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Using Information Technology and Community-based
Research to Improve theDental Health Care System
Kathryn A. Atchison, DDS, MPHProfessor, Division of Public Health and
Community DentistryUCLA School of Dentistry
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IntroductionHighly regarded patient carefor SOME people
poorly organized and incompletemedical (dental) records
unacceptable number of medicalerrors
fragmented and unfriendlypatient care system
lack of control over carecompleteness
inability to improve or maintain acommunity's health with limiteddental health care dollars.
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Crossing the Quality Chasm: A New Health System for the 21st Century, Committee on Quality Health Care in America, Institute of Medicine; National Academy Press, 2001.
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Definition of Quality:
The degree to which health care services for individual and populations increase the likelihood of desired outcomes and are consistent with professional knowledge.
Crossing the Quality Chasm: A New Health System for the 21st Century, Committee on Quality Health Care in America, Institute of Medicine; National Academy Press, 2001.
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Underlying Reasons for Inadequate Quality of Care
growing complexity of science and technology
increase in chronic conditions poorly organized care delivery
system (that often results in many underserved individuals)
constraints on our use of information technology
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“If we want safer, higher-quality care, we will need to have redesigned systems of care, including the use of information technology to support clinical and administrative processes.”
Crossing the Quality Chasm: A New Health System for the 21st Century, Committee on Quality Health Care in America, Institute of Medicine; National Academy Press, 2001.
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6 Aims for the 21st Century Health Care System
Safe Effective Patient-centered Timely Efficient Equitable
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Woven in to their recommendations to achieve
these goals are specific suggestions on increased use
of Information Technology.
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Does Dentistry fit with these objectives?
Emphasis on need for better information to manage chronic diseases
Chronic disease management: care must be ongoing, collaborative and multidisciplinary to be effective
Communication between providers is imperative for high quality care
Personal health information must accompany patients as they transition from home to various health professions' offices
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Purpose:Discuss uses of Information
Technology that could improve community health through:
Quality Assurance Case reports Program evaluation Clinical decision-making Outcomes research Epidemiological research Clinical Trials Stronger Evidence base!!
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Community-based Research Setting: King-Drew Medical Center
Purpose: to better understand patient preferences for surgical or non-surgical treatment for mandibular fracture.
Fracture treatment cost: Non-surgical - $2000; Surgical - $20,000
Complications: course of antibiotics ($100) to retreatment ($20,000) permanent disfigurement of keloid affected scar (priceless).
Sample: Hispanics and African American disenfranchised individuals.
Really tiny use acknowledgement for grant to NIDCR #1RO1DE13839.
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Safe:
Avoiding injury to patients from care that is intended
to help them.
6 A
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for
the
21st C
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Syst
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Safe:Medical history and treatment information is available to all
treating providers. Flashing alert on electronic record that
patient is allergic to codeine. Chart is readable to all providers from
emergency room to OR to outpatient clinic.
Doctor can contact pharmacy to alert them patient needs non-formulary drug or liquid version of antibiotics and pain pills.
6 A
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Safe:
Standards of quality are consistent across all days and
times of days.
Better schedule OR time so patient with fracture is not waiting for two days.
6 A
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Safe:
Patients and caregivers are informed about their
condition and treatment.
Of 33 patients in focus groups: 20 recalled informed consent 5 NO informed consent 8 silent6
Aim
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Effective:Providing services based on scientific knowledge to all who could benefit and
refraining from providing services to those not likely to benefit.
Patient information is portable so patient information is available to all treating members of the health care team.
Anticipation of needs: recall systems anticipate the patient's need for a return visit.
Post-operative return to clinic for follow-up month recall.
Catching patients who FAILED to return for wire removal.
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Patient-centered:Providing care that is respectful of
and responsive to individual patient preferences, needs, and values and ensuring that patient values guide
clinical decisions. Care must be based on a ‘continuous
healing relationship’ where the patient can receive care when he needs it and in many forms, including electronic health education, communications with the health care provider, and laboratory results.
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Patient-centered:
(continued)
Coordination and integration of care
Information, education and communication
Physical and emotional support Culturally competent
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Timely:
Reducing waits and sometimes harmful delays, both for those who
receive and give care.
Care is based on a 'continuous healing relationship' where patient can receive care when they need it and in many forms
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Timely:(continued)
OR / clinic time Email of lab results or consults Communication between providers Communication between providers
and patients
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Efficient:Avoiding waste of equipment, supplies, ideas, and energy.
Inventory management Confirming appointments Communication is efficient both
between caregivers and between patients and caregivers
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Equitable:Providing care that does not vary in
quality because of personal characteristics, such as gender,
ethnicity, geographic location, and socioeconomic status.
Tracking patient care provided - Ryan White
Outcomes research Epidemiological research
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IOM recommendations are appropriate and timely as the profession is moving to electronic patient records.
In keeping with overall guidelines, the profession, with this conference as a steppingstone, should build on these guides to apply them to dentistry and establish means for IT to improve the community’s oral health.
Conclusion: