From the First Tooth to Cavity Free at Three

Transcription

1 From the First Tooth to Cavity Free at Three Quality Improvement & New Components of Two Successful Integrated Oral Health Programs NNOHA Conference November 18, 2015 Presenters Anne Gibbs, RDH, BS Cavity Free at Three Supervisor Abby Laib, MS Oral Health Evaluator

2 What is Cavity Free at Three? A Colorado initiative housed at the Colorado Department of Public Health and Environment Oral Health Unit. Program outcomes Pregnant women receive oral health care Children have at least one dental visit by age one Early Childhood Caries is prevented

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4 Promote medical and dental integration & co-location CF3 Strategies Support policies/practices that improve access to oral health care Create effective & culturally appropriate messaging Train medical and dental providers on best practices Provide technical assistance support and resources

5 CF3 Model Medical/Dental Children Caries risk assessment Clinical evaluation Fluoride varnish application Anticipatory guidance/parent Education Goal setting Age one dental visit/ Establish a dental home Well Child Visit Video Pregnant Women Clinical evaluation Anticipatory Guidance/ Education Referral/visit to a dentist during pregnancy Dispel myths about providing care for pregnant women Oral Health During Pregnancy Video

6 Provider Resources Cavity Free at Three training Children s oral health Pregnancy and oral health Hands-on component Certification for medical providers Patient education materials Treatment kit Children s oral health- in 11 languages Pregnancy and oral health - in 11 languages Caries Risk Assessment Goal Setting sheet Flip-book Follow up support /Technical assistance Web site

7 Reimbursement Primary Care

8 CF3: Technical Assistance TA requests are generated through: Follow-up Survey, newsletters, website, general CF3 All TA requests are entered into Freshdesk, an online platform Streamlines TA & training needs Track and reports the frequency and level of TA required

9 Online Survey Data Collection Process Pre-registration for CF3 Training (aka Pre-test) Collected prior to training Current oral health practices for children & pregnant women Public insurance acceptance Demographics Training Check-in Online check-in at training and last name verification Used to filter out attendees and noshows for future data collection efforts Post-Training Survey Administered days post training Level of CF3 implementation Facilitators & Barriers of implementation TA Needs Billing code usage/acceptance of public insurance Demographics

10 CF3 Implementation Process Cavity Free at Three Training 1 ST STEP CF3 held 31 trainings & trained 420 providers, staff, & oral health advocates from 12/14-7/15. Post Training Survey 2nd STEP Eligibility Criteria Anyone who may be involved with the CF3 implementation. Inclusion - Provider - Nurses - Medical Staff Exclusion - Student - Healthcare Partner - Other 291 Providers and Staff Eligible to Participate in the Survey. 105 Trainees Participated in the Survey; 36% Response Rate. 3rd STEP 66 TA requests were submitted through the Survey.

11 Who is completing the TA survey? The majority (52.1%)of the survey respondents identified Medical as their primary practice type. Nurses (RN & LPRN) comprise the largest proportion of respondents (32.3%). Primary Practice Setting (n=105) 25.0% 52.1% 22.9% Medical Dental Local Public Health Agency Profession/Role (n=105) Nurse 32.3% Dental Hygienist 16.7% Medical Assistant 9.4% Physician 9.4% Administration/Office Staff 9.4% Nurse Practitioner 8.3% Dentist 6.3% Office Manager 3.1% Physician Assistant 2.1% Resident Physician 2.1% Dental Assistant 1.0%

12 What is the level of CF3 implementation? 78% of respondents indicated that they are Completely or Partially implementing CF3 into their practice. CF3 Model Implementation (Self-Report) 15.6% 30.2% 6.3% 47.9% Yes, completely Partially or Somewhat No, but we will likely implement in the future No, and we do not plan to implement

13 To what extent are they implementing CF3 services into their practices? Oral Health Services Provided (Self-Report) Fluoride Varnish 59.0% 56.8% 66.7% Counseling/Education 54.3% 53.1% 58.3% Referral to Dental Provider/Age Dental 1 visits 30.9% 50.5% 54.2% Oral Evaluation for < 3 years 49.5% 44.4% 66.7% Caries Risk Assessment 49.5% 48.1% 54.2% Knee to Knee 41.0% 35.8% 58.3% Caregiver Goal Setting 33.3% 30.9% 41.7% Pregnant Women Oral Health Services 21.0% 28.6% 54.2% Other 7.6% 3.7% 20.8% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% Total (n=105) Medical/LPHA (n=81) Dental (n=24)

14 What are barriers when implementing CF3? Medical/LPHA (n=81) Inadequate time to provide oral health services (n=21) Oral Health Services not covered by private insurance (n=12) Dental (n=24) Providing services for children under age 3 is not financially viable (n=3) Lack of Practice Enthusiam (n=2) Issues billing/receiving reimbursement (n= 9)

15 What are facilitators when implementing CF3? Medical/LPHA (n=81) CF3 Training Adequate (n=44) Patient Population Need for children <3 years (n=20) Necessary materials, supplies, & equipment (n=17) CF3 Components were easy to incorporate (n=15) CF3 Training Adequate (n=8) Dental (n=24) Patient Population Need for children <3 years (n=6) Necessary materials, supplies, & equipment (n=5) CF3 Components were easy to incorporate (n=5)

16 Secondary Outcome Data 60% 50% 51.4%* Colorado Medicaid g 40% 39.6% Total Eligibles Receiving any Dental or Oral Health Service 30% * Significant Increase p=< % 10% 3.7% 11.8%* 0% Age 0-5 Age < 1

17 Secondary Outcome Data Colorado Basic Screening Survey Healthy People 2020 Goal 100% Kindergarten 100% Head Start 80% 80% 60% 40% 20% 46% 45% 40% 27% 23% 14% 60% 40% 20% 42% 15% 0% Caries experience Untreated decay 0% Caries experience Untreated decay

18 CF3 Successes Policy 2009/2010: CO Medicaid & CHP+ open codes for oral health services in primary care 2014: Adult dental benefit for Medicaid 2014: RDH scope expansion: Tele-dentistry and ITR Patient education materials (11 languages!) 250 Trainings (2008-9/2015) 3608 total individuals trained 366 Dental providers (DDS, DMD, RDH) 516 Primary care providers (MD, DO, NP, PA) 2726 Nurses, medical/dental support staff, public health, other partners 2015: Launched TA program and platform to support providers with implementation

19 Questions?

20 Acknowledgements

21 Contact Information Colorado Department of Public Health and Environment Oral Health Unit CavityFreeAtThree.org To send an , click on the Contact Us tab

22 Discussion What are the challenges in the integration of oral health into primary care settings? Inadequate time to provide services Lack of reimbursement of services by insurance Encounter based reimbursement Need for staff training Electronic Health Records

23 Discussion What are the opportunities to support the integration of oral health into primary care settings? US Preventive Services Task Force recommendation (5/2014) AAP Bright Futures (9/2015) Health professional associations support Early and frequent visits to primary care by children National training curriculum available for staff competency