THE HEALTH CENTER DENTAL DASHBOARD: MAKE YOUR DATA WORK FOR YOU! November 8, 2016

Transcription

1 THE HEALTH CENTER DENTAL DASHBOARD: MAKE YOUR DATA WORK FOR YOU! November 8, 2016

2 Allison Cusick, MPA Speakers Senior Program Officer Delta Dental of Colorado Foundation High Performing Health Centers and Dashboard Pioneer Isaac Zeckel, DDS Chief Dental Officer HealthLinc Community Health Center NNOHA Dashboard Collaborative Team & National Oral Health Learning Institute Graduate Sandra Garbely-Kerkovich, DMD Senior Vice President & Chief Dental Officer, Choptank Community Health Center NNOHA Dashboard Collaborative Pilot Team An Nguyen, DDS, MPH Vice-President of Dental Services, Clinica Family Health Faculty, Dental Dashboard Collaborative Chad Lennox, MPH Director Washington Dental Service Foundation High Performing Health Centers and Dashboard Pioneer

3 Participants Will Be Able To: Recognize recommended oral health measures Understand ways that Health Centers can monitor and measure oral health data Learn how to use the Dental Dashboard template Hear from experts on best practices in using dashboards and possible roadblocks with gathering and using data

4 Session Overview History of the Project Why Dashboards? What are the 15 Oral Health Measures? Case Studies real health center examples How to Use the Dashboard Survey results Online Dashboard & User s Guide Questions & Answers/Discussion

5 History Of The Project Delta Dental of Colorado Foundation and Washington Dental Service Foundation have been working with expert advisers to develop a set of recommended oral health measures for High-Performing Health Centers. We have also developed an online, tool to help Health Centers gather data and graph it for the measures.

6 Development Participants from: CMS NNOHA Institute for Oral Health Colorado and Washington CHC CHCs working on oral health WA Dental Service Foundation Delta Dental of Colorado Foundation

7 Vision For This Work 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.

8 Quality Improvement And Data Health Centers are required to have an ongoing Quality Improvement/Quality Assurance (QI/QA) program that includes clinical services and management. The QI/QA program must include: Clinical director who supports the QI/QA program and provision of high quality patient care Periodic assessment of the appropriateness of the utilization of services provided or proposed to be provided to individuals served by the health center

9 Attention To Dental 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 Oregon Dental Quality Metrics Workgroup

10 Why Use A Dashboard Dashboards give a quick status update for key measures. They are a snapshot, not an in-depth analysis. Regularly seeing the data makes it much easier to respond quickly to areas of concern, or to change courses of action. Dashboards can be used to facilitate communication between departments, highlight successful strategies, to maintain momentum in QI activities, and identify operational deficiencies. It is a tool to take action!

11 Who Uses Dashboards? Shorter, more focused dashboards that are reviewed on a frequent basis are associated with higher performance. According to the results of this dashboard analysis, hospitals that use dashboards with fewer measures are more likely to be in the high-performance group, suggesting that higher-performing hospitals have developed dashboards that focus on areas they see as critical for quality. Furthermore, performance data are more actionable when such data are consistently reviewed by the board on a relatively frequent basis. Kroch et al. (2006)

12 The Dental Dashboard The Dental Dashboard is a set of measures that is an optional tool for Health Centers to use as part of their quality improvement program to More effectively monitor and measure factors that affect quality Establish baselines for key measures Set targeted improvements for individual measures Develop methods to improve performance Track improvements over time

13 The Dental Dashboard

14 WHAT ARE THE 15 ORAL HEALTH MEASURES? 1. Treatment Plan Completion 2. Caries at Recall 3. Oral evaluation and/or Risk Assessment of all Primary Care Patients 4. Risk Assessment of all Dental Patients 5. Topical Fluoride

15 MEASURES continued 6. Sealants (6-9 year olds) 7. Sealants (10-14 year olds) 8. Self-Management Goal Setting and Review 9. Self-Management Goal Sharing 10.Charges (Production) per Encounter

16 MEASURES continued 11. Encounters per Hour 12. No Shows 13. Direct Cost per Visit 14. Recall Rates 15. Recommendation to Family and Friends

