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Prevention Focused Patient Care in the Dental Practice

Prevention Focused Patient Care in the Dental Practice. Robert Compton, DDS Executive Director DentaQuest Institute. October 2013. Disclosure About DentaQuest. One of the largest dental benefits administrators in the United States. DentaQuest Benefits Company

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Prevention Focused Patient Care in the Dental Practice

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  1. Prevention Focused Patient Care in the Dental Practice Robert Compton, DDS Executive Director DentaQuest Institute October 2013

  2. Disclosure About DentaQuest One of the largest dental benefits administrators in the United States • DentaQuest Benefits Company • Serve nearly 20 million members in both government and commercial business sectors nationwide • Subcontract with over 70 health plans in 19 states • Contract with ten state agencies • DentaQuest Foundation • www.DentaQuestFoundation.org • DentaQuest Institute • www.DentaQuestInstitute.org 2

  3. www.DentaQuestInstitute.org 3

  4. Health Disparities Untreated Decay in 5 to 19 year olds Income/Poverty Level Race & Ethnicity CDC: Selected Oral Health Indicators in the United States, 2005-2008, May 2012 4

  5. 25% of Children Have 80% of Caries “The occurrence of caries in the permanent dentition is clustered: A quarter of the children and adolescents ages 5 to 17 with at least one permanent tooth accounted for about 80% of the caries experienced in permanent teeth. Differences in caries experience were found among race and race-ethnicity subpopulations” Kaste LM, et al. Coronal caries in the primary and permanent dentition of children and adolescents 1-17 years of age: United States, 1988-1991. J Dent Res. 1996 Feb; 75 Spec No:631-41

  6. Chronic Disease A human health condition or disease that is persistent or otherwise long-lasting in its effects. The term chronic is usually applied when the course of the disease lasts for more than three months.[1] A growing body of evidence supports that prevention is effective in reducing the effect of chronic conditions; in particular, early detection results in less severe outcomes. [2] Chronic Disease is a long-lasting condition that can be controlled but not cured.[3] World Health Organization Kenkel DS “Prevention” “Handbook Of Health Economics” The Center for Managing Chronic Disease http://cmcd.sph.umich.edu/what-is-chronic-disease.html 6

  7. Determinants of Health Adapted from: McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Aff (Millwood) 2002;21(2):78-93

  8. Chronic Care Model Clinical Information Systems Decision Support Self- Management Support Delivery System Design Productive Interactions Health System Community Informed Active Patient Prepared Proactive Practice Team Improved Outcomes http://www.improvingchroniccare.org

  9. Restorative Costs by Tooth Type 9

  10. Restorative Costs by Age Disease Management ECC Disease Management PreventistrySM Sealant Program PreventistrySM Fluoride Program

  11. ADA Sealant Recommendation Evidence-based clinical recommendations for the use of pit-and-fissure sealants. A report of the American Dental Association Council on Scientific Affairs. JADA, Vol. 139. March 2008 11

  12. Effectiveness of Sealants Evidence-based clinical recommendations for the use of pit-and-fissure sealants. A report of the American Dental Association Council on Scientific Affairs. JADA, Vol. 139. March 2008 Evidence from ADA Dental Sealant Recommendation • Reduction of caries incidence in children and adolescents after placement of resin-based sealants ranges from • 86 percent at one year • 78.6 percent at two years • 58.6 percent at four years. • Sealants are effective in reducing occlusal caries incidence in permanent first molars of children by • 76.3 percent at four years, when reapplied as needed. • Caries reduction was 65 percent at nine years with no reapplication during the last five years 12

  13. Most Restorations Could Have Been Prevented First Permanent Molars 13

  14. National Goals for Dental Sealants 14

  15. Medicaid 6-9 Y.O. Receiving Sealants in 2011 15

  16. Chronic Care Model: Clinical Information Systems http://www.improvingchroniccare.org/index.php?p=The_Chronic_Care_Model&s=2 Organize patient and population data to facilitate efficient and effective care Provide timely reminders for providers and patients Identify relevant subpopulations for proactive care Facilitate individual patient care planning Share information with patients and providers to coordinate care Monitor performance of practice team and care system

