the dental dashboard: using measurement to strengthen … · 2013-11-19 · washington dental...
TRANSCRIPT
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.
3 © 2013 Washington Dental Service Foundation
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
6 © 2013 Washington Dental Service Foundation
Why a Dashboard?
"What gets measured gets done."
- Peter Drucker
6
7 © 2013 Washington Dental Service Foundation
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
8 © 2013 Washington Dental Service Foundation
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….
9 © 2013 Washington Dental Service Foundation
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
10 © 2013 Washington Dental Service Foundation
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
11 © 2013 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
12 © 2013 Washington Dental Service Foundation
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
13 © 2013 Washington Dental Service Foundation
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
14 © 2013 Washington Dental Service Foundation
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
15 © 2013 Washington Dental Service Foundation
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.
16 © 2013 Washington Dental Service Foundation
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
17 © 2013 Washington Dental Service Foundation
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
18 © 2013 Washington Dental Service Foundation
Possibilities Approach
“What would need to change in order to make this possible?”
Improved EHR/EDR?
19 © 2013 Washington Dental Service Foundation
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
20 © 2013 Washington Dental Service Foundation
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!