17 How HealthLinc Uses Our Dashboard And Why We Would Never Go Back Isaac Zeckel, Chief Dental Officer, HealthLinc

18 Our Organization s Dashboard Staff Meetings Dental Rev Per = $ Exp Per = $ Loss Per = -$13.24

19 Jan-16 Apr-16 Jul-16 Oct-16 Jan-17 Apr-17 Jul-17 Oct-17 Jan-18 Apr-18 Jul-18 Oct-18 per cent Jan-16 Apr-16 Jul-16 Oct-16 Jan-17 Apr-17 Jul-17 Oct-17 Jan-18 Apr-18 Jul-18 Oct-18 Jan-16 Apr-16 Jul-16 Oct-16 Jan-17 Apr-17 Jul-17 Oct-17 Jan-18 Apr-18 Jul-18 Oct-18 $ per Visit per cent Jan-16 Apr-16 Jul-16 Oct-16 Jan-17 Apr-17 Jul-17 Oct-17 Jan-18 Apr-18 Jul-18 Oct-18 Jan-16 Apr-16 Jul-16 Oct-16 Jan-17 Apr-17 Jul-17 Oct-17 Jan-18 Apr-18 Jul-18 Oct-18 per cent per cent Emerging State of Our Dashboard Caries at Recall (<21 years) Caries Risk Assessment Documentation (<21 years) Sealants (6-9 years) No Shows (<21 years) Direct Costs per Visit (South Bend)

20 Day-to-day Implementation Application Support Practice Management Front Desk EDR DA/RDH/DDS Practice Management Process Coordinator Data Analytics tool Excel PDSA PDSA Dashboard Workgroup

21 How We Use Our Dashboard Drive a transition of culture Start conversations about how to provide a framework for evidence based preventative care Identify baselines and short/long term goals

22 Best Practices Start with small changes and test with volunteers that will be flexible Have reports that reflect the differences between clinics (they may start to compete) Work with the staff to improve the workflow

23 Best Practices

24 Possible Roadblocks Challenging legacy data Translation of dental lingo and dental staffing to those that collect the data Training and workflow changes especially with complex software

25 Advice Be consistent Make data visible Ensure Accuracy of data Collaborate with staff to modify/test workflows (PDSA) If you can collect the HRSA sealant measure, you can collect any measure.

26 How Choptank Community Health Uses Our Dashboard and Why We Will Never Go Back Sandra Garbely-Kerkovich, DMD Senior VP and Chief Dental Officer

27 Number of Days for New Patient Appointment PATIENTS PER HOUR Patients with F/U and recare Appointment CCHS QI measure access to care - Access team - - each Medical and Dental site dashboards reviewed monthly YTD No Show Count Site Total: 747 CCHS Total: 3, % 50% % J F M A M J J A S O N D 0% 0% 0% Jan Feb Mar April May June 54% 61% 69% 72% 77% 84% July Aug Sept Oct 0% 0% Nov Goal=95% Dec 0% Goal = 60 Days YTD New Patient Count growth measure Site Total: CCHS Total: 3,556

28 M-15 A-15 M-15 J-15 J-15 A-15 S-15 O-15 N-15 D-15 J-16 F-16 M-16 A-16 M-16 J-16 J-16 A-16 S-15 O-15 N-15 D-15 J-16 F-16 M-16 A-16 M-16 J-16 J-16 A-16 SELECT TEAM M-15 A-15 M-15 J-15 J-15 A-15 S-15 O-15 N-15 D-15 J-16 F-16 M-16 A-16 M-16 J-16 J-16 A-16 Dashboards 100% 80% 60% 40% 20% 0% 100% 80% 60% 40% 20% 0% PM1: % Pts w. Risk Assessed in MM OM2: % Pts w. decreased risk N N 800 Decreased Risk- % of pts that we are able to keep their risk decreased as we Complete tx. plans and enforce CRA amd SMG CRA documented in EDR and EHR at every appt CRA/SMG goal is 95% for every patient Data collected in both EDR and EHR 100% 80% 60% 40% 20% 0% PM3: % Tx Plans Complete w/in 6 mo. N Tx Plan Complete w/in 6 Months 0-20 yrs old goal 100% PA report generated using D0150 code and D9992 code -

29 Sealant Dashboard %Monthly Goal % 50% Jan % 70% Feb % 70% Mar % 70% Apr % 70% May % 70% Jun % 70% Jul % 70% Aug % 70% Sep % 70% Oct-16 70% Nov-16 70% Dec-16 70% January FebYTD MarYTD AprYTD MayYTD JunYTD JulYTD AugYTD SepYTD Total at risk with Qual Visit Total NDSEAL Total D % YDT 48.65% 55.26% 52.11% 52.38% 56.94% 61.66% 62.94% 63.27% 63.85%

30 Case Completion Dashboard 2016 Dental Case Completion % YTD/Month % Monthly Goal CCHS has monitored this goal since 2010 Quality Pillar Goal last year reached 73% - but recent barriers with opening all Dental schedules to Adult Medicaid NP and Adult uninsured/s/f NP 2015 Results 74.6% 75% Jan % 63.6% 76% Feb % 69.3% 76% Mar % 64.2% 76% Apr % 63.8% 76% May % 66.1% 76% Jun % 75.4% 76% Jul % 64.6% 76% Aug % 65.2% 76% Sep % 65.6% 76% Oct-16 76% Nov-16 76% Dec-16 76%

