Mission. Maine Quality Counts is a member driven nonprofit located in Manchester, Maine.

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2 Mission Maine Quality Counts is a member driven nonprofit located in Manchester, Maine. We are working to improve the health of all Maine people (and beyond) by transforming the way healthcare is delivered.

3 Priorities QC Brings Together the People Who Give, Get and Pay for Healthcare to Address Shared Priorities: Improve the alignment of heath care systems to transform health for all Maine people Provide quality improvement assistance to practices Engage consumers in healthcare Promote the integration of physical and behavioral health

4 Maine Child Health Improvement Partnership (ME CHIP) Mission To optimize the health of Maine children by initiating and supporting measurement-based efforts to enhance child health care by fostering public/private partnerships. Vision All practices providing health care to children will have the skills, support, and opportunities for collaborative learning needed to deliver high quality health care. ME CHIP is part of the National Improvement Partnership Network (NIPN)

5 CME Disclosure: Today s speaker does not have any relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity. CME will be available for participants who have signed into the live webinar. If there are multiple people at one computer, please type their names and addresses into the chat box for our attendance records. We do not have separate nursing CEUs- but you can get a CME certificate. A CME evaluation survey will be sent after the webinar via . Please complete the survey via Survey Monkey within 1 week. A CME certificate will be ed within 1 month of completion of the survey. Please Jackie Tiner (jtiner@mainequalitycounts.org) with questions.

6 Connect With Us Join our list mainequalitycounts.org Engage and be social

7 Important Webinar Notes You are in listen-only mode. Please use the Q&A function to ask questions or make comments. Video screen size and location is adjustable. In two days you will receive an with links to slides and recordings and CME survey.

8 Today s Speakers Jennifer M. Dubail, MD Jennifer M. Dubail, MD is a General Pediatrician in Portland, ME. Dr. Dubail graduated from University of Vermont Larner College of Medicine in She completed her Pediatric Residency at Maine Medical Center in She has been in General Pediatric practice for 10 years at Maine Medical Partners Portland Pediatrics. Dr. Dubail is affiliated with Barbara Bush Children s Hospital at Maine Medical Center.

9 Today s Speakers Eiren Menhennitt Since graduating in 2005 with a BS in Psychology from Springfield College, Eiren has been providing support to local nonprofit and healthcare organizations that focus on improving health in their communities. Over the last 10 years, Eiren has worked with over 50 nonprofit organizations ranging from education, environmental issues to end of life care. Eiren joined the MaineHealth ACO in 2013 as a part of the administrative team, but quickly advanced to her current position within a year. In her role as Pediatric Practice Support Specialist Eiren is responsible for communication and quality improvement support for pediatric and family medicine practices on behalf of the MaineHealth ACO and MaineHealth CHI and CI pediatric related programs. Contact Eiren at EMenhennit@mmc.org

10 Today s Speakers Laura Robbins Laura Robbins works at MaineHealth as the Director of both the From the First Tooth and Before the First Tooth statewide initiatives. Laura also works with Emory University with The Diabetes Training and Technical Assistance Center as a National Master Trainer. She previously worked at MaineGeneral Medical Center for 9 years as a Grant Director where she managed multiple federal grants most recently focused on Clinical Community Linkages, working to hardwire provider screening and referrals within primary care, alongside of building capacity within community to foster a referral/linkage from the clinical setting to community evidence based programs. Laura holds her CHES Certification and BS from the University of Maine at Farmington

11 Healthy Smiles by 2020 Going the Extra Smile A Statewide Oral Health Challenge & Recognition Program Jennifer Dubail, MD, FAAP, Eiren Menhennitt, BS and Laura Robbins, BS, CHES January 31 st, 2018 Webinar hosted by Maine Quality Counts for Kids & From the First Tooth

12 Learning Objectives Explain the From The First Tooth Healthy Smiles 2020 Challenge Provide examples for how integrating oral health has impacted a local pediatric practice Review data collection strategies and how MaineHealth was able to improve based on data Learn about key resources for your practice

13 From the First Tooth - History The From the First Tooth (FTFT) initiative aims to improve the oral health of Maine s youngest children, ages birth through 48 months by implementing an evidence-based preventive oral health intervention consisting of four components: Oral evaluation Application of fluoride varnish Health education for parents Referral to a dentist These services are provided by primary care providers typically as part of well child care. This initiative is funded by the Sadie Harry Davis Foundation and administered by MaineHealth.

