ABOUT THE DENTAQUEST INSTITUTE
The DentaQuest Institute is a national not for profit organization focused on quality in dental care. Our mission is to support and promote oral health through efficient and effective care and prevention. We emphasize a hands-on approach, working directly with oral health care providers across the country to make improvements to clinical care protocols, practice management processes, and use of technology – all with an emphasis on preventing and managing oral disease. Our partnerships throughout the United States are demonstrating that it is possible to improve oral health care, and to do so with dramatic results.
Here are a few of our quality improvement and technical assistance programs:
Clinical Quality Improvement
Early Childhood Caries
Dental Sealant
Dental Disease Management
Safety Net Solutions Practice Management Technical Assistance
Elimination of Dental Disease
Dental Safety Net Technical Assistance
Safety Net Solutions Practice ManagementSafety Net Dental Learning Center
Learn more at www.dentaquestinstitute.org
Congratulations, Dr. Mark Doherty
Technical Assistance for CHCs Starting Dental Programs
Early Childhood Caries Quality Improvement Project Enters Phase II
With a Focused Effort, Dental Sealants On the Rise
Elimination of Dental Disease Pilot Begins
DentaQuest Email Addresses Change:
We have changed the format of our email addresses to firstname.lastname@DentaQuestInstitute.org. Please adjust your email directories. We’d hate to miss hearing from you.
Congratulations, Dr. Mark Doherty
Safety Net Solutions founder and DentaQuest Institute Executive Director Mark Doherty, DMD, MPH, CCHP was recognized as Best Practice Management Consultant in Dr.Bicuspid’s 2011 Dental Excellence Awards. A passionate advocate for oral health, Dr. Doherty has a strong background in public health dentistry. Under his direction, the DentaQuest Institute’s Safety Net Solutions program has helped strengthen many dental clinics in communities across the country. This is a well-deserved recognition of Mark’s work and the DentaQuest Institute’s leadership in strengthening the dental safety net and innovating improvements to the oral health care delivery system.
Dr. Jay Anderson, Director of Practice Improvement, is pleased to introduce Cindy Hannon, MSW, who has joined the DentaQuest Institute as Quality Improvement Manager. Cindy will be involved with the quality improvement projects of the DentaQuest Institute, including the expansion of the Early Childhood Caries Initiative to a collaborative of nine hospital and health center sites across the United States, the continuation of the Dental Sealant Initiative which is currently under way in five community health center dental programs in Florida and Massachusetts, and the launch of a new quality improvement initiative in 2011. Read more about these initiatives in this newsletter.
Over the past decade, Cindy has been developing and managing quality improvement, health promotion, and prevention programs targeted at children and adolescents in two large metropolitan areas, Boston and Los Angeles. For the University of Massachusetts, Boston, Cindy was co-creator and program manager of A+, a health promotion quality improvement toolkit for YMCA of the USA. Prior to that, Cindy was managing director of the UCLA/RAND Center for Adolescent Health Promotion Prevention Research Center, and managing director and senior project manager for the Harvard Prevention Research Center on Nutrition and Physical Activity’s pediatric overweight quality improvement initiatives. Cindy is a graduate of Providence College and holds a MSW degree from the Boston College Graduate School of Social Work.
Technical Assistance for CHCs Starting Dental Programs
During 2010, the U.S. government made an $11 billion commitment to community health centers and $15 billion to prevention programs intended to double the capacity of community health centers (CHCs) from caring for 20 million individuals a year to 40 million. By 2015, with new capacity, CHCs will serve 1 out of 3 uninsured individuals. And with health care reform, for the first time, nearly every child in the U.S. will have access to affordable coverage for dental care.
“Many FQHC senior administrators and board members are eager to meet the federal challenge and are looking at how they can expand their scope of services to include dental, but are unsure of how to proceed,” observes Dr. Mark Doherty. In response, the DentaQuest Institute has developed a specialized version of its Safety Net Solutions technical assistance consulting to specifically target the issues and challenges of new FQHC dental start-ups. “We want to help CHCs create and launch dental programs that are positioned for success—on operational and care delivery measures,” says Dr. Doherty. “From planning to implementation, the goal of our Safety Net Solutions technical assistance is to ensure that the CHC dental program is on track to meet financial and productivity goals.”
CHCs beginning this process can start the conversation today by calling Dori Bingham, Safety Net Solutions, DentaQuest Institute at 508.329.2280. Visit www.dentaquestinstitute.org/safetynetsolutions.
Early Childhood Caries Quality Improvement Project Enters Phase II
As a last resort care solution, hospital-based dental clinics care for a disproportionate number of very young, low-income, and uninsured children suffering from Early Childhood Caries (ECC). The traditional way of treating these cases has been surgery in the operating room (OR). Children typically wait for months for an OR opening and as they wait, the pain continues and the disease progresses. Even after surgery, cavity recurrence rates are typically an unacceptable 23%-57% within 6 to 24 months.