31 How We Use Our Dashboard Data System changes that will result in improvement Learning Cycle 5: Full implementation of the finalized codes on Cheat Sheets at all dental sites was achieved and will be recorded appropriately by all ACTIVE providers. Hunches Theories Ideas Cycle 4: The Cheat Sheet was approved & given to all dental sites. Changes were made after testing to differentiate the patients needing sealants vs not needed. Cycle 3: A Cheat Sheet was fabricated by the Committee. Cycle 2: Committee worked on how the codes would be used and how to put the codes in Dentrix & Intergy Cycle 1: Use SmartCodes /ADA Codes to differentiate HRSA Sealant Measure needs in Dentrix (EDR)& Intergy(EDR). We asked ourselves How can we change our current system and now document accurately on the HRSA Sealant Measure?

32 Day-to-day Implementation At CCHS, our Quality Department collects the data and relays that information to our Dental Quality Improvement Team. We follow a guide (much like a PDSA) in teaching and coaching our staff. NNOHA QI Committee Team /site Champions QI Committee and site champions Site Huddles Tips & Tricks Patients

33 Best Practices create tools /cheat sheets

34 Possible Roadblocks Employee engagement or buy-in-change in culture difficult for staff already overwhelmed Data collection /retrieval EDR/EHR do not talk Starting TOO big aims/goals or PDSA s Non buy-in SMT team/ executive staff/administrative Complacency among staff data slips and not best practice or optimal anymore keeping things fresh in minds

35 Our Advice Get buy-in from staff and SMT re-enforce how it will improve patient care - mission Accept advice from peers join collaborative Analyze/Utilize data and dig deep to see trends Encourage staff with incentives celebrate WINS Listen to your staff they have great ideas and implement their ideas Start small, small, small! Use PDSA s One Day One Location One Provider One Patient One Test

36 How Clinica Family Health Uses Our Dashboard And Why We Would Never Go Back An Nguyen, DDS, MPH Vice-President of Dental Services Clinica Family Health November 2016

37 Our Organization s Dashboard

38 How We Use Our Dashboard 1. To support our chronic disease management model of care. 2. To drive quality improvement. 3. To support risk-based care and evidencebased practice. 4. To manage population health. 5. To support teambased care & ownership.

39 How We Use Our Dashboard 1. To support our chronic disease management model of care. 2. To drive quality improvement. 3. To support riskbased care and evidence-based practice. 4. To manage population health. 5. To support teambased care

40 How We Use Our Dashboard 1. To support our chronic disease management model of care. 2. To drive quality improvement. 3. To support risk-based care and evidencebased practice. 4. To manage population health. 5. To support teambased care & ownership.

41 R e s p o n s i v e How We Use Our Dashboard A RESPONSIBLE SYSTEM SUPPORTING RESPONSIVE TEAMS R e s p o n s i b l e

42 1. Support Chronic Disease Management 50 Caries at Recall Rate Clinica- % Caries at Recall Clinica - Median

43 2. Drive Quality Improvement A Possible Solution: To create more access, reduce scheduling complexity (by reducing number of rules) to facilitate fewer unbooked slots. MULTIPLE successful PDSA cycles build knowledge and accelerate the adoption of proven and effective changes.

44 2. Drive Quality Improvement 6 PDSA Cycles: Process Goal Accomplished!

45 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep Support Risk-Based Care Recall Rates 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Fluoride Application Rate Treatment Plan Completion Rate Recall Rate Treatment Plan Completion

46 4. Manage Population Health Caries at Recall Clinica % Caries Clinica - % Caries Median

47 5. Support Team-Based Care Care Team A: Visits Per Day 60 Care Team A: Recall Rates Care Team A: Treatment Plan Completion Rate Dentist and Hygienist implement best bundled treatment planning practices to reduce number of visits required. Dental Assistants implement best practices for efficient room set up and turnover to support more patient visits per day. Receptionists outreach to patients with outstanding treatment plan care gaps and fill the schedules.

48 Day-to-Day Implementation Business Intelligence (BI) team generates & manages reports. Departments are allocated BI support according to organization s strategic priorities. Administrative team runs & pushes reports to end users according to defined processes. Data can be pulled at will from the BI tool on employee desktops.

49 Best Practices Report intake process (use the User s Guide!). Define terms, numerator, denominator. Identify data sources & flows to support data entry. Determine actionable level of specificity ( roll-up ) and frequency of review for run charts. Validate the data before rolling reports out. Make the measures meaningful to you!

