the dental dashboard: using measurement to strengthen … · 2013-11-19 · washington dental...

Diane Lowry Oakes, MPH, MSW

Deputy Director

Washington Dental Service Foundation

An Nguyen, DDS, MPH

Vice-President of Dental Services

Clinica Family Health Services

National Primary Oral Health Conference

November 11, 2013

The Dental Dashboard: Using Measurement to Strengthen

Program Quality and Improve Patient Outcomes

2 © 2013 Washington Dental Service Foundation

Vision

Community Health Centers are sustainable, high performing healthcare providers with strong operations to ensure high productivity and health improvements (including oral health improvements) among their patients.


Dental Care by WA CHCs Increasing

WDS Foundation CHC Initiative Timeline

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Capacity building grants to CHC dental clinics

Sponsor Dental Directors to attend NNOHA

Dental Director Learning Network

Metrics Collection

WA Oral Health

Collaborative

Observed Colorado Oral

Health Collaborative

Consulting to individual CHC’s

Dashboard

Provided over $12 million in funding for programs and services in Colorado over the last 15 years, benefitting more than 419,000 people

Programs include: Chopper Topper sealant program, Cavity Free at Three, Inter-professional oral health training, and dental care for pregnant women and their children.

Recently launched Brush with Me oral health campaign

Community Health Center Initiative & Dashboard Project

Delta Dental of Colorado Foundation & CHCs


Why a Dashboard?

"What gets measured gets done."

- Peter Drucker

6


Quality Oral Health Program Characteristics

Have access to timely data that allows for rapid feedback and action on quality, productivity and costs:

• Exist in an environment where IT is accepted and integrated to enhance care

• Receive regular reports from the CFO to assist in clinic management

• Routinely produce dashboards and track measures

Have a strong quality improvement program in place: • Participate in the Health Center’s quality management system, track processes and

outcome measures

• Continuously engage in risk management activities

From NNOHA Characteristics of a Quality Oral Health/Dental Program, May 2011


Attention to Oral Health Metrics Expanding

National Quality Measures Clearinghouse

CHIPRA Pediatric Quality Measures Program

Meaningful Use measures

Dental Quality Alliance

Healthy People 2020

National Committee on Quality Assurance HEDIS

NNOHA

National Oral Health Quality Improvement Committee

National Quality Forum

Etc….


Dashboard Goal

The Oral Health Dashboard is a tool for Health Centers to use to more effectively monitor and measure quality and drive performance in order to improve oral and overall health of all Health Center patients.

In Washington: – Share via the Dental Director Learning Network

– Facilitate technical assistance with individual CHCs

– Gain attention of CHC leaders


Dashboard Development Process

Planning Team:

An Nguyen, Clinica Health Services (CO)

Tanya Weinberg, Colorado Health Foundation

Colleen Lampron, Delta Dental of Colorado Foundation

Jay Brooke, High Plains Community Health Center (CO)

Irene Hilton, National Network for Oral Health Access (NNOHA)

Sonia Sheck, National Network for Oral Health Access (NNOHA)

Marty Lieberman, Neighborcare Health (WA)

Diane Oakes, Washington Dental Service Foundation


Dashboard Convening – April, 2013

• Colorado and WA CHCs • CHCs working on oral

health metrics from around the country

Panelists from: • CMS • NNOHA • Institute for Oral Health

• WDS Foundation • DDCF


The Environment

Patient-Centered Medical Home – How does oral health fit? (NCQA Standards)

ACA

Meaningful Use requirements

EHR/EDR communication

Payment reform that incents health improvements

Getting attention to oral health from CHC leaders Drafting the Dashboard


Draft Dashboard

CHC POPULATION HEALTH

New Caries Rate

% of established dental patients that

have new caries at recall

Treatment Plan Completion

% of patients that have Phase I treatment

plan completed within 6 months

Risk Assessment of all CHC Patients

% of all health center patients that have

oral health risk assessment performed

Topical Fluoride

% of dental patients who received

topical fluoride application

Sealants (6-9 year olds)

% of 6-9 year old children who were seen by a

practitioner who received a sealant on one or

more first permanent molar tooth.

Self-Management Goal Setting &

Review

% of dental patients that have oral

health self-management goals set and

reviewed

Sealants (10-14 year olds)

% of 10-14 year old children who were seen by

a practitioner who received a sealant on one or

more first permanent molar tooth.

