increasing dental access: a collaboration between a community health center and a dental residency...
TRANSCRIPT
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INCREASING DENTAL ACCESS:A COLLABORATION BETWEEN A
COMMUNITY HEALTH CENTER AND A DENTAL RESIDENCY PROGRAM
Maryann Bailey, DDSDirector of Dental Services
Westside Health
Robert Arm, DMDDirector General Practice Residency Program
Christiana Care Health System
James Baker, DDS Delaware Institute of Dental Education
and Research, State of Delaware
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Goals:Today: Provide some practical information on dental
residency programs and how to incorporate residents into a community clinic setting.
Demonstrate the value of a partnership with teaching hospital to increase access to care
If time: Provide a history of the Dental Program at
Westside Health Review difficulties recruiting dentists in the
State
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Design – Based on needs of both programs
Accreditation ADA Access to Care
Education
Westside X 1 2
CCHS X X 2 1
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Westside Health’s mission
Respond with compassion and respectto the health care needs of vulnerable individuals and families by providing equal access to quality health care, with an emphasis on disease prevention and health promotion, regardless of ability to pay.
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Westside Health
Federally Qualified Community Health Center with three locations in and around Wilmington, Delaware
Large organizational growth over the last 10 years
17 FTE medical providers – MDs and NPs Multicultural patient population, majority
speak Spanish as their primary language
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100% FPL and Below
53%
101-150% FPL21%
Over 200% FPL
16%
151-200% FPL9%
Unknow n1%
Note: Federal Poverty Level for a family of three in 2004 was $15,670. (See http://aspe.hhs.gov/poverty/04poverty.shtml)Source: 2004 UDS Report to HRSA, BPHC
Figure 1
Westside Health PatientsBy Income Level, 2004
Westside Health Patients By Income Level, 2004
Westside Health PatientsBy Income Level, 2004
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Private Insurance
8%
Medicare4%
None/Uninsured
39%
Medicaid49%
Source: 2004 UDS Report to HRSA, BPHC
Figure 2
Westside Health Patients By Insurance Status, 2004
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White10%
Hispanic or Latino65%
Black/African
American21%
Asian/Pacific Islander
3%
American Indian/Alaska Native
1%Source: 2004 UDS Report to HRSA, BPHC
Figure 3
Westside Health Patients By Race/Ethnicity, 2004
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5,700
22,288
9,044
32,031
11,805
43,292
0
10,000
20,000
30,000
40,000
50,000
2002 2003 2004
We stside H e alth - Patie nts and Patie nt Visits
Patients
V is its
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Identification of Need
Patient Satisfaction Survey performed in 1996 asked patients to write in their recommendations for increased services at Westside.
The resounding answer was:
“Dental”
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Linkage with CCHS
Gave input into equipment and staffing needed to adequately run a dental program.
Offered assistance in recruitment of dentist to Westside and would help prepare that person for the Delaware Clinical Exam.
Interested in resident rotations at our CHC once a qualified dentist in place.
Dr. Arm’s expertise helped us apply for another New Access Point Oral Health Grant in 2001.
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Westside Dental Program
Opened December 2002 2,500 square foot space with four
operatories. Initial dentist was a NHSC Ready
Responder placed at Westside for a short time to establish dental care.
Nationwide recruitment for a Director of Dental Services
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Director of Dental Services Recruited
Westside covered my travel to Delaware to screen potential dental exam subjects.
This was an organization-wide effort, as staff and their families offered to be a test subject in exchange for free dental care and time off.
Dr. Arm coached me, a periodontist, on exam topics and refreshed my general dentistry skills before the exam in January 2003.
Westside provided transportation to Philadelphia for the exam subjects and dental supplies.
I chose to bring my own Dental Assistant for the exam.
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Dental Program Expansion, 2004-Present
226256
335
286 302327 337
314353
293327
383
468
543 551
436
584565
150
200
250
300
350
400
450
500
550
600
650
Jan-04
Feb-04
Mar-04
Apr-04
May-04
Jun-04
Jul-04 Aug-04
Sep-04
Oct-04
Nov-04
Dec-04
Jan-05
Feb-05
Mar-05
Apr-05
May-05
Jun-05
Month
Num
ber o
f Vis
its
Number of Visits Goal
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Westside’s Dental Program
March 2003-- 1 FTE dentist and 0.8 FTE hygienist
The need in the community far outweighed the capacity of our small dental clinic.
