1 / 52

Oral Health Surveillance in the US & States

Oral Health Surveillance in the US & States. Mike Manz, DDS, MPH University of Michigan and ASTDD Consultant Texas Oral Health Summit: Advocacy, Equity & Access Austin, Texas September 9-10, 2004. Oral Health Surveillance – State of the States . Mike Manz, DDS, MPH

wiley
Télécharger la présentation

Oral Health Surveillance in the US & States

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Oral Health Surveillance in the US & States Mike Manz, DDS, MPH University of Michigan and ASTDD Consultant Texas Oral Health Summit: Advocacy, Equity & Access Austin, Texas September 9-10, 2004

  2. Oral Health Surveillance – State of the States Mike Manz, DDS, MPH University of Michigan and ASTDD Consultant

  3. Great (Lake) State R e a l l y G r e a t T o w n # N W E 2 0 0 0 2 0 0 4 0 0 M i l e s S

  4. Surveillance My definition: What you want to know about who(m?) and what you do with it.

  5. Surveillance Defined • Surveillance vs. Surveys vs. Screening • Surveillance in public health is “the ongoing systematic collection, analysis and interpretation of outcome-specific data for use in the planning, implementation and evaluation of public health practice.” Thacker SB, Berkelman RL. Public health surveillance in the United States. Epidemiol Rev 1988;10:164-90.

  6. Specific Oral Health Surveillance Aims • Address problems described in Report of the Surgeon General on Oral Health at state (Texas) level www.surgeongeneral.gov/library/oralhealth/ • And… A National Call to Action to Promote Oral Health www.nidcr.nih.gov/sgr/CallToAction.asp • Assess progress toward Healthy People 2010 objectives (HHS- Office of Disease Prevention and Health Promotion) www.healthypeople.gov

  7. Report of the Surgeon General on Oral Health • Purpose of reports: “frame the science on vital health issues in a way that have helped educate, motivate and mobilize the public to more effectively deal with those issues” • Emphasized racial and socio-economic disparities particularly in children

  8. HP 2010 - Oral Health • Goal : Prevent and control oral and craniofacial diseases, conditions, and injuries and improve access to related services. • Objectives: 17, including oral health status, individual and population preventive exposure, and access to care • Age groups: • Caries: 2-4, 6-8, 15, adults • Sealants: 8, 14 • Edentulism: 65-74 • Periodontal Disease: 35-44 • Oral Cancer Screening: ge 40

  9. Existing Data Sources • National Level • NCHS - NHANES, NHIS • Fluoridation Census • NIDCR • State Level • BRFSS • WFRS/ MWF • YRBS • PRAMS • Previous surveys • Medicaid and private insurance data (claims - no dx codes)

  10. Existing Data Sources • NIDCR/CDC Data Resource Center • Existing national survey data and OH related questions

  11. Existing Oral Data - BRFSS • Core component • Optional modules and • State added questions addressing: • Access to care/last dental visit • Teeth cleaning/oral hygiene • Dental insurance • Edentulism/missing teeth • Tobacco use

  12. Collecting New Data (Filling Gaps) • Questionnaires vs. in-mouth screening • Conditions assessed • Resources • Costs • Response • Who’s doing the assessing • Self Assessment Reliability (pending)

  13. ASTDD www.astdd.org • State Activities • Best Practices • Resources Links including state oral health programs • Publications • Basic Screening Survey (BSS) • Seven Step Model • Program Guidelines • Technical Assistance

  14. Best Practice Approaches – State Oral Health Surveillance • Characteristics/utility of a good system • Sources of data • Building an OH surveillance system • National Oral Health Surveillance System (NOHSS) as a basis • Using existing data and integrating with existing systems (YRBS, PRAMS, BRFSS) • In-mouth surveys as needed

  15. Best Practice Approaches – State Oral Health Surveillance • Emphasis on • defining resources • use of system data for planning/decision making • importance of dissemination and partnering • CDC model cited: resources > activities > outcomes www.cdc.gov/oralhealth/library/infrastructure.htm

