Using Information Technology and Community-based Research to Improve the Dental Health Care System Kathryn A. Atchison, DDS, MPH Professor, Division of Public Health and Community Dentistry UCLA School of Dentistry

Introduction

Crossing the Quality Chasm: A New Health System for the 21st Century, Committee on Quality Health Care in America, Institute of Medicine; National Academy Press, 2001.

Definition of Quality: The degree to which health care services for individual and populations increase the likelihood of desired outcomes and are consistent with professional knowledge. Crossing the Quality Chasm: A New Health System for the 21st Century, Committee on Quality Health Care in America, Institute of Medicine; National Academy Press, 2001.

Underlying Reasons for Inadequate Quality of Care growing complexity of science and technology increase in chronic conditions poorly organized care delivery system (that often results in many underserved individuals) constraints on our use of information technology

If we want safer, higher-quality care, we will need to have redesigned systems of care, including the use of information technology to support clinical and administrative processes. Crossing the Quality Chasm: A New Health System for the 21st Century, Committee on Quality Health Care in America, Institute of Medicine; National Academy Press, 2001.

6 Aims for the 21 st Century Health Care System Safe Effective Patient-centered Timely Efficient Equitable

Woven in to their recommendations to achieve these goals are specific suggestions on increased use of Information Technology.

Does Dentistry fit with these objectives? Emphasis on need for better information to manage chronic diseases Chronic disease management: care must be ongoing, collaborative and multidisciplinary to be effective Communication between providers is imperative for high quality care Personal health information must accompany patients as they transition from home to various health professions' offices

Purpose: Discuss uses of Information Technology that could improve community health through: Quality Assurance Case reports Program evaluation Clinical decision-making Outcomes research Epidemiological research Clinical Trials Stronger Evidence base!!

Community-based Research Setting : King-Drew Medical Center Purpose : to better understand patient preferences for surgical or non-surgical treatment for mandibular fracture. Fracture treatment cost : Non-surgical - $2000; Surgical - $20,000 Complications : course of antibiotics ($100) to retreatment ($20,000) permanent disfigurement of keloid affected scar (priceless). Sample : Hispanics and African American disenfranchised individuals. Really tiny use acknowledgement for grant to NIDCR #1RO1DE13839.

Safe : Avoiding injury to patients from care that is intended to help them. 6 Aims for the 21 st Century Health Care System

Safe : Medical history and treatment information is available to all treating providers. Flashing alert on electronic record that patient is allergic to codeine. Chart is readable to all providers from emergency room to OR to outpatient clinic. Doctor can contact pharmacy to alert them patient needs non-formulary drug or liquid version of antibiotics and pain pills. 6 Aims for the 21 st Century Health Care System

Safe : Standards of quality are consistent across all days and times of days. Better schedule OR time so patient with fracture is not waiting for two days. 6 Aims for the 21 st Century Health Care System

Safe : Patients and caregivers are informed about their condition and treatment. Of 33 patients in focus groups: l 20 recalled informed consent l 5 NO informed consent l 8 silent 6 Aims for the 21 st Century Health Care System

Effective : Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit. Patient information is portable so patient information is available to all treating members of the health care team. Anticipation of needs: recall systems anticipate the patient's need for a return visit. Post-operative return to clinic for follow-up month recall. Catching patients who FAILED to return for wire removal. 6 Aims for the 21 st Century Health Care System

Patient-centered : Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide clinical decisions. Care must be based on a continuous healing relationship where the patient can receive care when he needs it and in many forms, including electronic health education, communications with the health care provider, and laboratory results. 6 Aims for the 21 st Century Health Care System

Patient-centered : (continued) Coordination and integration of care Information, education and communication Physical and emotional support Culturally competent 6 Aims for the 21 st Century Health Care System

Timely : Reducing waits and sometimes harmful delays, both for those who receive and give care. Care is based on a 'continuous healing relationship' where patient can receive care when they need it and in many forms 6 Aims for the 21 st Century Health Care System

Timely : (continued) OR / clinic time of lab results or consults Communication between providers Communication between providers and patients 6 Aims for the 21 st Century Health Care System

Efficient : Avoiding waste of equipment, supplies, ideas, and energy. Inventory management Confirming appointments Communication is efficient both between caregivers and between patients and caregivers 6 Aims for the 21 st Century Health Care System

Equitable : Providing care that does not vary in quality because of personal characteristics, such as gender, ethnicity, geographic location, and socioeconomic status. Tracking patient care provided - Ryan White Outcomes research Epidemiological research 6 Aims for the 21 st Century Health Care System

IOM recommendations are appropriate and timely as the profession is moving to electronic patient records. In keeping with overall guidelines, the profession, with this conference as a steppingstone, should build on these guides to apply them to dentistry and establish means for IT to improve the communitys oral health. Conclusion: