2013 cste annual conference june 12, 2013 · nohss indicator revision process nohss revision...

2013 CSTE Annual Conference

June 12, 2013

Presenting author:

Junhie Oh, Rhode Island Department of Health*†

Co-authors:

Gregg Reed, North Dakota Department of Health*†;

Kathy Phipps, Association of State & Territorial Dental Directors (ASTDD)*;

Mei Lin, Centers for Disease Control and Prevention Division of Oral Health*

* ASTDD Data Committee member

† CSTE Chronic Disease/MCH/Oral Health Committee member

Outline

NOHSS Indicators Background

NOHSS Indicator Revision Process

Revised NOHSS Highlights

Revised NOHSS Indicators

NOHSS Revision Impact

National Oral Health Surveillance System

(NOHSS)

Part of National Public Health Surveillance System (NPHSS)

Uses data to protect and promote the oral health of the population

Promotes state-based data sources for oral health, but not limited to state-based data

Includes national, state, and local data on oral health status, risk factors, access to community-based preventive services and use of the oral health care system

Defines core set of indicators

Provides a central system to bring together the data for core indicators from all or many states

NOHSS Indicator Development, 1998-1999

Collaboration between ASTDD, CDC and CSTE

CSTE approved initial set of 9 indicators

Designed to help states track Healthy People 2010 objectives

Addressed the lack of state oral health data

More about NOHSS development

Malvitz, et al. Preventing Chronic Disease, 2009

http://www.cdc.gov/pcd/issues/2009/Apr/pdf/08_0108.pdf

Ten NOHSS Indicators, 1999-2012

Incidence of oral and pharyngeal cancer

Mortality from oral and pharyngeal cancer

Dental visit

Teeth cleaning

Complete tooth loss

Water fluoridation status

Caries experience

Untreated tooth decay

Dental sealants

Loss of 6 or more teeth

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Added in 2006 after MMWR special issue on healthy aging

1999 CSTE PS of oral health indicators in the NPHSS

1999 CSTE PS of childhood oral health indicators in the NPHSS

1998 CSTE Position Statement (PS) of cancer in the NPHSS

NOHSS website is available at http://www.cdc.gov/nohss (Since 2001)

http://www.cdc.gov/nohss

http://www.cdc.gov/nohss

NOHSS Indicator Revision: Why Revise?

Data

Availability of new state-specific data sources

Use of more existing data sources

Release of Healthy People 2020 objectives

Updated NPHSS framework

Chronic Disease Indicator (CDI) review

Integration of population health and quality measures

NOHSS Indicator Revision: Why Revise?

Policy

Patient Protection and Affordable Care Act

Centers for Medicare and Medicaid Services (CMS)

oral health strategy

Electronic Health Records

NOHSS Indicator Revision Process

NOHSS Revision Workgroup including representatives from ASTDD,

CDC, & CSTE (2011)

Revised NOHSS indicators based on availability of state data aligned with

Healthy People 2020 objectives (2011-12)

Developed two Position Statements approved by CSTE (June 2012)

CDC & ASTDD response letters sent to CSTE (September 2012)

CSTE Position Statements & response letters posted on CSTE

website:

Proposed New and Revised Indicators for the NOHSS (12-CD-01)

Developmental and Emerging Indicators for the NOHSS (12-CD-02)

10

2012 Revised NOHSS Highlights

34 indicators, including 10 existing indicators

Added indicators to track Healthy People 2020 objectives

Covered more priority populations

Addressed cross-cutting areas

Added new data sources

Added caries indicators

pre-school children

older adults

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Indicators added to track additional Healthy People 2020 objectives

12

Healthy People 2010 objectives

related with Original NOHSS indicators

Healthy People 2020 objectives

related with Revised NOHSS indicators

• 3.5 (Oral & pharyngeal cancer mortality)

• 21.1b (Children’s caries experience)

• 21.2b (Children’s untreated tooth decay)

• 21.4 (Older adults’ complete tooth loss)

• 21.10 (Use of oral health care system)

•21.8 (Children’s dental sealant)

• 21.9 (Population served by fluoridated

water)

• C-6 (Oral & pharyngeal cancer mortality)

• D-8 (Dental exam among adults with diabetes)

• OH-1.1, OH-1.2 (Children’s caries experience)

• OH-2.2, OH-2.2 (Children’s untreated tooth decay)

• OH-3.2, OH-3.3 (Older adults’ untreated tooth

decay)

• OH-4.2 (Older adults’ complete tooth loss)

• OH-7 (LHI) (Use of oral health care system)

• OH-8 (Low-income children’s preventive dental

service)

• OH-9 (School-based health center’s oral health

services)

• OH-11 (FQHC’s oral health services)

• OH-12.2 (Children’s dental sealant)

• OH-13 (Population served by fluoridated water)

LHI: Leading Health Indicator


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Preschool children attending Head Start

