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

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.

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.

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.

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

“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.

6 Aims for the 21st Century Health Care System

Safe Effective Patient-centered Timely Efficient Equitable

Woven in to their recommendations to achieve

these goals are specific suggestions on increased use

of Information Technology.

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

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!!

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.

Safe:

Avoiding injury to patients from care that is intended

to help them.

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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.

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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.

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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

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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: