Presentation on theme: "State Oral Health Plan and Prevention Agenda Update"— Presentation transcript:
1State Oral Health Plan and Prevention Agenda Update Jayanth Kumar, DDS, MPHDirector, Bureau of Dental HealthNew York State Department of Health
2Framework for Comprehensive State Oral Health Plans What should be done?Setting Optimal Nationaland State Objectives:(data-driven)Data: unmetSurveillanceneeds, serviceand data gapsData: process,What is achieved?outcome, impactKnowledge forWhat could be done?ImplementingevaluationsData: provenDeterminingEvidence-Basedprevention andEffective StrategiesData: diseasePossible StrategiesDecision Makingbest processes(outcome-driven)burden, target(science-driven)populations, andimplementationbarriersData: societal influences,current capacity,environmental analysisWhat can be done?Planning Feasible Strategies(capacity-driven)
3Setting State Objectives Increase awareness of the importance of oral health to overall health and well-being.Reduce the prevalence of tooth decay.Increase acceptance and adoption of effective preventive interventions.Reduce disparities in access to effective preventive and dental treatment services.
4A Framework for Public Health Action: The Health Impact Pyramid Chairside guideCampaignsEvidence-based practiceSchool Dental Sealant ProgramFluoridationInsurance coverageEducation & CounselingClinical interventionsLong lasting protective interventionsChange the context to make individual’s default decisions healthySocioeconomic factorsIncreasing population impactIncreasing individual effort needed
5Prevalence of caries, untreated caries and dental sealant, and New York State 3rd Grade Survey.
6Dental insurance, fluoride tablet use and dental visit, and New York State 3rd Grade Survey
7Figure 9a. Trends in tooth loss Figure 9a. Trends in tooth loss. Percentage of persons (ages 65 and older) who have lost all natural permanent teeth. New York State BRFSS, 1999 to 2010.
10Childhood Caries in NYS: Emergency Department and Ambulatory Surgery Facility Visits 54845683563549725122436129001500Moderator: Jay, is it really that children need to be seen in operating rooms for treatment of cavities. How frequently does this happen?Note: renamed titled of slideChildren (< 6 years) Visiting Emergency Departments (EDs) and Ambulatory Surgery Facilities (ASFs) for Treatment of Early Childhood Caries in New York State, SPARCS , 2010
11Percent with at Least One Dental Visit and One Preventive Dental Visit, NYS Medicaid Program 2011
12Trends in Dental Visit in Children by Income Groups Source: ADA
14Clinical Preventive Services More than half (56%) of children and adolescents did not visit the dentist during the preceding year in 2009, and 86% of children and adolescents did not receive a dental sealant or a topical fluoride application during the preceding year in More than two thirds (69%) of 5–19 year-olds did not have a dental sealant during 2005–2010 (7).
15ChallengesImprovingpublic perceptionutilization of effective preventive measuresInsurance coveragediversity and flexibility of the dental workforce, & uneven distribution of dental professionalsmeasurement and tracking of oral diseases, risk factors, the dental workforce and utilization of dental services.Addressing the high cost of dental education and the debt burden
16GoalsGoal 1: Integrate oral health into systems, policies and programs which improve overall health. Goal 2: Prevent oral diseases and address risk factors through evidence-based interventions. Goal 3: Eliminate oral health disparities and improve access to high quality, comprehensive, continuous oral health services for all New Yorkers. Goal 4: Strengthen systems which improve the oral health of people with special health needs. Goal 5: Increase knowledge sharing statewide to enhance the adoption of best practices, replicate proven efforts, and improve community oral health literacy. Goal 6: Increase capacity, diversity, and flexibility of the workforce to meet the needs of all New Yorkers. Goal 7: Maintain and enhance the existing surveillance system to measure key indicators and for tracking progress.
17StrategiesBring together stakeholders periodically and develop a statewide agenda for actionExplore opportunities to form regional partnershipsStrengthen the oral health surveillance systemEncourage educational and training programs to update competencies and standards
18People with special health needs: Objectives Identify successful reimbursement strategiesIncrease inter-professional collaborationImplement changes in the surveillance system to enable data collectionIdentify Centers of Excellence for providing oral health careAssess the number of dental providers serving people with special health care needsAddress waiting times for appointmentTrain caregiversDevelop research activities that address the oral health issues
19Prevention Agenda Goal #5: Reduce the prevalence of dental caries among NYS children. Objective 5-1: By December 31, 2017, reduce the prevalence of tooth decay among NYS children by at least 10%.Objective 5-2: By December 31, 2017, increase the proportion of NYS children who have protective dental sealants by at least 10%.Objective 5-3: By December 31, 2017, increase the proportion of NYS children who receive regular dental care by at least 10%.Objective 5-4: By December 31, 2017, increase the percentage of NYS population receiving fluoridated water by 10%.Objective 5-5: By December 31, 2017, strengthen systems to improve the oral health of people with special health needs.
