april 25 , 2012 albuquerque area dental meeting
DESCRIPTION
Update on the IHS ECC Collaborative & Virtual Learning Community Program (VLCP ) & A Call to Action. April 25 , 2012 Albuquerque Area Dental Meeting. ECC has different levels of severity, from non- cavitated lesions to multiple surfaces. Stages of ECC. Overall Goal. - PowerPoint PPT PresentationTRANSCRIPT
Update on the IHS ECC Collaborative&
Virtual Learning Community Program (VLCP)&
A Call to Action
April 25, 2012Albuquerque Area Dental Meeting
• ECC has different levels of severity, from non-cavitated lesions to multiple surfaces
Stages of ECC
Overall Goal
• Reduce ECC prevalence by 25% in 5 years
• 2010 BSS in the Albuquerque Area: – 5.7 average teeth decayed (2nd highest)– 77.7% of 2-5 year-olds had experienced
caries (2nd highest)/IHS average was 62.3%
ECC Collaborative Objectives
1. Increase dental access for 0-5 year old AI/AN children 25% in five years.
2. Increase the number of children 0-5 years old who received a fluoride varnish treatment by 25% in five years.
ECC Collaborative Objectives
3. Increase the number of sealants among children 0-5 years old by 25% in five years.
4. Increase the number ITRs provided for children ages 0-5 by 50% in five years.
VLCP Goal
The goal of the Virtual Learning Community is to increase awareness and knowledge about ECC and ECC best practices throughout IHS, Tribal, and Urban (I/T/U) dental programs.
Jicarilla/Dulce is the only Albuquerque Area program that applied for the VLCP (39 sites participating nationwide)
National Data
VLCP Site ChangeFY 2009 – Q1, FY 2012
Non-VLCP Site ChangeFY 2009 – Q1, FY 2012
National ChangeFY 2009 – Q1, FY 2012
Access, 0-5 + 8% + 6% + 7%
Sealants, 0-5 + 54% + 23% + 32%
Fluoride Patients, 0-5 + 21% + 16% + 17%
Medical Fl Apps, 0-5 + 140% + 130% + 136%
ITRs, 0-5 + 61% + 80% + 73%
VLCP “Champions”:Highlighted on March VLCP call
• Increased dental access from 47-103% in the first quarter.
• Increased fluoride varnish by medical providers by 125 applications.
• Increased ITRs by 295% for 0-2 year olds and 1000% percent for 0-5 year olds
Best Practices: What Works?
• Identifying local champions: examples included dental staff, public health nurses, and tribal policy makers.
• A dedicated case manager.
• Marketing ITRs to your own dental staff and getting them comfortable with young children.
• Working routinely with the well-child or WIC clinics.
How is the Albuquerque Area doing?
• Data reports run from National Dental Data Mart– Albuquerque Indian Dental Clinic (AIDC)– Albuquerque 1 (Sandia, Zia Pueblo)– ACL– Mescalero– Santa Fe (Santa Fe, Santa Clara, Santo Domingo, Cochiti, San Felipe)– Zuni (separate for Zuni and Pine Hill)– Southern Colorado (Southern Colorado and Towaoc)– Jicarilla (Dulce)– Taos– Albuquerque 2 (Iselta, Jemez, Alamo)– Ysleta
0-5 Access to Care, Albuquerque Area
• 9% increase in 0-5 year-old access since 2009
FY 2009 (baseline) FY 2010 FY 2011 FY 2012 (projected)0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
0-2 year-olds3-5 year-olds0-5 year-olds
0-2 year-old access
2009 (baseline) 2010 20110
50
100
150
200
250
300
350
400
450
500AIDCAlb1ACLMescaleroSanta FeZuniSouthern ColoradoJicarillaTaosAlb2YsletaPine Hill
Zuni (116% increase) is the only clinic in the Area that has shown continuous improvement in access. What are they doing that we can all learn from?