  17. Monitor Performance of Practice Team 17 17

  18. Identify Relevant Subpopulation for Proactive Care Provide Timely Reminders for Providers & Patients 18

  19. Monitor Performance of Care Team 19

  20. Fluoride Recommendation Professional applied topical fluoride: Evidence-based clinical recommendations. ADA Council on Scientific Affairs. JADA 2006;137;1151-1159 20

  21. Frequency for Periodontal Maintenance Periodontal Maintenance (2003) J Periodontol 2003;74:1395-1401 Many patients presenting with recurrent gingivitis without additional attachment loss after definitive periodontal therapy may be adequately maintained with PM performed semiannually. In general, data suggest that most patients with a previous history of periodontitis should obtain PM at least four times per year, since that interval will result in a decreased likelihood of progressive disease, compared to patients receiving PM on a less frequent basis 21

  22. Perio Patients Receiving Perio Maintenance First goal is to increase the percentage of perio patients receiving at least 2 maintenances per year 22

  23. Identify Relevant Subpopulation for Proactive Care Provide Timely Reminders for Providers & Patients 23

  24. Health System: Provide Incentives Based on Quality 24

  25. Results for Populations 25

  26. Fluoride Results for Network Providers Names of Providers on X Axis 26

  27. Perio Results for Network Providers Names of Providers on X Axis 27

  28. Overall Results for Network Providers The highest bonuses are in $7,000 - $8,000 range Around 60% of dentist achieve the fluoride goal Around 75% of dentists achieve the perio goal Around 85% of dentists receive a financial bonus Improved quality of care Improved our Program Quality Score Reimbursed for quality not just quantity (P4P) 28

  29. Early Childhood Caries and Severe ECC ECC Disease Management

  30. AAPD Early Childhood Caries The disease of ECC is the presence of 1 or more decayed (noncavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in a child under the age of 6. In children younger than 3 years of age, any sign of smooth-surface caries is indicative of severe early childhood caries (S-ECC). From ages 3 through 5, 1 or more cavitated, missing (due to caries), or filled smooth surfaces in primary maxillary anterior teeth or a decayed, missing, or filled score of ≥4 (age 3), ≥5 (age 4), or ≥6 (age 5) surfaces also constitutes S-ECC. 30

  31. Chronic Care Model: Self Management Support http://www.improvingchroniccare.org/index.php?p=The_Chronic_Care_Model&s=2 Empower and prepare patients to manage their health and health care Emphasize the patient’s central role in managing their health Use effective self-management support strategies that include assessment, goal-setting, action planning, problem-solving and follow-up Organize internal and community resources to provide ongoing self-management support to patients

  32. Risk-Based Disease Management Protocols • INITIAL OR RECALL APPT • Medical history • Caries Risk Assessment (CRA) • Exam/X-rays • Behavioral assessment • VISIT 1 • Self-management goals (diet, oral hygiene, home fluoride) • Fluoride varnish • Indicated clinical care • Restorative ITR Visit(s) • Provide restorative care as indicated • Provide ITR as indicated • Schedule OR time if indicated • Disease Management Visit • Caries Risk Assessment • Clinical/X-ray exam • Fluoride varnish • Re-define or re-emphasize self-management goals • Behavioral assessment • Children at Low Risk • Schedule next Disease Management visit in 6 month • Children at Medium Risk • Schedule next Disease Management visit in 3 months • Children at High Risk • Schedule next Disease Management visit in 1 month 32

  33. Patient’s Caries Risk Status is Not Static ECC disease management approach based on premise that a patient’s caries risk status is not static, but can be managed and improved over time. 34

  34. Improved Outcomes and Patient Experience 35

  35. www.dentaquestinstitute.org 36

  36. Contact information Rob.Compton@dentaquestinstitute.org Robert Compton, DDS Executive Director DentaQuest Institute October 2013

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