14 From The First From Tooth the First Tooth 204 of the targeted 260 primary care practices have been trained in person using the Smiles for Life, Module 6: Caries Risk Assessment, Counseling and Fluoride Varnish with additional slides on clinic work flow, EMR documentation, and billing 179 of 204 are implementing 100% of the large pediatric practices with >500 children ages months are trained and implementing From The First Tooth Over 100 primary care practices have integrated the Maine Oral Health Risk Assessment into the Electronic Medical Record

15 What is the Healthy Smiles 2020 Challenge? A clinically based challenge and recognition program developed by the Maine From the First Tooth Initiative in place to engage with practices and health systems to integrate the USPSTF Recommendation B - Dental Caries in Children from Birth Through Age 5 Years into all family medicine and pediatric practices in order to improve the quality of children s oral health in Maine. All practices in Maine and Memorial Hospital are encouraged to join this friendly Challenge and recognition program!

16 Why is this Important? 30% 20% 10% MaineCare 4 by 4 Data Percent of children who have received at least 4 fluoride applications by 4 yrs. old, by year 8% 12% 16% 19% 21% 26% 0%

17 Adapting the Process - Well Child Visits AAP Bright Futures Guidelines Planning for success within your practice Identify roles within the practice Implementation and sustaining change Tools and tips for integration

18 Bright Futures Periodicity Schedule Oral Health

19 Preventing Dental Caries in Children From Birth Through Age Five

20 Define and Measure Success Define an aim statement Identify measure and targets Established dental home Oral evaluations completed Fluoride varnish applied Fluoride varnish applied without a dental home 4 by 4 (four fluoride varnish before turning 4 years old) Create a measurement plan and data collection Demonstrate impact/reporting

21 MOC Opportunity - AAP

22 Define Practice Infrastructure

23 Define Practice Infrastructure

24 Launching the Challenge within Your Practice Engagement within the practice and leadership support All staff involved Friendly Provider to Provider competition Practice competition within a System Define Roles: Data collection and self-report on the From the First Tooth Website Clinical Champion Cheerleaders

25 Example of MMP Pediatric Office Quality Board

26 From the First Tooth Clinical Champion Support Dr. Dubail and Dr. Stone available via phone, and availability for practice site visits. Dr. Jennifer Dubail, MD, FAAP MMP Portland Pediatrics; (207) Dr. Jeffrey Stone, DO, FAAP Waterville Pediatrics; (207)

27 EHR Integration Considerations Determine where to embed documentation Question considerations: Dental home established Oral Risk Assessment Questions Oral Evaluation Fluoride Varnish applied/declined If given at dental home within the past 12 months (Meaningful Use) Fluoride supplementation Oral Health Plan After Visit Summary

28 EHR Integration Example - Centricity

29 FTFT Data - Pilot

30 Quality Improvement Strategies MaineHealth Accountable Care Organization (MHACO) Practice Support Specialist Quality and Measurement Support Technical support Data reporting and analysis Quarterly Pediatric Quality Dashboard/Transparent Data Began distribution August, 2016 Regional overview Practice and provider level reports available

31 Additional Quality Improvement Strategies Engage Leadership Identify practice champion(s) Embed training and re-training into clinical competences Practice coaching, including observation and workflow support/development

32 MHACO Pediatric Quality Dashboard Fluoride Varnish Trends Trends Most practices are exceeding the 33% Target Total has improved by 12 percentage points since August, 2016 Region 5 re-trained all staff between June- October, % 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Fluoride Varnish Applied (12-48 months) Region 1 Region 2 Region 3 Region 4 Region 5 TOTAL

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34 Data - Healthy Smiles 2020 Challenge Measurement Parameters Patient Panel: Number of children 6-48 months and have teeth Measure: Percent of patients ages 6 through 48 months, with teeth, seen in the measurement period with at least one documented fluoride varnish in the measurement period applied in the office or noted in EHR/other record keeping system - as completed outside of the medical home Numerator: Patients in the denominator with at least one fluoride varnish ages 6 through 48 months in the measurement period Denominator: Patients ages 6 through 48 months at the beginning of the measurement period, with teeth, with a visit to their PCP office within the measurement period. Source: Electronic Health Record or other record keeping system Annual Metric Challenge Goals: Metric Calendar Year baseline End of 2018 End of 2019 End of 2020 Percent of any office visit in target age group in which children receive an fluoride varnish, OR noted in EHR/other record as completed outside of the medical home. 30% 40% 50% 60%

35 Data - Healthy Smiles 2020 Challenge Reporting Baseline: 1/1/2017 through 12/31/ submit during registration process Bi-annual and annual roll up data submissions Data Date Frames Submission Date 1/1 6/29 7/31 Annual Roll Up (1/1 12/31) 2/15 Data Submission: (Self Report) A. Total Patients in Denominator B. Patients in Denominator by age category Total # children 6-12 months Total # children months Total # children months Total # children months C. Patients in Numerator by age category Children 6-12 months Children months Children months Children months

