oral health quality for safety net dental programs
DESCRIPTION
by Jay AndersonTRANSCRIPT
Oral Health Quality For Safety Net Dental Programs
Jay R .Anderson, DMD, MHSADirector Practice ImprovementDentaQuest 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 knowledge
1. 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 Organizations
JCAHO 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 PDSA
F Find a process to improve O Organize an effort to work on improvementC Clarify current knowledge of the processU Understand process variation and capability
S 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 care
Dental chart/medical record is used as documentation of the care provided.
Outcomes MeasurementOutcomes measurement is the process of systematically
tracking a patient's 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
56%
48%
60% 60% 60%
0%
20%
40%
60%
80%
100%
FY09 Q1 FY09Q3 FY09Q4
No New Cavities ‐ Albany Park No New Cavities ‐ Humboldt ParkOral Health Goal
Oral health patients complete treatment plan within one year
70%94% 97%97% 90%
90% 90% 90%
0%
20%
40%
60%
80%
100%
FY09 Q1 FY09Q3 FY09Q4
Treatment Plan Complete ‐ Albany Park
Treatment Plan Complete ‐ HumboldtParkOral Health Goal
Sample Metrics from Erie Family Health Center in Chicago
Productivity ReportingSample Metrics from Erie Family Health Center in Chicago
Measure
Description
Numerator
Denominator Measurement
DataSource
Cavity Free Percentage of oral health patients that are caries free
Numerator: Number of oral health patients from the denominator who are Caries free.
Denominator: All oral health patients seen in the measurement year
This can be stratified by age group as needed.
Your practice
Measure
Description
Numerator
Denominator Measurement
DataSource
Annual Dental Visit The percentage of patients who had at least one dental visit during the measurement year.
Numerator: Number of patients with one or more dental visits with a dental practitioner during the measurement year.
Denominator: All eligible patients served by the HRSA funded program.
The measure is reported for each of the following age stratifications and as a combined rate. • 2-3 years • 4-6 years • 7-10 years • 11-14 years • 15-18 years • 19-21 years • >21 years • >65 years A patient had a dental visit if a submitted claim/encounter contains any of the codes in Table ADV-A. This measure can be expanded to include adults
HEDIS® Measure – Adapted to include additional age groups Note: Visits for many 1 year olds will be counted because the specification includes children whose second birthday occurs any time during the measurement year.
Measure
Description
Numerator
Denominator Measurement
DataSource
Annual Dental Visit
The percentage of patients who had at least one dental visit during the measure ment year.
Numerator: Number of patients with one or more dental visits with a dental practitioner during the measurement year.
Denominator: All eligible patients served by the HRSA funded program.
The measure is reported for each of the following age stratifications and as a combined rate. • 2-3 years • 4-6 years • 7-10 years • 11-14 years • 15-18 years • 19-21 years • >21 years • >65 years A patient had a dental visit if a submitted claim/encounter contains any of the codes in Table ADV-A. This measure can be expanded to include adults
HEDIS® Measure – Adapted to include additional age groups Note: Visits for many 1 year olds will be counted because the specification includes children whose second birthday occurs any time during the measurement year.
Measure
Description
Numerator
Denominator Measurement
DataSource
Documented Comprehensive Treatment Plan (Comprehensive dental exam includes periodontal assessment as well as determination of presence of decay.] (HDC)
Percentage of all dental patients with a compreh ensive or periodic recall oral exam, for whom the Phase I treatmen t plan is documen ted
Numerator: Number of patients from the denominator that have a documented treatment plan.
Denominator: Number of patients that receive a comprehensi ve oral exam (ADA code 0110) or a periodic recall (ADA code 0120) oral exam
I. 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.
HRSA Health Disparity Collaborative Tested HAB OPR ORHP
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
DataSource
Completed Compre hensive Treatme nt Plan
Percentage of all dental patients for whom the Phase I treatment plan is complete d within a 12 month period.
Numerator: Number of patients from the denominator with a completed Phase 1* treatment within 12 months of initiation.
Denominator: Number of patients that receive a comprehensive oral exam (ADA code 0110) or a periodic recall (ADA code 0120) oral exam within the measurement year
Phase 1 Treatment is completed when: Patient has been discharged to periodic follow up after all items in the phase 1 treatment plan as noted above are completed. Note: if the patient chooses to discontinue Phase 1 therapy, then the treatment would be considered complete.
HRSA Health Disparity Collaborative Tested HAB OPR ORHP
Measure
Description
Numerator
Denominator Measurement
DataSource
Topical Fluoride percentage of patients with at least one topical fluoride treatment during the report period
Numerator: number of patients with at least one topical fluoride treatment during the report period
Denominator: Number of patients with a documented dental visit during the report period
Modified
Measure
Description
Numerator
Denominator Measurement
DataSource
Fluoride varnish applicati ons
Percentage of children age 12 to72 months with 1 or more fluoride varnish applicatio ns document ed
Numerator: Number of patients in the denominator with a topical fluoride varnish (D1206) documented (within the previous 12 months)
Denominator: Number of children 1-6 years of age with a documented dental visit in the last 12 months
Modified from HRSA Oral Health Disparity Collaborative to include age 6
HRSA Health Disparity Collaborative Tested
Measure
Description
Numerator
Denominator Measurement
DataSource
Dental Sealant The percentage of children between the ages of 6 and 21 years who received at least a single sealant treatment from a dentist.
Numerator: The number of children between the ages of 6 and 21 years who received at least a single sealant treatment from a dentist during the reporting period.
Denominator: The percentage of all children between the ages of 6 and 21 years who had a dental visit during the reporting period. *
Notes: Important at eruption time of the first molar (5-7) and the second permanent molar(11-13); CHIP and MCHB focus on "3rd graders" while service delivery grantees collect information according CDC and age groupings; consensus needed on age groups for stratification.
Measure used by MCHB and States of Maine, Kansas, Texas, Virginia and Tennessee with HRSA modification to age 21
Measure
Description
Numerator
Denominator Measurement
DataSource
Primary Care Provider Dental Counseli ng: medical setting
Percentage of children age 12 to 48 months who received patient education and anticipat ory guidance for oral health in the medical setting
Numerator: Children age 12 to 48 months with dental/oral health counseling by a primary care provider documented (last 12 months)
Denominator: Children age 12 to 48 months seen by a primary care provider documented (last 12 months)
Measure
Description
Numerator
Denominator Measurement
DataSource
Oral health educatio n Service given by a dentist or dental hygeinist , dental assistant and/or dental case manager
Percentage of oral health patients who received oral health education at least once in the measure ment year.
Numerator: Number of oral health patients who received oral health education at least once in the measurement year.
Denominator: Number of oral health patients that received a clinical oral evaluation at least once in the measurement year.
patients who had only an evaluation or treatment for a dental emergency in the measurement year will be excluded.
adapted from HIV/AIDS Bureau Measure
Measure
Description
Numerator
Denominator Measurement
DataSource
Periodontal screenin g or examinat ion
Percentage of oral health patients who had a periodont al screening or examinati on at least once in the measure ment year.
Numerator: Number of oral health patients who had periodontal screening or examination at least once in the measurement year
Denominator: Number of oral health patients that received a clinical oral evaluation at least once in the measurement year.
Exclusions: 1. Patients who had only an evaluation or treatment for a dental emergency in the measurement year. 2. Full denturist patients (This measure may also be very useful for DM, and perinatal?)
adapted from HIV/AIDS Bureau Measure
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 InstituteDirector, DentaQuest Oral Health [email protected]