1. The Future of the Texas Dental Workforce to Improve Access to Care Robert Wood, MPH Biostatistician, Department of Family and Community Medicine and Regional Center for Health Workforce Studies, University of Texas Health Science Center at San Antonio Texas Oral Health Summit: Advocacy, Equity and Access Austin, Texas September 9-10, 2004

2. Robert Wood MPH & Jane E. M. Steffensen MPH, CHES UTHSCSA RCHWS at CHEP - 2002 Austin, Texas September 2004 Workforce Surveillance: The Border Health Workforce Informatics Initiative Texas Oral Health Summit: Advocacy, Equity & Access

3. RCHWS at CHEP - 2002 Address U.S.-Mexico Border Health Workforce issues Address U.S.-Mexico Border Health Workforce issues through research and data development projects through research and data development projects and serve the workforce information needs of Arkansas, and serve the workforce information needs of Arkansas, Louisiana, New Mexico, Oklahoma, and Texas. Louisiana, New Mexico, Oklahoma, and Texas. Mission of RCHWS at CHEP

4. Informatics Health workforce “informatics, defined as the systematic application of information and computer science and technology to health practice, research, and learning”. Premise: “..that health outcomes will be improved and health costs lowered by the provision of accurate and timely individual and aggregated information that supports health decision makers at the consumer, provider, community, and national levels.” Adapted from “A National Agenda for Public Health Informatics: Summarized Recommendations from the 2001 AMIA Spring Congress” WILLIAM A. YASNOFF, MD, PHD, J. MARC OVERHAGE, MD, PHD, BETSY L. HUMPHREYS, MLS, MARTIN LAVENTURE, MPH J Am Med Inform Assoc. 2001;8:535–545.

5. From Data to Knowledge

6. County and/or State or even National boundaries aren’t always barriers to those who seek health care

7. Addressing the Information Needs Information Issues: Dental Health Workforce DemographicsDental Health Workforce Demographics –Age, sex, age, Ethnicity?, FTE in multiple practice sites? Tracking individuals in the workforce across timeTracking individuals in the workforce across time –Retention of ‘legacy’ data in standard format in necessary for true tracking Rational Service areas defined using Multiple Practice site locations?Rational Service areas defined using Multiple Practice site locations? –(real addresses for geo-coding) –Service area definitions less constrained by County or State (or National) boundaries?

8. Addressing the Information Needs Information Issues: Dental Health Workforce DemographicsDental Health Workforce Demographics –Age, sex, age, Ethnicity?, FTEs in multiple practice sites?

9. Percentage of Dentists by Age in Texas, 1999 >60% Dentists <50 yrs. Average Age = 48 yrs.

13. Percentage of Dentists & Population by Race / Ethnicity, USA, 1999 Bureau of Labor Statistics, Bureau of the Census * PI – Pacific Islander ** AI–AN – American Indian – Alaska Native

14. Addressing the Information Needs Needs/Recommendations: Partnerships and ongoing communication with professional associations to collect ethnicity and other health workforce data not always available. Action: Second Border Health Workforce Roundtable in El Paso (July 30, 2003) with Border workforce information stakeholders. Discussed were: Data exchange and data standardization (within and across states). Data exchange and data standardization (within and across states). Adoption of Geo-coding procedures Adoption of Geo-coding procedures

15. Addressing the Information Needs Information Issues: Tracking individuals in the workforce across timeTracking individuals in the workforce across time –Retention of ‘legacy’ data in standard format is necessary for tracking

17. Dentists in 43 Border Counties

18. Addressing the Needs Need: Development of a centralized information system and a comprehensive mechanism for data collection. Also, defining the border in terms of geography, migration, culture, demographics, and rural versus urban areas. Actions: GIS studies are being conducted Dental Workforce migration data between Texas border and non-border regions are available (1995-2000) and will be updated and extended to urban vs. rural areas Dental Workforce migration data between Texas border and non-border regions are available (1995-2000) and will be updated and extended to urban vs. rural areas

19. Addressing the Information Needs Information Issues: Rational Service areas defined using Multiple Practice site locations?Rational Service areas defined using Multiple Practice site locations? –(real addresses for geo-coding) –Service area definitions less constrained by County or State (or National) boundaries?

20. Dental Health Professional Shortage Areas (Dental-HPSAs), Texas 1999 Dental HPSAs: 71 Whole Counties 15 Partial Counties Prepared by: Health Professions Resource Center Office of Policy and Planning Texas Department of Health Data Source: Division of Shortage Designation USDHHS April 20, 1999

26. Addressing the Information Needs Need: Data on FTEs and direct care for all health professionals – including Dentists. Also, better information on practice location addresses, FTE at each location and service range (Medicaid, CHIP). Action: Discussions with the agencies collecting workforce data in Texas and the Border states toward standardization and inclusion of direct care and FTE data in progress. Discussions with the agencies collecting workforce data in Texas and the Border states toward standardization and inclusion of direct care and FTE data in progress. (Texas agencies collect and disseminate more information than is done by some other Border states)

27. Addressing the Information Needs Need: Partnerships and ongoing communication with professional associations to collect ethnicity and other workforce data not available throughout the Border Action: Second Border Health Workforce Roundtable in El Paso (July 30, 2003) with Border workforce information stakeholders. Initiatives discussed: Data exchange and data standardization Data exchange and data standardization Geocoding Geocoding Proposal for cooperative projects Proposal for cooperative projects

28. Health Workforce Informatics Policy Goals Long-term Goals: Long-term Goals: Improving health workforce capacity and quality Strategic Goals: Strategic Goals: Provide reliable, valid and timely information for internal and external decision making Informatics integrated into Major Outcomes : 1. Beginning the development of an Border region-wide decision support system 2. Beginning the development of an automated statistical ‘surveillance’ system for core health workforce data 3. Developing and maintaining a web-based, interactive, user-friendly data system for workforce tracking and assessment

29. What now? Can we help each other? Data sharing: can we actually exchange data? Defining the minimal data set: is small beautiful? Data standards: the impossible dream? Geo-coding: can we get the point? Longitudinal and tracking capability: can we ever remember? ever remember? How to sustain the effort: can we survive aging? What else?