36 Recognition Program Travel to fromthefirsttooth.org/challenge to learn more and register!

37 Resources for your Practice From the First Tooth staff will offer technical assistance and quality improvement services to assist your practice in increasing the number of children receiving preventative dental care as part of primary care. Additional Resources: Clinical Champion assistance In person and virtual training for practice staff Quality Improvement support Patient education materials and practice resources

38 Maine Virtual Early Childhood Caries Prevention Training Early childhood caries prevention focused training on increasing children s access to preventive oral health services. Objectives of the training include: Review the prevalence, etiology and consequences of early childhood caries (ECC) How to perform an appropriate oral examination on small children How to perform a Caries Risk Assessment Review the effects, sources, and benefits of fluoride varnish How to apply fluoride varnish Advise families on strategies to prevent caries After the participant reviews the instructional training and passes the required learning questions, they will receive 1 CME credit. The virtual training is now live! Travel to to access the training.

39 Smiles for Life Module 6

40 Patient Education Materials

41 Resources for Your Practice

42 Quality Improvement Quality improvement is an effective way to improve patient care. In the primary care setting, there are multiple opportunities to develop, test and optimize processes. Quality improvement should be a continual and integral process. Four general areas for consideration: Defining an Aim Statement Identify Measures and Targets Creating a Measurement Plan/Data Collection Demonstrating Impact/Reporting

43 MOC Opportunity through AAP No Cost for AAP Members; $199 for non members 3 data cycles; Enter data on 20 charts a cycle Collect 14 data points around oral health to enter into EQIPP Analyze Data and Identify Gaps Provides QI Resources

44 Ready, Set, Go Fluoride Varnish!! You can DO this we are here to help and support your practice! Next steps: Identify practice roles and support Register your practice for the Challenge Upload your practice 2017 baseline data Contact us when you need help! (207)

45 Partnership for Children s Oral Health Becca Matusovich, Executive Director Quality Counts Webinar - Jan 31, 2018

46 Partnership for Children s Oral Health A network of Maine organizations and individuals united by a shared mission: To eradicate dental disease in Maine children Goal: Catalyze collaborative action and innovation Initial multi-year funding committed by the Sadie and Harry Davis Foundation, additional investments will come from a range of sources

47 Current status of oral health among Maine children: improving, but more work remains Great progress has been made through From the First Tooth and other efforts, and more is still needed to ensure that all children have the tools for good oral health. The majority of children with MaineCare are not accessing preventive dental services regularly 4 out of 10 Maine children have cavities by 3 rd grade About 1/4 of Maine 3 rd graders have no sealants on any of their permanent molars Sources:

48 What will it take to ensure that all children can have the good oral health they deserve? Disease management methods Data tracking & trends over time Culture that promotes oral health Policies that impact oral health Navigation support roles Community Outreach & education Schoolbased Oral Health Programs From the First Tooth (& BTFT) Dental Homes

49 Initial work: 4 Action Teams forming in 2018 Partnership Council coordinates and provides collaborative leadership across the network

50 Interested in getting involved? Contact: Becca Matusovich, Executive Director

51 Questions and Thank You! Contact Information: From The First Tooth - Maine Laura Robbins, CHES, Director, From the First Tooth and Before the First Tooth; lhrobbins@mainehealth.org Susan Cote, RDH, MS, Program Manager, From The First Tooth; cotes4@mainehealth.org Wendie Lagasse, MCHES; Wendie.Lagasse@MaineGeneral.org FTFT Central Maine Region Kellie Stanhope, RDH; kstanhope@emhs.org FTFT Northern Eastern Region Kayla Cole, Quality Counts, Program Director; kcole@mainequalitycounts.org Eiren Menhennitt, Pediatric Practice Support Specialist; emenhennit@mmc.org Dr. Jennifer Dubail, MD, FAAP, From the First Tooth Clinical Champion; DUBAIJ2@mmc.org Dr. Jeffrey Stone, DO, FAAP, From the First Tooth Clinical Champion; JStone@watervillepediatrics.com

52 Acknowledgements

53 Discussion Q&A 53

54 Please join us for future QC Webinars: February 6, 2018 Alternative Treatments to Pain Speaker: Elisabeth Fowlie Mock February 8, 2018 MAAP Collaborative ADHD Learning in Maine (CALM) ADHD and Clinical Topics Speaker: Carol Hubbard, MD March 8, 2018 Collaborative and Proactive Solutions for Children with Challenging Behavior: Lives in the Balance Speaker: Ross Greene, MD March 13, 2018 Snuggle ME Guidelines - What's New? Speaker: Kelly Bowden 54

55 Contact Information Amy Belisle, MD, Director of Child Health Quality Improvement, Maine Quality Counts, , x1002 Kayla Cole, Project Manager, QC for Kids, x1027 Jackie Tiner, QC for Kids Administrative Coordinator, x