0-5 Sealants, Albuquerque Area
• 13% increase in 0-5 year-old sealants since 2009• 47% increase in 0-2 year-old sealants since 2009
(but very small numbers, from 99 to 159)
FY 2009 (baseline) FY 2010 FY 2011 FY 2012 (projected)0
500
1000
1500
2000
2500
0-2 year-olds3-5 year-olds0-5 year-olds
0-2 year-old sealants
2009 (baseline) 2010 20110
20
40
60
80
100
120AIDCAlb1ACLMescaleroSanta FeZuniSouthern ColoradoJicarillaTaosAlb2YsletaPine Hill
Only AIDC and Santa Fe have had significant increases in 0-2 year-old sealants (by 21 and 30, respectively). Why?
Glass ionomer Sealants
• Endorsed by the IHS Division of Oral Health
• Poulsen Study – 50% of sealants in primary 1st molars, and 75% of sealants in primary 2nd molars, were retained after 12 months in young children (see attached study)
• With a caries rate of 77.7% in the Area, and with almost half of children experiencing caries by age two, shouldn’t we be doing GI sealants on just about every 0-2 year-old we see?
0-5 Fluoride Patients, Albuquerque Area
• 9% increase in 0-5 year-old sealants since 2009• 13% increase in 0-2 year-old sealants since 2009
FY 2009 (baseline) FY 2010 FY 2011 FY 2012 (projected)0
500
1000
1500
2000
2500
3000
3500
4000
4500
0-2 year-olds3-5 year-olds0-5 year-olds
0-2 year-olds receiving fluoride varnish
2009 (baseline) 2010 20110
50
100
150
200
250
300
350
400
450AIDCAlb1ACLMescaleroSanta FeZuniSouthern ColoradoJicarillaTaosAlb2YsletaPine Hill
Everyone except Southern Colorado decreased from 2010-2011. Why?
% of 0-2 year-old children accessing dental care in 2011 who did not receive fluoride varnish
• AIDC: 5% (21/409)• Alb 1: 50% (14/28)• Mescalero: 94% (30/32)• Santa Fe: 18% (41/232)• Zuni: 7% (29/420)• Southern Colorado: 31% (18/59)• Jicarilla: 17% (19/112)• Taos: 24% (5/21)• Alb 2: 56% (69/124)• Ysleta: 0% (0/1)• Pine Hill: 57% (27/47)
• We recommend that all 0-2 year-old children accessing care receive fluoride varnish.
Other recommendations on fluoride varnish
• Provide fluoride varnish to every 0-5 year-old that you see either in a clinic or community setting.
• Enter fluoride varnish codes in RPMS or the EDR as you complete them; if applied in a community setting, enter those applications as well.
• Work with your clinic’s site manager to learn how to enter fluoride data from community settings.
• Allow open access for 0-5 year-olds to apply fluoride varnish by any dental staff.
• Apply fluoride varnish 3-4 times annually to increase effectiveness.
0-5 ITRs, Albuquerque Area
• 33% increase in 0-5 year-old sealants since 2009• 318% increase in 0-2 year-old sealants since 2009 (small
numbers, from 11 to 67)
FY 2009 (baseline) FY 2010 FY 2011 FY 2012 (projected)0
50
100
150
200
250
300
350
400
0-2 year-olds3-5 year-olds0-5 year-olds
ITRs, 0-5 year-olds, Albuquerque Area
2009 (baseline) 2010 20110
20
40
60
80
100
120
140
160
180AIDCAlb1ACLMescaleroSanta FeZuniSouthern ColoradoJicarillaTaosAlb2YsletaPine Hill
Mescalero (increase from 0 to 27) and AIDC (increase from 0 to 171) have the biggest improvements. How have they embraced ITRs?
“The only thing we have to fear is fear itself” - FDR
• What may be your concernsabout ITRs?
– Management of patient– Coding issues (2940)– No anesthesia?– Substandard care?
Look at the numbers…
• According to the 2010 BSS of 0-5 year-olds:– 57.1% of 2-5 year-olds in the Albuquerque Area had
untreated decay– This was the 3rd highest in the country, and 14% higher than
the national average
• The average fee of a pediatric dentist is 150% higher. The average cost of OR treatment may be as high as $8,000 per case.
• Is it better to do nothing or try something?
In addition…
• ITRs are endorsed by the American Academy of Pediatric Dentistry (AAPD)Reference: AAPD “Policy on Interim Therapeutic Restorations”
• The long-term success of ITRs is comparable to amalgamsSee attached Mandari article