practitioners,• practitioner communication skills and attitudes,• documentation of services provided,
Determinants of Excellence in Dental Health Care• coordination and follow-up,• patient commitment,• adherence to a therapeutic regimen,• patient satisfaction,• and clinical outcomes.
The Joint Commission on the Accreditation of Healthcare OrganizationsJCAHO provides the following criteria:• Efficacy: Is the care/procedure useful?• Appropriateness: Is it right for this patient?• Accessibility: If right, can this patient get it?• Acceptability: If right and available, does this patient want it?• Effectiveness: Is it carried out well?• Efficiency: Is it carried out in a cost-effective way?• Continuity: Did it progress without interruption, with appropriate follow up, exchange of information and referral?
Continuous Quality Improvement (CQI)A continuous quality improvement model first used and promoted by the Hospital Corporation of American is known as FOCUS PDSAF Find a process to improveO Organize an effort to work on improvementC Clarify current knowledge of the processU Understand process variation and capabilityS Select a strategy for continued improvement
Continuous Quality Improvement (CQI)P Plan the improvement interventionD Do the interventionS Study the results of what was doneA Act on these results to improve the intervention
Quality Assurance (QA)• Quality Assurance is another formal set of activities that measure the kind and degree of excellence of health care services provided.• Quality Assurance includes both a measurement phase (quality assessment) and corrective actions (quality improvement) to remedy any deficiencies identified through the quality assessment process.
Quality Measurement (QM)The measurement phase in a quality assurance program, in which pre-established criteria or standards for professional performance, with respect to patient, administrative, and support services, are compared against the health care actually provided is also a component of quality careDental chart/medical record is used as documentation of the care provided.
Outcomes MeasurementOutcomes measurement is the process of systematically tracking a patients clinical treatment and responses to that treatment using generally accepted oral health outcomes measures, or quality indicators, such as:• presence or absence of dental disease,• improved oral health status,• exposure to preventive care,• functional status,• personal disease management,• and patient satisfaction.• Patient Safety
UDS Oral Health Measures Total Patients: 3,438,340 $ $ 371.65 per patient per year
Sample Metrics from Erie Family Health Center in Chicago Pediatric oral health patients enrolled in program for at least one year experience no new cavities 100% 80% 60% 60% 60% 60% 40% 48% 56% 20% 0% FY09 Q1 FY09Q3 FY09Q4 No New Cavities ‐ Albany Park No New Cavities ‐ Humboldt Park Oral Health Goal
Sample Metrics from Erie Family Health Center in Chicago Oral health patients complete treatment plan within one year 100% 90% 90% 90% 80% 60% 94% 97% 97% 90% 40% 70% 20% 0% FY09 Q1 FY09Q3 FY09Q4 Treatment Plan Complete ‐ Albany Park Treatment Plan Complete ‐ Humboldt Park Oral Health Goal
Productivity ReportingSample Metrics from Erie Family Health Center in Chicago
Measure Description Numerator Denominator Measurement DataSourceCavity Free Percentage of Numerator: Number Denominator: This can be stratified by age group as Your practice oral of oral health All oral health needed. health patients from patients seen patients the denominator in the that are who are Caries measurement caries free. year free
Measure Description Numerator Denominator Measurement DataSourceAnnual Dental Visit The percentage Numerator: Number Denominator: The measure is reported for each of HEDIS® Measure of patients who of patients with one All eligible patients the following age stratifications and as – Adapted to had at least one or more dental visits served by the a combined rate. include additional dental visit with a dental HRSA funded • 2-3 years age groups during the practitioner during program. • 4-6 years Note: Visits for measurement the measurement • 7-10 years many 1 year olds year. year. • 11-14 years will be counted • 15-18 years because the • 19-21 years specification • >21 years • includes children >65 years A whose second patient had a dental visit if a birthday occurs any submitted claim/encounter contains time during the any of the codes in Table ADV-A. measurement year. This measure can be expanded to include adults
Measure Description Numerator Denominator Measurement DataSourceAnnual Dental The percentage Numerator: Number Denominator: The measure is reported for each of the HEDIS® Measure – Visit of of patients with All eligible following age stratifications and Adapted to patients one or more patients as a combined rate. include who had dental visits with served by the • 2-3 years additional age at least a dental HRSA funded • 4-6 years groups one practitioner program. • 7-10 years Note: Visits dental during the • 11-14 years for many 1 visit measurement • 15-18 years year olds will during year. • 19-21 years be counted the • >21 years because the measure • >65 years specification ment A patient had a dental visit if a includes year. submitted claim/encounter children contains any of the codes in Table whose second ADV-A. This measure can be birthday expanded to include adults occurs any time during the measurement year.
