Impacts f State Level Dental Hygienist Scpe f Practice n Oral Health Outcmes in the U.S. Ppulatin Building Trust in Peple and Places C-spnsred by: Prfessinal Standards Authrity Centre fr Trust, Peace and Scial Relatins Cumberland Ldge March 9 and 10, 2017 Jean Mre, DrPH, MSN Directr Center fr Health Wrkfrce Studies Schl f Public Health University at Albany, SUNY jean.mre@health.ny.gv
The Center fr Health Wrkfrce Studies at the University at Albany, SUNY Established in 1996 A center f the University at Albany Schl f Public Health Cmmitted t cllecting and analyzing data t understand wrkfrce dynamics and trends Gal t infrm public plicies, the health and educatin sectrs and the public Brad array f funders in supprt f health wrkfrce research www.chwsny.rg 2
Tday s Presentatin Based n findings frm a federally funded research study n dental hygiene scpe f practice: A Dental Hygiene Prfessinal Practice Index by State, 2014. Rensselaer, NY: Oral Health Wrkfrce Research Center, Center fr Health Wrkfrce Studies, Schl f Public Health, SUNY Albany; March 2016 http://www.ralhealthwrkfrce.rg/wpcntent/uplads/2016/08/dh_prfessinal_practice_index_by_state_2014.pdf Als published in Health Affairs: Expanded Scpes Of Practice Fr Dental Hygienists Assciated With Imprved Oral Health Outcmes Fr Adults. Health Aff (Millwd). 2016 Dec 1;35(12):2207-2215. http://cntent.healthaffairs.rg/cntent/35/12/2207 Research team: Margaret Langelier, Tracey Cntinelli, Bridget Baker, and Jean Mre www.chwsny.rg 3
Dental Hygiene Scpe f Practice in the U.S. Imprving ppulatin ral health requires a cmprehensive ral health team Dental hygienists (DHs) primarily fcus n preventive ral health services DH scpe f practice (SOP) varies cnsiderably by state in the U.S. Des this variatin matter? Research questin: Des a mre expansive SOP fr DHs impact n ral health utcmes in the ppulatin? www.chwsny.rg 4
Measuring Variatin in DH SOP Scpe f practice (SOP) describes the legal practice envirnment fr a health prfessinal, including qualificatins, allwable services, level f supervisin, and settings where services can be prvided The Dental Hygiene Prfessinal Practice Index (DHPPI), a numerical scale that quantifies state-specific DH SOP, was develped in 2001 Higher scres n the DHPPI are generally assciated with a brader set f tasks, mre autnmy (i.e. less direct versight) and greater pprtunity fr direct reimbursement fr dental hygienists State-specific DH SOP was scred using the DHPPI in 2001 and again in 2014 www.chwsny.rg 5
DHPPI Scale: Fur Overarching Cmpnents Fur cmpnents with multiple variables in each The ttal pssible scre in an ideal practice envirnment is 100 Regulatry Envirnment ( max. 10 pts. 4 variables) Levels f Required Supervisin (max. 47 pts. 10 variables) Tasks Permitted (max. 28 pts. 13 variables) Reimbursement (max. 15 pts. 2 variables) The DHPPI scale was factr analyzed and determined t be statistically valid The index measures pssible nt actual practice Scring invlved a thrugh review f statute and regulatin gverning dental hygiene practice in each state www.chwsny.rg 6
Dental Hygiene Prfessinal Practice Index (DHPPI) State Scres 2001 DHPPI scres ranged frm 10 in West Virginia t 97 in Clrad 2014 scres ranged frm 18 in Alabama and Mississippi t 98 in Maine Mean scre n the DHPPI increased frm 43.5 in 2001 t 57.6 in 2014 www.chwsny.rg 7
Des DH SOP Matter? 2014 Analysis Multilevel lgistic mdeling using: 2014 DHPPI scres Behaviral Risk Factr Surveillance System individual level data describing the ral health status f individuals in states Cntrlled fr state and individual level factrs including cmmunity water fluridatin, demgraphic and sciecnmic factrs Finding: Mre expansive SOP fr DHs in states was psitively and significantly assciated (p<0.05) with having n teeth remved due t decay r disease amng individuals in thse states www.chwsny.rg 8
Des the 2001 DHPPI Wrk Over a Decade Later? Existing scale may nt accurately assess current ideal practice fr DHs Histrical scale based n the premise that lwer levels f supervisin wuld increase access t preventive ral health services In sme states the 2001 ideal has been nearly achieved DH fcus shifting t include expanded tasks and irremediable restrative services that require team based care and dental versight r supervisin www.chwsny.rg 9
The 2016 DHPPI DHs nw seen as ral health preventive specialists rather than nly as a dental extender Mre autnmus rles Team based care New technlgies New settings fr care delivery Design prcess fr the new DHPPI included a literature review and fcus grups with dental hygienists Factr analysis again cnfirmed the integrity f the cnstruct As expected, scres were lwer n the new index The variables include new wrkfrce mdels including dental hygiene therapy, use f lasers, and sme basic restrative tasks Currently in the prcess f analyzing the impact f SOP n utcmes using the mst recent BRFSS http://www.ralhealthwrkfrce.rg/wpcntent/uplads/2017/03/ohwrc_dental_hygiene_scpe_f_practice_2016.pdf www.chwsny.rg 10
Changing Scpe f Practice fr Dental Hygienists 2001, 2014, 2016 High scring states in 2014 tended t als be high scring n the new index (eg ME, CO, CA, WA, NM have all been classified as excellent envirnments at each scring) Sme states have been innvatrs in expanding practice pprtunities fr dental hygienists (eg VT nw authrizes dental therapists wh must be dental hygienists) Others have taken an incremental apprach t scpe f practice (eg IA classified as satisfactry at each scring) Lw scring states tend t remain lw scring (eg GA, MS, NC classified as restrictive at each scring) www.chwsny.rg 11
Cnclusin The DHPPI prvides an bjective, statistically valid measure fr the prfessinal practice envirnment fr DHs Research cnfirms the prfessinal practice envirnment f DH is linked t ppulatin ral health utcmes The updated DHPPI reflects the evlving rles fr DHs Health prfessins regulatin must be flexible enugh t supprt innvatin while still prtecting patient safety and ensuring quality f care www.chwsny.rg 12
Thank yu QUESTIONS? www.chwsny.rg 13