by Jay Anderson

1. Oral Health Quality For Safety Net Dental Programs
Jay R .Anderson, DMD,
MHSA
Director Practice Improvement
DentaQuest Institute

3. Defining Quality of Care
• Care: the services rendered by members of the health
professions for the benefit of a patient
• Quality of care: the degree to which health services to
individuals and populations increase the likelihood of
desired health outcomes and are consistent with current
professional knowledge
1. Dorland’s Medical Dictionary
2. Medicare: A Strategy for Quality Assurance. IOM, 1990, p.21

4. Quality Dental Care
• The Institute of Medicine (IOM) outlined six aims for
changing the health care system. Care must be
– safe,
– effective,
– patient-centered,
– timely,
– efficient
– equitable.

5. Determinants of Excellence in Dental
Health Care
• structural adequacy,
• access and availability,
• technical abilities of practitioners,
• practitioner communication skills and attitudes,
• documentation of services provided,

6. Determinants of Excellence in Dental
Health Care
• coordination and follow-up,
• patient commitment,
• adherence to a therapeutic regimen,
• patient satisfaction,
• and clinical outcomes.

7. The Joint Commission on the Accreditation of
Healthcare Organizations
JCAHO provides the following criteria:
• Efficacy: Is the care/procedure useful?
• Appropriateness: Is it right for this patient?
• Accessibility: If right, can this patient get it?
• Acceptability: If right and available, does this patient
want it?
• Effectiveness: Is it carried out well?
• Efficiency: Is it carried out in a cost-effective way?
• Continuity: Did it progress without interruption, with
appropriate follow up, exchange of information and
referral?

8. Continuous Quality Improvement (CQI)
A continuous quality improvement model first used and
promoted by the Hospital Corporation of American is
known as FOCUS PDSA
F Find a process to improve
O Organize an effort to work on improvement
C Clarify current knowledge of the process
U Understand process variation and capability
S Select a strategy for continued improvement

9. Continuous Quality Improvement (CQI)
P Plan the improvement intervention
D Do the intervention
S Study the results of what was done
A Act on these results to improve the intervention

10. Quality Assurance (QA)
• Quality Assurance is another formal set of activities that
measure the kind and degree of excellence of health
care services provided.
• Quality Assurance includes both a measurement phase
(quality assessment) and corrective actions (quality
improvement) to remedy any deficiencies identified
through the quality assessment process.

11. Quality Measurement (QM)
The measurement phase in a quality assurance program,
in which pre-established criteria or standards for
professional performance, with respect to patient,
administrative, and support services, are compared
against the health care actually provided is also a
component of quality care
Dental chart/medical record is used as documentation of
the care provided.

12. Outcomes Measurement
Outcomes measurement is the process of systematically
tracking a patient's clinical treatment and responses to
that treatment using generally accepted oral health
outcomes measures, or quality indicators, such as:
• presence or absence of dental disease,
• improved oral health status,
• exposure to preventive care,
• functional status,
• personal disease management,
• and patient satisfaction.
• Patient Safety

13. UDS Oral Health Measures
Total Patients: 3,438,340
$
$ 371.65 per patient per year

14. Sample Metrics from Erie Family Health
Center in Chicago
Pediatric oral health patients enrolled in program for
at least one year experience no new cavities
100%
80%
60% 60% 60% 60%
40% 48%
56%
20%
0%
FY09 Q1 FY09Q3 FY09Q4
No New Cavities ‐ Albany Park No New Cavities ‐ Humboldt Park
Oral Health Goal

15. Sample Metrics from Erie Family Health Center in Chicago
Oral health patients complete treatment plan within
one year
100%
90% 90% 90%
80%
60%
94% 97% 97% 90%
40% 70%
20%
0%
FY09 Q1 FY09Q3 FY09Q4
Treatment Plan Complete ‐ Albany Park
Treatment Plan Complete ‐ Humboldt
Park
Oral Health Goal