  16. Best Practice Approaches – State Oral Health Surveillance • Oral health surveillance system evaluation criteria • Impact/effectiveness – important indicators and dissemination • Efficiency – regular schedule, cost effective data collection, analysis, and dissemination • Sustainability – continuous over years to analyze trends • Collaboration/integration • Resources and partnering • Integrating oral health into other programs • Objectives/rationale – clear on why system exists and how data will be used

  17. Guidelines for State and Territorial Oral Health Programs • Based on 1988 IOM Future of Public Health Report model with components: • Assessment • Policy development • Assurance

  18. Guidelines for State and Territorial Oral Health Programs • Specific guidelines on Assessment • Oral Health Status and Needs • Monitor oral health status and needs • Assess oral health in special populations • Document dental service needs • Analyze determinants of oral health (includes assessment of OH services, workforce, and knowledge/perceptions of constituents and care providers) • Assess state and local fluoridation

  19. Guidelines for State and Territorial Oral Health Programs • Implement OH surveillance system • Develop (Seven Step Model) • Maintain – systematic continuous collection • Disseminate findings • Support local surveillance • Surveillance (evaluation) of OH programs/services • Integrate with other state systems • Coordinate/collaborate with other government/industry/university etc. surveillance • Surveillance of potential OH hazards (radiation, amalgam (Hg), infection control, nitrous oxide…)

  20. ASTDD Resources • Seven Step Model • Basic Screening Survey (BSS) • BSS EpiInfo program module

  21. Seven Step Model • Lays out the steps in developing a needs assessment system (simple to complex) • Identify partners – form advisory committee • Conduct a self assessment • Plan the needs assessment • Collect data • Organize and analyze data • Prioritize issues and report findings • Evaluate the needs assessment

  22. Objectives of BSS Surveys • To provide information not available from existing data sources • Assess basic (but important) indicators - simple training for non-dental professionals • To provide information on: • Caries experience and untreated caries • Dental sealants • Can add - dental trauma, malocclusion, dental fluorosis, oral pathology, missing teeth…..

  23. Objective Objectives • Derive population estimates from sample • Get good estimates - representative sample • Be able to estimate statistically how good these estimates are (probability sampling) • Avoid biases in sample (good design and following protocol) • Avoid biases in data collection (standardization and following protocol)

  24. What You Can Get • State estimates • County specific estimates for bigger counties • Estimates by SES (F/R lunch) • Estimates by urban/rural • Estimates by health region

  25. What You Can Do With It • Compare to national (NHANES) and other state (NOHSS) data / report (NOHSS, MCH) • Track disease trends over time/ assess progress toward Healthy People Objectives • Explore variations by geography, SES, etc. = disparities • Provide for optimal program planning for improving the oral health of the population

  26. What’s going on? - CDC • Data Systems • MWF• NOHSS • Oral Health Maps• Synopses • WFRS

  27. National Oral Health Surveillance Systemwww.cdc.gov/nohss/ • CDC/ASTDD – monitor disease burden • 8 oral health indicators • Dental visits (NHIS, BRFSS) • Teeth cleaning (BRFSS) • Edentulism (BRFSS) • Fluoridation (WFRS) • Caries experience (BSS) • Untreated caries (BSS) • Dental sealants (BSS) • Oral cancer (Vital statistics, cancer registries)

  28. National Oral Health Surveillance System • Inclusion Criteria for Caries/Sealants Data • Within past 10 years • Statewide probability sample • Trained/calibrated examiners (yearly) • NIDCR or BSS criteria used • SUGGEST minimally 3rd grade (K-2) • Stratified by grade (vs. age) • Submitted by school year • Would like nonresponse adjustment • % F/R lunch for sample kids, schools, and state

  29. Examples - Pennsylvania • Battery of Surveys 1998-2000 • School – Grades 1,3,9 and 11 (caries counts) • Parent interview on subset (SES, insurance, perceived need, concerns, parents oral history, dental knowledge) • School nurses – log of emergency visits/dental • Fluoridation census • State mandated oral screenings - entry (K or 1), 3, and 7 - school summaries dmf and treatment need (since 1949 - boxed in Harrisburg) = untapped resource