PATIENT SATISFACTION

Recommendation to Family & Friends

% of patients that would recommend dental

clinic to family and friends

No Shows

% of patients that do not show for their

dental appointments

FISCAL & OPERATIONAL SUSTAINABILITY

Relative Value Units (RVU) per

Encounter

Encounters per Hour

Direct Cost per Visit

Total expenses divided by the

number of visits

Recall Rates

% of patients up to date with recall

Risk Assessment of all Dental Patients

% of all dental patients that have oral

health risk assessment performed

Self-Management Goal Sharing

% of health center patients that have oral

health self-management goals reviewed by

their medical provider


Balance

Feasibility with future vision

Standards to enable comparison with ability to tailor for individual CHC situations

Synergy with national recommendations while being useful on the ground

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Population Health Metrics

New Caries Rate % of established dental patients

that have new caries at recall

Treatment Plan Completion % of patients that have treatment plan

completed within 6 months

Clinical Interventions 1. Risk Assessment: % of dental patients that have oral

health risk assessment 2. Topical Fluoride: % of patients who receive topical

fluoride application 3. Sealants: % of 6-9 year old children who were seen by

a practitioner who received a sealant on one or more first permanent molar tooth.

4. Sealants: % of 10-14 year old children who were seen by a practitioner who received a sealant on one or more second permanent molar tooth.

5. Self-Management Goal Setting and Review: % of dental patients that have oral health self-management goals set and reviewed

Dental/Medical Integration • Risk Assessment: % of all

health center patients that have oral health risk assessment

• Self-Management Goals: % of health center patients that have oral health self-management goals reviewed by their medical provider.


Fiscal and Operational Sustainability

Relative Value Units (RVU) per Encounter

Direct Cost per Visit Total expenses divided by the

number of visits

Recall Rates % of patients up to date with

recall

Encounters per Hour


Patient Satisfaction

Recommendation to Family and Friends % of patients that would recommend

dental clinic to family and friends

No Shows % of patients that do not show for their

dental appointments


Possibilities Approach

“What would need to change in order to make this possible?”

Improved EHR/EDR?


Test Phase I

NOW: A few CHCs in WA and CO putting metrics into practice and identifying:

– Mechanics for getting data out of the EHR system

– Operational process changes needed to track data (e.g. training providers)

– How data can be used for quality improvement

NEXT: User’s Guide

THEN: Test Phase II - dental/medical measures & oral health outcomes of implementing the dashboard


Feedback

Any essential metric that is missing?

Any included metric that is not useful?

Important tweaks to metric definitions?

Content that would be helpful in a user’s guide?

Treatment Plan Completion Rate

Defined: percentage of patients who have dental treatment plan completed within 6 months.

Operationalized:

– Developed report in Business Intelligence program.

– Created “dummy” code in EDR.

– Trained staff on how to use code.

Treatment Plan Completion Rate: Baseline

We have a problem!

So, what’s next?

Avoid the “blame game.”

Brainstorm ideas with staff.

Small scale trial of the best idea(s).

Monitor change using data/reports.

Spread ideas that work!

Set goals!

Treatment Plan Completion Rate: Staff Feedback

Staff Feedback:

– Pts can’t get return appts. FD frustrated w/ telling pts to “call back.”

– Pts aren’t getting “better”; tx plans not completed.

– Clinic feels like “revolving door.”

Schedule Problems:

– Procedure carve-outs: appt availability doesn’t match pt demand.

– Unfilled slots filled with new pts and LOEs.

Treatment Plan Completion Rate: A Good Idea

Schedule Template Revision:

– Maximizes use of EDDAs; frees dentist to move onto other pts.

– Schedule dictated by pt needs.

Staff Concerns:

– “Seems complicated; FD will mess up.”

– Unpredictability of schedule.

Treatment Plan Completion Rate: PDSA

Plan: Try small scale changes (most suggested by staff). Trained front desk staff on how to implement new schedule (a “game”).

Do: Implemented changes over a short period of time.

Study: Gathered data/feedback and reviewed results with staff.

Act: Implement new and improved scheduling template.

REPEAT!

Treatment Plan Completion Rate: Outcomes!

Clinica’s Key Lessons Learned

Data is a key component of any quality improvement plan.

Develop a data-driven culture. – Review data routinely and predictably.

– Thoughtfully act on the data.

– Data drives behavior!

Use QI tools that work.

Be hard on the problem, not the people, and celebrate successes!

the dental dashboard: using measurement to strengthen … · 2013-11-19 · washington dental...

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