Eli Schwarz - School of Dentistry. Do quality metrics derive from dental. practice activities and flow back into the dental school?

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1 Acknowledgments Dr. Denice Stewart Senior Associate Dean Clinical Affairs, School of Dentistry, Oregon Health & Science University, Portland OR, and Past Chair, Consortium for Oral Health, Research, and Informatics (COHRI) Dental Educators Role in Quality Measurement Dr. Nicole Kimmes Assistant Dean Faculty Development and Technology, School of Dentistry, Oregon Health & Science University, Portland OR, and Past Chair, Consortium for Oral Health, Research, and Informatics (COHRI) Eli Schwarz KOD DDS, MPH, PhD, FHKAM, FCDSHK, FACD, FRACDS Department of Community Dentistry Dental Quality Alliance, Chicago May 2015 Schwarz -School of Dentistry Outline of this Presentation Role of the Dental Educator Dental educators and health care quality a complex context; Dental education dental care system: Chicken or the egg? Society s health quality agencies and their impact; Critical lag of dental quality metrics; Oregon s Health Care Transformation as an example of what is coming and why it is important; Bridging the gap between the academic/research and the dental practicing community. Mentor [assist the student to learn/understand/translate] Role model [demonstrate appropriate behaviors/attitudes to the next generation of dentists] Assessor [supervise and control] Eli Dental Educator Role in a Complex System Health Policy CODA Dental Schools/ Dental Hygiene/Therapy Health Care System Other Health Professionals Interprofessional Education Payers OH Practitioners Communities/ Individuals/ Patients practice activities and flow back into the dental school? school activities and flow into practice? 1

2 Dental Educator Role in a Complex System Health Policy Health Care System CODA Dental Schools/ Dental Hygiene/Therapy Payers OH Practitioners Communities/ Individuals/ Patients Quality Metrics in Dentistry - Context 2001 Six specific dimensions that a health care system must fulfill to deliver quality care: Effectiveness Providing services based on scientific knowledge (avoiding overuse of inappropriate care, underuse of appropriate care) Patient Centeredness Care that is respectful of and responsive to patient preferences, needs, and values Timeliness Reducing wait times and sometimes harmful delays Safety Avoiding injuries to patients from care that is intended to help Efficiency Avoiding waste of equipment, supplies, ideas, and energy Equity Care does not vary in quality because of personal characteristics 2003 IOM 2015 Impact of Interprofessional Education on Patient Outcomes Five core competencies that all clinicians should possess, regardless of their discipline, to meet the needs of the 21st-century health system. Provide patient-centered care. Work in interdisciplinary teams.. Employ evidence-based practice. Apply quality improvement. Utilize informatics. Recommendation 2: Health professions educators and academic and health system leaders should adopt a mixed-methods research approach for evaluating the impact of interprofessional education (IPE) on health and system outcomes. IOM

3 The Interprofessional Learning Continuum (IPLC) Model Agency for Healthcare Research and Quality (AHRQ) National Quality Measures Clearinghouse (NQMC) Evidence-Based Practice Centers IOM 2015 National Quality Measures Clearinghouse (NQMC domains) Agency for Healthcare Research and Quality (AHRQ) National Quality Measures Clearinghouse (NQMC) Evidence-Based Practice Centers National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) Consumer Assessment of Healthcare Providers and Systems (CAHPS) Centers for Medicaid and Medicare Services (CMS) Electronic Health Record Meaningful Use Initiative (EHR) EPSDT measures National Quality Forum (NQF) Agency for Healthcare Research and Quality (AHRQ) National Quality Measures Clearinghouse (NQMC) Evidence-Based Practice Centers National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) Consumer Assessment of Healthcare Providers and Systems (CAHPS) Centers for Medicaid and Medicare Services (CMS) Electronic Health Record Meaningful Use Initiative (EHR) EPSDT measures National Quality Forum (NQF) Dental Quality Alliance (DQA) 3