Met again with CCHS to discuss dental resident rotations.
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2004 Oral Health Expansion Grant Proposal
Fit out and equip another four operatories, bringing total to eight.
Add another fulltime dentist Increase hygiene hours Extend hours to include two evenings
per week. Establish dental residency rotation at
Westside
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Dental Resident Rotations At Westside
The final piece of the Oral Health Expansion Grant
Westside had experience working with Family Practice residents from CCHS.
Both partners committed to the realization of this plan with Senior Leader support..
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Value of Dental Residency Affiliation
Increased access to care– residents can perform evaluations and treatment with
oversight from dental preceptor. Cost efficient Cost efficient
– use of facilityuse of facility– cost of providerscost of providers
Potential to help with future recruitment of dentists for Westside and the state
Contributes to the professional development of Westside dentists.
Referral source for difficult patients– oral surgery, patients requiring sedation, and medically compromised patients.
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Residency Collaboration
Just started July 2005 Westside hosted the new residents for an
afternoon of orientation before start date. Resident rotations will increase dental
providers by 0.6 FTEs. Thus far, staff impressed with
professionalism of the residents and patients are pleased with care.
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– Christiana HospitalChristiana Hospital, , in Newark, a 780-in Newark, a 780-bed hospital, providing the highest bed hospital, providing the highest capabilities in neonatal care, plus major capabilities in neonatal care, plus major regional, comprehensive, heart and regional, comprehensive, heart and cancer centers.cancer centers.
– Wilmington HospitalWilmington Hospital,, in Wilmington, a in Wilmington, a 291-bed, community hospital, providing 291-bed, community hospital, providing emergency and acute care services to emergency and acute care services to those who live and work in the city and those who live and work in the city and its suburbs.its suburbs.
Christiana Care operates two acute-care teaching hospitals in New Castle
County, DE
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CCHS Mission
To improve the health of all individuals in the communities we serve.
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CCHS Vision
To establish a strong, independent, coordinated healthcare system of unsurpassed excellence which is patient-focused and community-based.
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CCHS’sAffiliation Requirements:
Facility must meet all accreditation standards–Space–Documentation–Quality assurance–Patient procedures, work-ups, etc–Support staff – 4 handed assisting
- dental hygiene
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CCHS’sAffiliation Requirements:
Must have an approved attending– Evaluate residents – Evaluate patients treatment – Have a desire to teach/mentor– Fill out evaluations, required forms– Be part of resident review committee
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CCHS’sAffiliation Requirements:
Qualified Residents– Qualified candidates – can we recruit?– Spots must be filled– All residents must be accepted to rotations -
can’t refuse anyone All must be part of any remediation plans
– Residents must be team players– Diverse backgrounds/schools
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CCHS’sAffiliation Requirements:
Distant Sites – Housing must be provided– Distant learning available
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Requirements for Dental Resident Rotations - Met
Qualified dentist on staff to precept the residents
Enough physical space and equipment to support operations – 4 new operatories added
Fully staffed practice to efficiently assist dental care by the residents.
Establish policies, documentation guidelines, and quality improvement activities compatible with the standards of the Commission of Dental Accreditation.
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Goals of Christiana Care Health System Affiliation with Westside
Increased opportunities for resident education Educate residents on culturally effective care
through exposure to a multicultural patient population.
Improve educational curriculum – 4 handed dentistry
Maintain accreditation Increase access to dental care in the community
– mission statement of both Retain dentists in state after residency.
Currently, over 80% stay in Delaware.
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CCHS General Practice Residency Program - Changes
Goal – Increase the residency from six to eight residents per year – two added in 2005 to support Westside rotation
Problems recruiting residents – broken contracts, withdrawals
Even with only six to start WE STAYED COMMITTED TO THE PROGRAM
Seventh added late June Eight to be added in September
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Problems – Change Rotations: THIS YEAR
•24 blocks – ½ month but 8 residents 8+ months - General Dentistry
• 1 1/2 months - OMFS
• 1 1/2 Months - Consult Rotation
•Wednesday AM- Endodontics
•Wednesday PM – Implants
•Thursday PM – Periodontics
•Friday AM - Pediatrics
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Implant Program –
A Key to Attracting Residents
Wednesday PM – Implant TeamDrs. Zucker, Baker, Isaacs
Drs. Rafetto, Granite - OMFS
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Rotations
Consultations - Inpatient/ ambulatory Emergency Department Anesthesia Other sites
Problems with scheduling
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PROGRAM ANNOUNCEMENT
Delaware State Loan Repayment Program
For Physicians and Dentists
June 2002
Appropriate access to health care services throughout the state requires an adequate number and appropriate geographic distribution of physicians and dentists. The documented shortage of physicians and dentists in certain parts of Delaware is a concern.