Children attending Kindergarten

Children enrolled in Medicaid/CHIP

FQHC patients

Older adults in long-term care facilities/meal sites


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Address cross-cutting areas

Preconception care: Dental cleaning before pregnancy

Diabetes: Dental visit in the past year

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Data sources

Screening data - Basic Screening Survey (BSS)

• BSS for 3rd Grade

• BSS for Head Start

• BSS for Kindergarten

• BSS for older adults in long-term care facilities/meal sites

Survey data

• Behavioral Risk Factor Surveillance System (BRFSS)

• National Survey of Children’s Health (NSCH)

• Pregnancy Risk Assessment Monitoring System (PRAMS)


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Data sources

Registry data

• Surveillance Epidemiology and End Results (SEER)/National

Program of Cancer Registries (NPCR)

Administrative data

• Water Fluoridation Reporting System (WFRS)

• Vital Statistics

• CMS EPSDT Report (Form 416)

• CHIP Annual Reporting Template System (CARTS)

• National Assembly for School Based Health Care (NASBHC)

• HRSA Uniform Data System (UDS)


By priority population

Preschool children

School children

Adults

Older adults

By oral health topic

Oral health status

Access to care

Community-based preventive service

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Revised NOHSS Indicators: 34 Indicators

Head Start

Caries experience


Need for treatment

Kindergarten

3rd Grade

Caries experience


Dental sealants (3rd)

Need for treatment

Incidence of oral & pharyngeal cancer

Mortality from oral & pharyngeal cancer

≥65 years

Complete tooth loss

Lost 6 or more teeth

Older Adults in LTC/

meal sites


Need for treatment

Pregnant Women

Teeth cleaning before

most recent pregnancy

≥18 years Dental visit in past year

Teeth cleaning in past year

Adults with Diabetes Dental visit in past year

Preschool Children School Children Adults Older Adults

Population served by optimally fluoridated water

FQHC Patients Dental visit in calendar year

School-Based Health

Centers that provide

sealants, dental

treatment services,

topical fluoride

All children 1-17 years

Dental visit in past year

Revised NOHSS Indicators

Medicaid/CHIP Enrollees

Preventive dental visit

Dental treatment visit

Sealants (6-9 years)


Indicators in blue: original NOHSS indicators

Head Start

Caries experience


Need for treatment

Kindergarten

3rd Grade

Caries experience


Dental sealants (3rd)

Need for treatment



≥65 years

Complete tooth loss



meal sites


Need for treatment

Pregnant Women









School-Based Health


sealants, dental

treatment services,

topical fluoride



Revised NOHSS Indicators by Priority Population

Medicaid/CHIP Enrollees





Head Start

Caries experience


Need for treatment

Kindergarten

3rd Grade

Caries experience


Need for treatment



≥65 years

Complete tooth loss



meal sites


Need for treatment Medicaid/CHIP Enrollees




Sealants (10-14 yrs)

Pregnant Women









School-Based Health


sealants, dental

treatment services,

topical fluoride



Revised NOHSS Indicators by Topic:

Oral Health Status

Dental Sealants (3rd)

Head Start

Caries experience


Need for treatment

Kindergarten

3rd Grade

Caries experience


Need for treatment



≥65 years

Complete tooth loss



meal sites







Pregnant Women









School-Based Health


sealants, dental

treatment services,

topical fluoride




Access to Care


Head Start

Caries experience


Need for treatment

Kindergarten

3rd Grade

Caries experience



Need for treatment



≥65 years

Complete tooth loss



meal sites







Pregnant Women









School-Based Health


sealants, dental

treatment services,

topical fluoride




Community-based Preventive Service


34 indicators, including 10 existing indicators

Added indicators to track Healthy People 2020 objectives


low income population, vulnerable older adults

Addressed cross-cutting areas

pregnant women, diabetic populations

Added new data sources

CMS, CARTS, NASBHC, NSCH, PRAMS, UDS

Added caries indicators

pre-school children & older adults

24

NOHSS Revision Impacts

Improve tracking of state progress related to Healthy People

2020 objectives

Provide guidance and tools to state OH programs to utilize

new indicators

Support integration of OH into coordinated disease

prevention and treatment effort

Use indicators primarily drawn from existing, publicly

available data sources

No new burden of data collection or reporting on states

Voluntary system

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NOHSS Workgroup continues efforts in

Regular review and evaluation of NOHSS indicators

Improving and developing methods and data sources

Developing new indicators Dentist participation in Medicaid/CHIP

Regional/local Oral Health Programs directed by a dental professional

State Oral Health Surveillance System

Collaborating with other organizations

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Questions?

Thank you to the following organizations

for their assistance with this presentation:

ASTDD, CDC and CSTE

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The findings and conclusions in this report are those of the authors and do not

necessarily represent the official position of CDC, ASTDD, CSTE, Rhode Island

Department of Health, and North Dakota Department of Health.

2013 cste annual conference june 12, 2013 · nohss indicator revision process nohss revision...

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