4 IOM Report Critical Comments on Quality in Oral Healthcare National Quality Forum Summary on Dental In general, dentists do not use a universally accepted diagnosis coding system. Oral health lags significantly behind the remainder of the health care system in developing quality measures, and as a result little is known about the quality of oral health care. Much more needs to be done to improve the quality assessment, improvement, and reporting efforts in oral health in order to answer some of the basic questions regarding improving oral health and oral health access. Considerable number of oral health performance measures exist, many are redundant, overlapping, ill-defined or non-standardized; Process measures are abundant; outcome measures are scarce; Lack of diagnostic coding limits the ability to collect and report data; Few examples of measures that are both standardized and robust enough to be tied to incentives; Well developed and tested patient experience of care survey exists, but not in widespread use IOM 2011 (p.118) National Quality Forum Dental Educator Role in a Complex System Health Policy Health Care System Also, health professions oversight processes, such as accreditation, certification and licensure, function at the national level, thereby affording a leverage point for systemwide change and for the inclusion of particular educational content in a curriculum. CODA Dental Schools/ Dental Hygiene/Therapy Payers OH Practitioners Communities/ Individuals/ Patients Commission on Dental Accreditation (CODA) The Commission on Dental Accreditation expects each program to define its own goals and objectives for preparing individuals for the practice of general dentistry. (p.22) In its mission statement the Commission has clearly articulated its purposes in dental accreditation: to ensure the quality of dental and dental-related educational programs and to enhance and encourage improvement in the quality of those programs. (p.2) The Consortium for Oral Health Research and Informatics (COHRI) was formed in February 2007 during a users group meeting of dental schools who used the same EHR platform (axium). Quality assurance: A cycle of PLAN, DO, CHECK, ACT that involves setting goals, determining outcomes, and collecting data in an ongoing and systematic manner to measure attainment of goals and outcomes. The final step in quality assurance involves identification and implementation of corrective measures designed to strengthen the program. Self-study guide for dental education programs, CODA

5 J Dent Educ 2011 COHRI output J Dent Educ 2011 J Dent Educ 2013 Int J Med Inf 2013 J Amer Med Inform 2014 Diagnostic Terminology Dental Diagnostic Terminology (DDS) ~ EZ- Codes Electronic Health Record (axium) Big Data through crossinstitutional collaboration practice activities and flow back into the dental school? school activities and flow into practice? Oregon Health Transformation Overriding Goals Triple Aim Oregon Health Plan (Medicaid) Health Care Delivery system in 2014 Oregon Health Authority Oregon Health Plan (OHP) $$ PMPM Global Budget 16 Local Community CCOs CCO contracts Better health for the population Better care for individuals Oral Physical Mental OHP contracts H E A L T H Oregon Health Plan Members More than 1,000,000 after Medicaid expansions Lower cost through improvements Eli Navigators Primary Care Homes Coordinated care Coordination/collaboration Incentives Shared Systems & Learning Community Health Plans 5

6 Performance measurement structure State Commitment to CMS: Quality and Access Metrics Oregon Metrics and Scoring Committee was established in 2012 Main purpose: Establish outcomes and quality measures for CCOs as part of the Accountability Plan waiver agreement with CMS Initial task: To define quality improvement metrics for the CCO integration of the physical and mental health fields Later: Define quality metrics for dental care for 2014 integration process State is accountable to CMS for 33 metrics significant financial penalties for the state for not improving CCO s are accountable for 17 of the metrics there are financial incentives for improvement or meeting a benchmark The 33 metrics are grouped into 7 quality improvement focus areas: Improving behavioral and physical health coordination Improving perinatal and maternity care Reducing avoidable ED visits and re-hospitalizations Ensuring appropriate care is delivered in appropriate settings Improving primary care for all populations Reducing preventable and unnecessarily costly utilization by super users Addressing discrete health issues (such as asthma, diabetes, hypertension) Eli Eli Metrics & Scoring Committee Resolution: Dental sealants on permanent molars CAHPS Patient Experience Baseline Data Oregon Medicaid children receiving dental sealant in FFY 13 (EPSDT): 6-9 year olds: 13.4% year olds: 10.4% Recommended Benchmark Oregon Weighted average for the two age groups: 20% Question #4 -- A regular dentist is one you would go to for check-ups and cleanings or when you have a cavity or tooth pain. Do you have a regular dentist? Question #14 -- If you needed to see a dentist right away because of a dental emergency in the last 12 months, did you get to see a dentist as soon as you wanted? Second dental measure awaiting decision: Annual dental visit Eli Eli How do these developments affect us as dental educators? Mentor [assist the student to learn/understand/translate] Role model [demonstrate appropriate behaviors/attitudes to the next generation of dentists] Conclusions Dental educators have the responsibility to ensure that the next generation of oral health care providers are competent users of society s language and methods of high quality healthcare; For years, the lack of appropriate use of a standardized diagnostic terminology and quality metrics have disadvantaged oral health care fitting into society s ongoing health care transformation; Dental educators and the dental profession have initiated parallel processes of developing quality measures; The sooner these processes are coordinated and aligned the better for dental educators, graduates, and for the practicing professions. Eli 6

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