16. Productivity Reporting
Sample Metrics from Erie Family Health Center in Chicago

17. Measure Description Numerator Denominator Measurement DataSource
Cavity Free Percentage of Numerator: Number Denominator: This can be stratified by age group as Your practice
oral of oral health All oral health needed.
health patients from patients seen
patients the denominator in the
that are who are Caries measurement
caries free. year
free

18. Measure Description Numerator Denominator Measurement DataSource
Annual Dental Visit The percentage Numerator: Number Denominator: The measure is reported for each of HEDIS® Measure
of patients who of patients with one All eligible patients the following age stratifications and as – Adapted to
had at least one or more dental visits served by the a combined rate. include additional
dental visit with a dental HRSA funded • 2-3 years age groups
during the practitioner during program. • 4-6 years Note: Visits for
measurement the measurement • 7-10 years many 1 year olds
year. year. • 11-14 years will be counted
• 15-18 years because the
• 19-21 years specification
• >21 years • includes children
>65 years A whose second
patient had a dental visit if a birthday occurs any
submitted claim/encounter contains time during the
any of the codes in Table ADV-A. measurement year.
This measure can be expanded to
include adults

19. Measure Description Numerator Denominator Measurement DataSource
Annual Dental The percentage Numerator: Number Denominator: The measure is reported for each of the HEDIS® Measure –
Visit of of patients with All eligible following age stratifications and Adapted to
patients one or more patients as a combined rate. include
who had dental visits with served by the • 2-3 years additional age
at least a dental HRSA funded • 4-6 years groups
one practitioner program. • 7-10 years Note: Visits
dental during the • 11-14 years for many 1
visit measurement • 15-18 years year olds will
during year. • 19-21 years be counted
the • >21 years because the
measure • >65 years specification
ment A patient had a dental visit if a includes
year. submitted claim/encounter children
contains any of the codes in Table whose second
ADV-A. This measure can be birthday
expanded to include adults occurs any
time during
the
measurement
year.

20. Measure Description Numerator Denominator Measurement DataSource
Documented Percentage of Numerator: Number Denominator: I. Phase 1 Treatment Plan: * HRSA Health
Comprehensive all of patients Number of Plan for Prevention, Disparity
Treatment Plan dental from the patients that maintenance and/or elimination Collaborative
(Comprehensive patients denominator receive a of oral pathology from dental Tested
dental exam with a that have a comprehensi caries or periodontal disease. HAB
includes compreh documented ve oral exam Plan includes: oral cancer OPR
periodontal ensive or treatment plan. (ADA code prevention; prevention ORHP
assessment as periodic 0110) or a education and services;
well as recall periodic emergency treatment;
determination oral recall (ADA diagnostic services and
of presence of exam, code 0120) treatment planning; restorative
decay.] (HDC) for oral exam treatment; basic periodontal
whom therapy (non surgical); basic
the oral surgery that includes
Phase I simple extractions and biopsy;
treatmen non-surgical endodontic
t plan is therapy; and space maintenance
documen and tooth eruption guidance for
ted transitional dentition.

21. Phase 1 Treatment Plan
• Plan for Prevention, maintenance and/or elimination
of oral pathology from dental caries or periodontal
disease. Plan includes: oral cancer prevention;
prevention education and services; emergency
treatment; diagnostic services and treatment
planning; restorative treatment; basic periodontal
therapy (non surgical); basic oral surgery that
includes simple extractions and biopsy; non-surgical
endodontic therapy; and space maintenance and
tooth eruption guidance for transitional dentition.

