Creating an Oral Health Quality Measures Dashboard For Health Center Dental Programs

June 9, 2011Jay R .Anderson, DMD, MHSADirector Practice ImprovementDentaQuest Institute

Instrument Flying

Why Create A Dashboard• Align Oral program measures with nationally accepted quality

indicators (useful for trends, benchmarks and comparisons)• Encourage and enable Health Centers to engage in continuous

quality improvement and promote Nation-wide collaboration around quality improvement.

• Encourage programs to use broadly applicable core set of measures,

• Encourage investment in quality improvement infrastructure (HIT, training, technical assistance, human resources)

• Consistent Measures of Quality, Value, Comparisons, Transparency

Why Create A Dashboard• To promote efficiency in planning and

implementation of Oral Health quality activities

• To create local and national level discussion of oral health quality measurement: roles, practices and results

• To promote collaboration and efficiencies around quality priorities and measurement

Why Create A Dashboard?

“If You Don’t Know Where You are Going, Then You Probably Will End Up Somewhere Else.”

Yogi Berra

Straighten Up and Fly Right

Or Fly in the Past

HRSA UDS

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

Benefits of Dash Boards• Graphic information - having all the critical

information for program and quality management on a timely basis

• Save Money and Resources by developing efficient and effective programs

• Contiuous Quality Improvement• Document critical information for Health

Reform, HRSA Grants, Health Center Board, staff meetings and patient care-

Challenges of Dashboards• Requires technology• Electronic Dental/Health Record or

Registry• Creating internal and external metrics• Staff and management alignment on

measures and implementation

Fly Into The Future

Star TrekAct, and you shall have dinner; wait, and you shall be dinner.

-Gowron, Klingon proverb, Star Trek: Deep Space Nine

Geordi: Data... I made that joke seven years ago. Data: I know! I just got it!

-Star Trek: Generations

Data to Lal: "We should always strive to be better than we are. It does not matter that we may not achieve our intended objective.

We can rest assured that our struggles will yield their own rewards." -Star Trek: Generations

It was...fun... -James Kirk, on life, Star Trek: Generations

Slide Credits• Dr. Lee Francis, CEO Erie Family Health

Center, Chicago, Illinois– Slides 9-12

• HRSA Oral Health Workgroup– Slides 13-26

Contact Information

Jay R. Anderson, DMD, MHSADirector, Practice Improvement DentaQuest Institute

Director, DentaQuest Oral Health Centerjay.anderson@dentaquestinstitute.org

508-329-2406