50 MANAGER TEAM EMPLOYEE Best Practices Integrate use of data into everyday practice. Cadence of Accountability Ownership of data and team performance. Daily team huddles make performance goals clear. Data reviewed in 1:1 meetings with manager make data actionable. Use data to drive projects.

51 Possible Roadblocks Competition for BI resources. Prioritized report development. Financial incentives for medical performance. Is this coming for dental? Limited structured data sources & impact on data quality. Artificial operational processes for data entry that require end-user training/adherence. Need for dummy codes.

52 Creating a Culture of Quality Building Blocks of Leadership and vision. A vision is not just a picture of what could be; it is an appeal to our better selves, a call to become something more. (Rosabeth Moss Kanter) Data is a powerful storyteller. Give it a voice, and let it speak frequently. Support good habits.

53 Advice Start small, but don t forget to start! Prioritize your work and learn as you go. Some metrics feed into each other & help paint a fuller picture. Outcome measures are long-range. Use process measures as proxies for short-term performance. Don t get sidetracked by more data. Use measurement to inspire action.

54 Advice If we all agree that the goal of our work is to improve the health of our patients, how will we know that we are successful? DATA! Comfort with transparency and a will to improve.

55 Using the Dental Dashboard Chad Lennox, MPH, Director Washington Dental Service Foundation

56 Survey of Dashboard Users September 2016 Results: Use for meaningful data, quality improvement, and to see change for patients Majority are in the process of implementation (some haven t started yet) TIME, buy-in, and getting data out of the EDR are the biggest barriers in using the Dashboard

57 For what purpose do you use the Health Center Dental Dashboard? Facilitate communication between departments Highlight successful strategies Maintain momentum in Quality Improvement activities Identify operational deficiencies Compare to other organizations when national measures are used

58 Which of the 15 of The Health Center Dental Dashboard measures are you regularly using?

59 How are YOU using the Dashboard? 3 most used measures Sealants No shows Treatment plan completion Prior to introducing the dashboard, the sealant measure was very inaccurate. Non-dental staff members were pulling the data, but they had no idea of full sealant measure requirements, so the did not pull all the necessary data for the measure

60 Why Use the Dashboard at All? We are moving into a world of outcomes driven reimbursement States are beginning to demand dental metrics UDS sealant measure If you can t measure it, you ll never move the dial Most important It provides you a tool to develop your Vision as a dental leader in your organization

61 HOW TO USE THE ORAL HEALTH MEASURES Selecting oral health measures places a value on oral health and focuses quality improvement efforts towards them. You do not need to select all 15 measures. Start with 1-2 measures (3 max in the first 3 months) that are inline with your center s mission, your strategic plan, or parallel national standards. Collect data regularly, share with the appropriate people, use the data to instigate action. Add additional measures when you re ready. These measures were designed for IMPROVEMENT.

62 Overview The Dental Dashboard includes two resources: Users Guide and data charting. The User s Guide is a companion to support the implementation and use of the Dental Dashboard. The in-depth document gives users more details about: How the recommended measures were selected Specifies the numerators and denominators What codes are needed to track the measures Tips for how to collect the data Instructions for how to access the online template

63 Users Guide & Dental Quality Alliance Specifications Measures list inspired by the 2015 NNOHA Dashboard Version ces/dental-dashboardinformation/users-guide/ Measure specifications for clinical measures and noshows developed by Dental Quality Alliance

64 Charting Tools The Dental Dashboard includes two resources: Users Guide and data charting. An online template is available at You can also download a simple Excel spreadsheet to create your graphs

65 THE ONLINE DENTAL DASHBOARD Users import the downloaded data into the chart presentation tool and can easily view graphs of their selected measures.

66 QI Learning Collaborative Dashboard September 2016

67 Next Steps The Dashboard is free to use, but user s will need to sign up to receive the Excel template; Access to the Dashboard and the User s Guide is posted on NNOHA s website: Measures continue to be refined through NNOHA s Dashboard Learning Collaborative;

68 Next Steps NNOHA will be hosting a Learning Community to: Support measurement Develop comparison reports. NNOHA will send out information about the opportunity to be involved.

69 What type of technical assistance or support would you need to be successful in implementing a Dashboard in your health center? What would you need from: NNOHA HRSA Turn and Talk Sharing & Next Steps Partners such as Delta Dental foundations or other funders

70 Contact Information Colleen Lampron, MPH NNOHA Dashboard Consultant & Collaborative Director Irene Hilton, DDS, MPH NNOHA Dental Consultant & Collaborative Chair