22. Measure Description Numerator Denominator Measurement DataSource
Completed Percentage of Numerator: Number Denominator: Phase 1 Treatment is completed when: HRSA Health
Compre all dental of patients from Number of Patient has been discharged to Disparity
hensive patients the denominator patients that periodic follow up after all items Collaborative
Treatme for whom with a completed receive a in the phase 1 treatment plan as Tested
nt Plan the Phase Phase 1* comprehensive noted above are completed. HAB
I treatment within oral exam Note: if the patient chooses to OPR
treatment 12 months of (ADA code discontinue Phase 1 therapy, then ORHP
plan is initiation. 0110) or a the treatment would be considered
complete periodic recall complete.
d within a (ADA code
12 month 0120) oral
period. exam within
the
measurement
year

23. Measure Description Numerator Denominator Measurement DataSource
Topical Fluoride percentage of Numerator: number of Denominator: Number of Modified
patients with patients with at least patients with a
at least one one topical fluoride documented dental
topical treatment during the visit during the
fluoride report period report period
treatment
during the
report period

24. Measure Description Numerator Denominator Measurement DataSource
Fluoride Percentage of Numerator: Denominator: Modified from HRSA Oral Health HRSA Health
varnish children Number of Number of Disparity Collaborative to include Disparity
applicati age 12 patients in the children 1-6 age 6 Collaborative
ons to72 denominator years of age Tested
months with a topical with a
with 1 or fluoride varnish documented
more (D1206) dental visit in
fluoride documented the last 12
varnish (within the months
applicatio previous 12
ns months)
document
ed

25. Measure Description Numerator Denominator Measurement DataSource
Dental Sealant The percentage Numerator: Denominator: Notes: Important at eruption time of the Measure used by
of The number of The first molar (5-7) and the second MCHB and
children children between percentage of permanent molar(11-13); CHIP States of
between the ages of 6 and all children and MCHB focus on "3rd Maine,
the ages 21 years who between the graders" while service delivery Kansas, Texas,
of 6 and received at least ages of 6 and grantees collect information Virginia and
21 years a single sealant 21 years who according CDC and age Tennessee
who treatment from a had a dental groupings; consensus needed on with HRSA
received dentist during visit during age groups for stratification. modification
at least a the reporting the reporting to age 21
single period. period. *
sealant
treatment
from a
dentist.

26. Measure Description Numerator Denominator Measurement DataSource
Primary Care Percentage of Numerator: Denominator:
Provider children Children age 12 Children age
Dental age 12 to to 48 months 12 to 48
Counseli 48 with dental/oral months seen
ng: months health by a primary
medical who counseling by a care provider
setting received primary care documented
patient provider (last 12
education documented months)
and (last 12 months)
anticipat
ory
guidance
for oral
health in
the
medical
setting

27. Measure Description Numerator Denominator Measurement DataSource
Oral health Percentage of Numerator: Denominator: patients who had only an evaluation or adapted from
educatio oral Number of oral Number of treatment for a dental emergency HIV/AIDS
n health health patients oral health in the measurement year will be Bureau
Service patients who received patients that excluded. Measure
given by who oral health received a
a dentist received education at clinical oral
or dental oral least once in the evaluation at
hygeinist health measurement least once in
, dental education year. the
assistant at least measurement
and/or once in year.
dental the
case measure
manager ment
year.

28. Measure Description Numerator Denominator Measurement DataSource
Periodontal Percentage of Numerator: Denominator: Exclusions: adapted from
screenin oral Number of oral Number of 1. Patients who had only an HIV/AIDS
g or health health patients oral health evaluation or treatment for a Bureau
examinat patients who had patients that dental emergency in the Measure
ion who had a periodontal received a measurement year.
periodont screening or clinical oral 2. Full denturist patients
al examination at evaluation at (This measure may also be very
screening least once in the least once in useful for DM, and perinatal?)
or measurement the
examinati year measurement
on at least year.
once in
the
measure
ment
year.

29. Slide Credits
• Dr. Lee Francis, CEO Erie Family Health
Center, Chicago, Illinois
• HRSA Oral Health Workgroup

30. Contact Information
• Jay R. Anderson, DMD, MHSA
Director, Practice Improvement DentaQuest Institute
Director, DentaQuest Oral Health Center
jay.anderson@dentaquestinstitute.org
508-329-2406