  30. Illinois • Just completing BSS survey / Division of Chronic Disease (CV and obesity) BMI • 1994 DMF survey with trauma/mouthguards info • BRFSS, cancer registry, PRAMS, NOSHA, MCH, Medicaid - summary of data collected/how/ and when, Illinois specific indicators • Communication and information to collect on regular basis from local agencies (may develop ground-up surveillance system) • Workforce survey (practice characteristics, retirement) • Fluoride survey – awareness of dentists/hygienists

  31. Kentucky • LARGE statewide surveys in 1987, 2001 • Presently developing surveillance system • 3 year cycles of replicate samples conducted annually • State representation annually, county level after 3 years and annual surveys merged for improved state estimates

  32. Ohio • Large surveys – 87, 92-93, 98-99, 04-05 • State to county level surveys (vs. VT) • Down to grade 3 and BSS indicators • County profiles website • Detailed data available to counties for monitoring, and reporting, and grant applications $$$$$

  33. Ohio cont. • Annual data • 25 sentinel sites (reassessed) • MCH requirements • Need/Readiness assessment • Hospital data (OH Hospital Assn) • Workforce data • Census data • Medicaid Data • Ohio Family Health Survey

  34. Summary • Oral Health Surveillance: Past, Present, and Future Challenges. J Public Health Dent 2003;63(3):141-9. • Trend to state and local data collection • Integration with existing systems • Visual only simpler oral indicators • Variety of conditions/behaviors (vs. DMF) • Timely analysis and dissemination

  35. Summary – Logical Conclusion The better you can define the problem, the better your chances of obtaining resources and addressing the problem.

  36. Bonus Time - Sampling Issues • Representative of Who? • Precision of population estimates • Level of Estimates • State • Region • County • (Small Area Estimation) • Subpopulations of interest

  37. Methods • Representative PPS (probability proportional to size) sampling of schools to produce state and subpopulation estimates • Systematic Selection from an ordered list to achieve “implicit stratification” on region, urban/rural, and free/reduced lunch eligibility, …. your choice

  38. # S o # S o u t h w e s t e r n D i s t r i c t N o r t h C e n t r a l D i s t r i c t N o r t h w e s t e r n D i s t r i c t Sampled School Districts and Regions Pittsburgh Philadelphia

  39. P o p u l a t i o n b y C o u n t y 4 5 0 0 - 1 0 0 0 0 0 P I T T S B U R G H S D 1 0 0 0 0 P H I L A D E L P H I A C I T Y S D Sampled School Districts and County Populations P A O H N A S c h o o l D i s t r i c t s 1 - 2 5 0 0 0 0 2 5 0 0 0 1 - 4 5 0 0 0 0 4 5 0 0 0 1 - 7 0 0 0 0 0 7 0 0 0 0 1 - 1 5 0 0 0 0 0 N W E 1 0 0 0 1 0 0 2 0 0 M i l e s S

  40. Sampling Terms • Probability Sampling • Purposive (“Expert Choice”) Sampling • Simple Random Sampling • Cluster Sampling • Stratification and Stratified Random Sampling • Systematic Sampling (Implicit Stratification) • Probability Proportional to Size (PPS) • Weights • Oversampling • Nonresponse (BAD)

  41. But how many kids should we screen??????? • Simple but unsatisfying answer – how many can you screen? • Certain % of the population? - nope • Real first question - how much precision do you want (or will settle for) at what level? • Second question – do you have other data for sample size calculation • Third question – what’s your sample design?

  42. Sample Size –Effects of Sample Design • Stratification – small gains in precision • Clustering – potentially big loss in precision • Main variable(s) of interest • Design Effect – practical definition • Expected Non-response

  43. Sample Size –Effects of Sample Design • In our case (BSS) – proportions • Simpler formula than continuous variables: • v(p0) = (1-f) p0 q0 / n-1 • Conservatively use p0 = 50% • For 95% CI = +/- 10% n = 97 • For 95% CI = +/- 5% n = 384 • For 95% CI = +/- 3% n = 1,066

  44. Sample Size –Effects of Sample Design • Then multiply by estimated design effect • Remember basically the same calculations are appropriate for the designated population level, e.g. • If want this precision for regional level estimates and have 5 regions, then X 5 • If want this precision for county level estimates and have 35 counties, then X 35

More Related