And Help From the State
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Challenges – Westside
Scheduling Scheduling – Best for patients and scheduling Best for patients and scheduling same time each weeksame time each week
SeminarsSeminars– Problems with last minute changesProblems with last minute changes
Residents are slowerResidents are slower Orientation – takes chair side time away Orientation – takes chair side time away Time from dentists schedule to superviseTime from dentists schedule to supervise
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Challenges - Christiana
Recruitment of residentsRecruitment of residents Making a rotation schedule for several Making a rotation schedule for several
sitessites Meeting educational demandsMeeting educational demands Scheduling seminarsScheduling seminars Continuity of CareContinuity of Care
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Challenges - CCHS Residents
Missing special clinics –Missing special clinics –– Pediatric Dentistry Friday AM’sPediatric Dentistry Friday AM’s– Endodontics Wednesday AM’sEndodontics Wednesday AM’s
TravelingTraveling– Returning for seminarsReturning for seminars
Length of session –Length of session –– CCHS has different hoursCCHS has different hours
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Benefits - Westside
Increased ProvidersIncreased Providers Evening CoverageEvening Coverage Referral source for difficult caseReferral source for difficult case
– Major Oral SurgeryMajor Oral Surgery– Difficult EndodonticsDifficult Endodontics– Those who need sedationThose who need sedation– Medically compromisedMedically compromised
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Benefits - CCHS Resident
Excellent 4-Handed DentistryExcellent 4-Handed Dentistry– One assistant assigned to residentsOne assistant assigned to residents– Better chair side set-upBetter chair side set-up
Efficient patient careEfficient patient care More continuity of care – return casesMore continuity of care – return cases
ALL SEVEN RESIDENTS STATED:ALL SEVEN RESIDENTS STATED:– No problemsNo problems– Enjoy the rotationEnjoy the rotation
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Plans for Program Evaluation
Did program improve access to dental care?
Were the educational standards met? Did residents remain in Delaware? Were any dental residents attracted to
community dentistry through exposure to Westside?
Did this affiliation assist in recruitment of future dentists to Westside?
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Outcome Assessment
Only time will tell– need a minimum of two years experience to track changes.
Hopefully, this program will help change the face of dental care in Delaware.
Delaware State Loan Repayment Program established in 2002 for dentists to help with recruitment. This is just a start.
Working together to increase access to care with the State and changing the requirements.
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Starting NeedsStarting NeedsChampionsChampions
Westside Health
Lolita Lopez, President and CEO
Drs. Donohue, Bailey
Christiana Care
Drs. Arm, Granite, Administration
Delaware
Public Health, DIDER
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Starting NeedsTaking a Chance
Willing to try, reevaluate, change At least a two year commitment Starting Funds Building/expansion expense
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Westside - Gaining Momentum
Evening hours added. Final four operatories completed Hygiene hours increased Practice Management changes to limit new
patient scheduling to one month at a time. Establishment of same day or next day
emergency appointments. Development of an internal referral system to
give priority to children, pregnant women, and adult patients with chronic disease.
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Westside - Gaining Momentum (cont)
Integration of dental health into the Bureau of Integration of dental health into the Bureau of Primary Health Care sponsored Health Disparities Primary Health Care sponsored Health Disparities CollaborativesCollaboratives
Diabetes Dental Sessions established to provide Diabetes Dental Sessions established to provide unique changes in Delivery System Designunique changes in Delivery System Design– CDE present in dental waiting room to provide CDE present in dental waiting room to provide
education on dental health with diabeteseducation on dental health with diabetes– Private grant funding obtained to financially support Private grant funding obtained to financially support
initial diabetic dental appointment and hygieneinitial diabetic dental appointment and hygiene– Patient gift bags as incentive to follow through with Patient gift bags as incentive to follow through with
dental care.dental care.
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