Dr. Manwai Ng, Dentist-in-Chief at Children’s Hospital Boston and the DentaQuest Institute Quality Improvement Team questions whether effective long-term ECC management might not call for a paradigm shift from a surgical model of care to a chronic disease model, which includes surgical care when it is needed.
The DentaQuest Institute designed and launched a quality improvement demonstration pilot in 2008 to test whether ECC can be arrested and managed using a chronic disease model. Our goals were to reduce the percent of patients with new cavitation by 33%, reduce the percent of patients who have experienced OR treatment by 20%, and reduce by 50% the percent of patients complaining of pain on their most recent visit.
Over an 18-month period, the DentaQuest Institute and the dental clinics at Children’s Hospital Boston and St. Joseph Hospital for Specialty Care (Providence, RI) used an evidence-based, disease management approach that emphasizes caregiver education and patient follow-up. Phase I project analysis revealed measurable improvements (see chart). Researchers also found clinicians and staff very willing to support this type of systems change when it makes sense conceptually. Equally revealing, parents were very receptive to prevention and self-management goals but needed ongoing reinforcement and support.
In December, with Dr. Ng as the research leader, the DentaQuest Institute launched Phase II of the ECC Quality Improvement Collaborative. This phase tests the disease management protocols in a variety of settings, including community health centers. The goal is to arrest and manage the progression of the disease so it does not require surgical intervention. Phase II clinical sites include Children’s Hospital Boston (Boston, MA), Holyoke Health Center (Holyoke, MA), St. Joseph’s Hospital (Providence, RI), Nationwide Children’s Hospital (Columbus, OH), University Pediatric Dentistry (Buffalo, NY), Collier Health Services, University of Florida Pediatrics, (Naples, FL), Native American Health Center (San Francisco, CA), and Neighborcare Health Centers (Seattle, WA).
With a Focused Effort, Dental Sealants On the Rise
The U.S. Department of Health and Human Services’ Healthy People 2010 framework set a goal of increasing the proportion of children who have received dental sealants on their molar teeth to 50%. As the chart shows, only a handful of states have reached this goal as of 2009.
At the start of 2010, the DentaQuest Institute engaged five community health center dental programs to test a quality improvement protocol to increase the number of children who are getting sealants if they need them. The project’s target is a 50 percent improvement. “This is not simply a matter of applying sealants,” explains Dr. Jay Anderson, Director of Quality Improvement for the Institute. “Our protocol combines outreach, education, application of sealants, and analysis of structural issues that advance or impede the delivery of care, as well as follow-up tracking.”
Clinical participants groups are Lynn Community Health Center (MA), Brookside Community Health Center (MA), Fitchburg Community Health Center (MA), Borinquen Community Health Center (FL), and Community Health of South Florida (FL). Early data analysis shows that every site has made progress toward the target. One site successfully provided sealants to 95% of all children who need them.
The American Dental Association (ADA) has stated in 2008 that sealants "are under-used, particularly among those at high risk of experiencing caries; that population includes children in lower-income and certain racial and ethnic groups.” Says Dr. Anderson, "We hope this Quality Improvement Project results in a protocol that is easy to follow in any safety net dental program and that we can also provide empirical documentation to support the ADA’s assertion that placing sealants over existing caries is important because it removes a barrier to providing a proven intervention.”
Elimination of Dental Disease Pilot Begins
Safety net dental programs are often the "emergency room" for urgent care dental problems. Once the cause of the crisis is diagnosed and fixed, the patient is gone – often for good or until the next dental emergency. And that leaves little to no opportunity for the dental care staff to become engaged in disease management, preventive education, and an ongoing treatment plan.
Patient care protocol changes at the DentaQuest Oral Health Center, the model dental office affiliated with the DentaQuest Institute, have shown that the appropriate application of preventive intervention can shift the balance of disease-associated risk factors in favor of protective factors. Their work has shown that this is best done not simply through the treatment of symptoms but through ongoing risk assessments, disease management plans, hygiene instruction, and patient monitoring over time. This is more easily accomplished when the patient has a dental home.
The DentaQuest Institute’s 2011 Quality Improvement Project will work with three safety net dental programs to develop and test protocols to engage safety net patients beyond the immediate urgent care need with risk assessments, education, and ongoing treatment plans. “Our first-year goal for this initiative is to eliminate observable dental disease within one year of treatment planning, and to increase patient’s ability to self-manage his/her environment and hygiene to sustain a disease-free oral environment,” said Dr. Anderson.
Phase one participants include Lynn Community Health Center (MA), Heart of Texas Community Health Center (TX), and Fitchburg Community Health Center (MA).
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