A Clinical Outcome Measure “Tracking our Dental Program’s Treatment Plan Completion rate” Phase 1 Therapy A Clinical Outcome Measure Alexandra L. Chan DDS,MPH Hill Health Corporation Director of Dental Services New Haven, Derby Connecticut Chan HHC

Extensive growth from 1 site to 19 sites over the years A little bit about Hill Health Corporation- opened in 1968. The first CHC and largest in the state of CT Extensive growth from 1 site to 19 sites over the years Multi specialty medical, dental and behavioral health care with focus on “special needs” populations We had over 168,000 visits annually last year We just completed a multi million dollar expansion of our dental programs’ 3 sites with continuous dental residency training partnerships in 2008. Renovations are in progress for our existing main campus. Chan HHC

Q- Why track treatment plan completion rates in your dental program? DESIRED Program Objective Q- Why track treatment plan completion rates in your dental program? A- This gives an overall picture of the quality of the program and how you are doing. The more treatment plans that “go to completion” in a timely manner, the more “new” patients your program can accommodate. Chan HHC

1.Increased access to care This leads to: 1.Increased access to care 2. Staff work efficiently towards a common goal 3. Staff have accountability in terms of the success of the program. 4. Additionally, by tracking clinical quality outcomes, you can monitor the decrease in active dental disease, caries rate (& periodontal disease) Chan HHC

What is the Process or problem we are attempting to improve? How many actual “Phase 1 Cases “ (Preventive services, periodontics, caries control-extractions and restorative) are we actually completing at Hill Health Center Dental? Chan HHC

Treatment Plan Phase 1 Completion rate Tracking HRSA/Office of Performance Review (OPR) recommendations for Dental Programs Stated Performance Measure- What % of patients have we completed? Focus on Comprehensive Care. Completion of Phase I Therapy (Preventive services, Periodontal treatment, caries control-(extractions and restorative) Chan HHC

How will our Intervention lead to an improved process or outcome ? Significant Principals Providers at the Hill Health Corporation Dental program should provide follow up care in a timely manner and complete patients’ Phase 1 treatment plans versus focusing on episodic care. Treatment plan completion rates drop if we have high “no show” rates . For every patient completed we can bring in a new patient- increased access to care. Chan HHC

Another key point is “intention” While we continue to work on improving our software and reporting mechanisms and data sets as a baseline for improvement… Critical to know how many of our patient’s are actually completing Phase 1 Therapy (preventive, restorative extraction, periodontics therapy) in a timely manner. Also, our special needs patients only have a few chances to get it done once and get it done right. Chan HHC

The continuous vision for the program is to give all our patients the best possible dental care with robust and meaningful dental visits. After all, restoring and rehabilitating one’s oral health needs greatly improves an individual’s quality of life on many levels and leads to improved overall health status. Chan HHC

We must ask ourselves what will we be measuring at baseline and after the intervention. We must determine whether our intervention led to an improvement or merely a change? Chan HHC

Date Source Collection/Methodology Procedure- Command for Treatment Plan completion rate (all Dentists- all 3 sites- all ages) 1. Data is extracted from Dentrix electronic dental record- for completed procedure codes D0150 /D0120 (comprehensive exam and Periodic exam) for the period  EXAMPLE – select designated 12 month period. 2. The commands and codes are then given to our data consultant by Dental Director .They are then cross matched with data in our health center “Data Warehouse”. 3. To find out if Phase 1 therapy (definition of Phase 1 therapy=  preventive, restorative/fillings, extractions has been completed - that is.... "what % of these patients who had a comprehensive /or periodic exam during that given time AND  had their dental work/treatment plan completed in that 12 month period.   Chan HHC