20Achieving targets State Oral Health Program Surveillance & EpidemiologyState Oral Health ProgramAchieving targetsPopulation-based ProgramsHealth Systems InterventionsCommunity-Clinical Linkages
22Fluoridation in New York State Prevention Agenda Target 78.5% Population served:12.9 m (71.4%)Fluoridating Systems: 123Moderator (transition to Jay): So there seems to be a lot of options for oral health prevention, what does NYS recommend?New York ‘s fluoridation program began in 1945 with a classic epidemiological study in Newburgh and Kingston. Since then, more than 40 reports have been published covering fluoridation’s effect on health outcomes and cost savings. These reports have been disseminated widely via scientific publications, symposia and webinars.The population receiving fluoridated water has steadily increased. At present, about 12.9 million residents served primarily by 123 water systems receive fluoridated water. However, there are several large geographic areas without fluoridation.
23Fluoridation: Defend and Promote Monitoring the fluoride levelTrainingUpgrading equipment & technical assistanceEvaluation
25Prevalence of Caries by Subgroups Moderator: You are suggesting that overall we are seeing improvements in oral health indicators. Are there groups where we haven’t seen improvements and what might explain this lack of improvement.
26Addressing common risk factors in dental offices The best kick-off question:Do you and your family typically drink bottled water or tap water?
27School policies and programs School dental screeningSchool dental programs
28ECC Learning Collaborative Partnered with DentaQuest Institute for their Phase III ECC Learning CollaborativeEnrolled four teams from WNYDeveloping New York State faculty to replicate the collaborativeGoalsReduce % of patients with new cavitation by 50%Reduce % of patients complaining of pain by 30%Reduce % of patients with referral for operating room treatment and sedation by 50%Ends on February 28, 2015Planning expansion strategies
29HRSA Maternal and Child Health Initiative PERFORMANCE MEASURE 12A) Percent of women who had a dental visit during pregnancy andB) Percent of infants and children, ages 1 to 6 years, who had a preventive dental visit in the last yearLearning CollaborativeIntegration into MCH programsEducation & TrainingReimbursement for primary care providersCollaboration with Perinatal NetworksCommunity linkagePerinatal Care Standards in Medicaid
30Policy and GuidanceReimbursement for smoking cessation counseling (SCC) must meet the following criteria:SCC must be provided face-to-face by either a dentist or by a dental hygienist that is supervised by the dentist.SCC must be billed by either an office-based dental practitioner or by an Article 28 clinic that employs a dentist.Dental practitioners can only provide individual SCC services, which must be greater than three minutes in duration, NO group sessions are allowed.Dental claims for SCC must include the CDT procedure code D1320 (tobacco counseling for the control and prevention of oral disease).
31Health Workforce Shortage Creating incentives to locate practices in shortage areasLoan repaymentPractice supportInnovative workforce solutionsVirtual dental homeTeledentistry
32SUMMARY State Oral Health Programs Achieve the Vision of Healthy People in Healthy Communities Build consensus, develop a common agenda, and mobilize for actionBuild and foster partnershipsCollaborate and promote integrationLeverage resourcesSupport communitiesMeasure progress and review policies and programs
34Salience Promote oral health as integral to overall health Eliminate health disparitiesState Oral Health ProgramSalienceImprove the quality of lifePromote oral health as integral to overall healthPromote optimum oral health for all
35Collecting, Analyzing & Providing Data State Oral Health Program Supporting communitiesEducation & TrainingProgram SupportGrants, Technical Assistance, GuidanceBuilding Partnerships, Coalitions, Networks
36State Oral Health Program Establishing Collaborations Federal FundingCDC, HRSAState Oral Health ProgramLeveraging resourcesState FundsFoundationsEstablishing Collaborations
37People with special health needs Objective 4.a: By 2017, identify successful reimbursement strategies for providers and hospitals that address the additional time and resources needed to treat people with special health needs.Objective 4.b: By 2017, ensure that systems developed to increase interprofessional collaboration and inform consumers about dental care address the challenges faced by people with special health needs.
38Objective 4.c: By 2017, implement changes in the surveillance system to enable data collection on oral health and access to dental care for people with special health needs.Objective 4.d.: By 2017, identify Centers of Excellence for providing oral health care to people with special health needs.Objective 4.e: By 2017, assess the number of dental providers serving people with special health care needs and determine how many are needed to serve people with special health needs.
39Objective 4.e: By 2017, develop and implement strategies to ensure that waiting times for routine appointments are no longer than one month, and dental emergencies are addressed within 24 hours for patients with special health needs.Objective 4.f.: By 2020, ensure that all health care workers employed to assist people with special health care needs are trained in their daily oral health care.Objective 4.g: By 2017, develop research activities that address the oral health issues of people with special health care needs.