Measure Description Numerator Denominator Measurement DataSourceDocumented Percentage of Numerator: Number Denominator: I. Phase 1 Treatment Plan: * HRSA Health Comprehensive all of patients Number of Plan for Prevention, Disparity Treatment Plan dental from the patients that maintenance and/or elimination Collaborative (Comprehensive patients denominator receive a of oral pathology from dental Tested dental exam with a that have a comprehensi caries or periodontal disease. HAB includes compreh documented ve oral exam Plan includes: oral cancer OPR periodontal ensive or treatment plan. (ADA code prevention; prevention ORHP assessment as periodic 0110) or a education and services; well as recall periodic emergency treatment; determination oral recall (ADA diagnostic services and of presence of exam, code 0120) treatment planning; restorative decay.] (HDC) for oral exam treatment; basic periodontal whom therapy (non surgical); basic the oral surgery that includes Phase I simple extractions and biopsy; treatmen non-surgical endodontic t plan is therapy; and space maintenance documen and tooth eruption guidance for ted transitional dentition.
Phase 1 Treatment Plan• Plan for Prevention, maintenance and/or elimination of oral pathology from dental caries or periodontal disease. Plan includes: oral cancer prevention; prevention education and services; emergency treatment; diagnostic services and treatment planning; restorative treatment; basic periodontal therapy (non surgical); basic oral surgery that includes simple extractions and biopsy; non-surgical endodontic therapy; and space maintenance and tooth eruption guidance for transitional dentition.
Measure Description Numerator Denominator Measurement DataSourceCompleted Percentage of Numerator: Number Denominator: Phase 1 Treatment is completed when: HRSA Health Compre all dental of patients from Number of Patient has been discharged to Disparity hensive patients the denominator patients that periodic follow up after all items Collaborative Treatme for whom with a completed receive a in the phase 1 treatment plan as Tested nt Plan the Phase Phase 1* comprehensive noted above are completed. HAB I treatment within oral exam Note: if the patient chooses to OPR treatment 12 months of (ADA code discontinue Phase 1 therapy, then ORHP plan is initiation. 0110) or a the treatment would be considered complete periodic recall complete. d within a (ADA code 12 month 0120) oral period. exam within the measurement year
Measure Description Numerator Denominator Measurement DataSourceTopical Fluoride percentage of Numerator: number of Denominator: Number of Modified patients with patients with at least patients with a at least one one topical fluoride documented dental topical treatment during the visit during the fluoride report period report period treatment during the report period
Measure Description Numerator Denominator Measurement DataSourceFluoride Percentage of Numerator: Denominator: Modified from HRSA Oral Health HRSA Health varnish children Number of Number of Disparity Collaborative to include Disparity applicati age 12 patients in the children 1-6 age 6 Collaborative ons to72 denominator years of age Tested months with a topical with a with 1 or fluoride varnish documented more (D1206) dental visit in fluoride documented the last 12 varnish (within the months applicatio previous 12 ns months) document ed
Measure Description Numerator Denominator Measurement DataSourceDental Sealant The percentage Numerator: Denominator: Notes: Important at eruption time of the Measure used by of The number of The first molar (5-7) and the second MCHB and children children between percentage of permanent molar(11-13); CHIP States of between the ages of 6 and all children and MCHB focus on "3rd Maine, the ages 21 years who between the graders" while service delivery Kansas, Texas, of 6 and received at least ages of 6 and grantees collect information Virginia and 21 years a single sealant 21 years who according CDC and age Tennessee who treatment from a had a dental groupings; consensus needed on with HRSA received dentist during visit during age groups for stratification. modification at least a the reporting the reporting to age 21 single period. period. * sealant treatment from a dentist.
Measure Description Numerator Denominator Measurement DataSourcePrimary Care Percentage of Numerator: Denominator: Provider children Children age 12 Children age Dental age 12 to to 48 months 12 to 48 Counseli 48 with dental/oral months seen ng: months health by a primary medical who counseling by a care provider setting received primary care documented patient provider (last 12 education documented months) and (last 12 months) anticipat ory guidance for oral health in the medical setting
Measure Description Numerator Denominator Measurement DataSourceOral health Percentage of Numerator: Denominator: patients who had only an evaluation or adapted from educatio oral Number of oral Number of treatment for a dental emergency HIV/AIDS n health health patients oral health in the measurement year will be Bureau Service patients who received patients that excluded. Measure given by who oral health received a a dentist received education at clinical oral or dental oral least once in the evaluation at hygeinist health measurement least once in , dental education year. the assistant at least measurement and/or once in year. dental the case measure manager ment year.
Measure Description Numerator Denominator Measurement DataSourcePeriodontal Percentage of Numerator: Denominator: Exclusions: adapted from screenin oral Number of oral Number of 1. Patients who had only an HIV/AIDS g or health health patients oral health evaluation or treatment for a Bureau examinat patients who had patients that dental emergency in the Measure ion who had a periodontal received a measurement year. periodont screening or clinical oral 2. Full denturist patients al examination at evaluation at (This measure may also be very screening least once in the least once in useful for DM, and perinatal?) or measurement the examinati year measurement on at least year. once in the measure ment year.
Slide Credits• Dr. Lee Francis, CEO Erie Family Health Center, Chicago, Illinois• HRSA Oral Health Workgroup
Contact Information• Jay R. Anderson, DMD, MHSA Director, Practice Improvement DentaQuest Institute Director, DentaQuest Oral Health Center email@example.com 508-329-2406