Run = Procedure codes for Phase 1 therapy for…. ALL patients that received procedure D0150/D0120 (A Comprehensive and Periodic Exam during our measurement period) And had the following codes treatment planned (Phase 1 therapy) and completed during the measurement period: 1. preventive- codes- D1110 and D1120, D1351, 2. restorative- D2150, D2140, D2160,D2161, D2330,D2331,D2332,D2335,D2391,D2392,D2393 and D2394  3. extractions D7140,D7210,D7250 4 . Determine if these Ph 1 therapy codes were completed for all these patients that received procedure D0150/D0120. They are cross matched for completed procedures (code 102 chart status) and also treatment plan/work in progress (code 105 chart status)- in our data warehouse Chan HHC

Dental treatment plan completion rate outcomes:   1. FY 2007 (July 1, 2006- June 2007) our dept completion rate was 53% (goal set in 2006 was 30%) 2. FY 2008 (July 1 2007-June 30, 2008)  our dept completion rate increased to 63% (goal set in 2007 was 40%) 3. CY January 1- Dec 31, 2007 dept completion rate increased to 67% (goal in 2007 was 40%) 4. CY January 1-Dec 31, 2008 dept completion rate TBD/not available (goal in 2008 is 50%) Chan HHC

FY 2007 Dental Dept Treatment Plan Completion rate= 53%, Program Goal Year 1 =30% Chan HHC

Performance Measure –UDS/ Calender YEAR January 1- December 31, 2007 All site Phase 1 Treatment Plan completion rate-67 % Program Goal Year 1 = 40% Chan HHC

FY 2008 Dental Dept Treatment Plan Completion rate=63 %, Program Goal Year 2 =40% Chan HHC

Finish up patients currently in progress/”treatment plan phase” Short term goal/plan Finish up patients currently in progress/”treatment plan phase” Start taking new patients again and opening books- goal to continuously increase treatment plan completion rate. A waiting list will be created when new patients request an appointment for a routine exam. For every completed “treatment plan patient”, we can take a new patient in. This will help reduce the clinical backlog and improve our “Treatment Plan completion rates/outcomes” which will be tracked quarterly= Increased access to care. Chan HHC

Long Term Goal According to our Oral Health Work Plan objectives for 2008-2013 submitted to the Department of Public Health (CT) and 330 Grantee Selected OH Clinical Outcome Measure Strategy and Anticipated Outcome= Goal in 2006=At least 30 % of our dental patients will have their Treatment Plans completed within a year (Phase 1 Therapy-Preventive, Periodontal and Caries control) per Bureau of Primary Health Care/Office of Performance Review/ Oral Health Collaborative 2006. Our treatment plan completion rate back in 2006 was 53%. Currently in 2007 we exceeded the increased baseline goal of 40%. The Dental Program now has a 67% completion rate for the 2007 Calender/UDS Year. We plan to improve in 10 % increments every year. Chan HHC

include our targeted dates of baseline data collection, Timeline implementation for the project include our targeted dates of baseline data collection, project design, data collection, assessment project completion. -Evaluate your goal over the next 5 years Chan HHC

Outcomes Goal- Continuous Quality Improvement and surpassing previous levels of compliance. Demonstrating that our dental patients are incorporating oral health into their overall health practices Chan HHC

Replication/Sustainability Tracking clinical quality outcomes enhances our focus on continuous quality improvement. With designated performance measures through reliable data collection this allows us to constantly identify opportunities for healthcare improvement and delivery Results-better care and improved clinical outcomes for our patients. Chan HHC

Administrative Effectiveness Future investment in Electronic Medical Record with HL 7 interface w/ Dentrix and have best practice alerts to indicate to medical providers if their medical patient is due for an oral health exam. A focus on interdisciplinary care approach is our goal. “Oral health is integral to overall health”. Chan HHC

We continue in Mr. Cornell Scott’s memory and continue to grow We continue in Mr. Cornell Scott’s memory and continue to grow . We practice with compassion and dignity and know that his leadership ideals and spirit is in everything we do. Chan HHC

Thank You! Questions: achan@hillhealthcenter.com Visit us on the web: www.hillhealthcenter.com Chan HHC