In Phase III of ECC, the chronic disease management approach to ECC will be expanded to up to 40 sites from across the country in a Breakthrough Series Collaborative beginning August 2013 and extending through February 2015. Building on the work of the Phase II teams, participating Phase III teams will engage in a variety of activities to implement the practices and protocols of disease management for early childhood caries. Using established quality improvement methods, staff, quality improvement experts, and national and regional faculty will provide training and technical assistance to Phase III teams.
Learn more about the ECC Collaborative by viewing a recording of the informational webinar that took place on Monday, June 24 at 3:00pm ET. On this call faculty outlined the collaborative process and answered questions about participating in the collaborative. View the webinar by clicking here. Click here to view the slides of the presentation.
For detailed information on the quality improvement process, timeline, expectations, and requirements for participation in this collaborative, please review the ECC Phase III Recruitment Package.
CLICK HERE to apply for the project.
Early Childhood Caries (ECC), or aggressive tooth decay in very young children, is a chronic, infectious dental disease. And like all dental disease, ECC is almost completely preventable.
When young children don’t get the preventive care they need and deserve early in life, many end up in hospital-based dental clinics where the only solution is to treat the disease surgically in the operating room. Early childhood caries is painful to the child, and if untreated, can impact the proper development of permanent teeth. The results are eating and speech problems, and negatively impacted learning in children.
Hospital-based dental clinics and dental safety net programs such as Federally Qualified Health Centers (FQHC) care for a disproportionate number of low-income and racial and ethnic minority children with early childhood caries. Many of the children end up being treated surgically, with months-long backlogs for expensive operating room care and a high rate of reoccurrence after treatment.
About 28% of preschoolers and 51% of 6 to 11 year olds have cavities.
What We Did - ECC Phase I
In 2008, the DentaQuest Institute, Children’s Hospital Boston, and St. Joseph's Health Services of RI developed a protocol to implement an evidence-based method of managing and preventing early childhood tooth decay in patients seeking treatment at hospital-based dental clinics. Since the fall of 2008, over 450 children were enrolled, treated and followed.
The goal was to reduce the percentage of cavity recurrence in patients treated at the hospital dental clinics by 33%, reduce the percentage of patients who are treated in the operating room by 20%, and reduce the percentage of patients complaining of pain on their most recent visit by 50%. Principal Investigators for Phase I were Dr. Man Wai Ng, Dentist-in-Chief at Boston Children's Hospital, and Dr. Dan Kane, Director of Dentistry at St. Joseph's Health Services of RI.
The ECC Collaborative used an evidence- and risk-based disease management approach adapted from the concept of chronic care management of medical conditions. Participating dental clinics used every point of intervention to engage and educate the child's guardians and then to make sure the child had access to reliable preventive and restorative care by connecting him/her with a dental home for ongoing support and coordination of follow up evaluations. In the process of meeting this objective, investigators also tracked the cost per case.
ECC Phase II
In 2011, the DentaQuest Institute launched Phase II of the ECC Collaborative. Seven FQHC's and hospital based dental clinics began implementing and testing the disease management protocol with patients under 5 years old and presenting with at least one carious lesion. Participating groups include Holyoke Health Center (Holyoke, MA), Boston Children's Hospital (Boston, MA), Nationwide Children's Hospital (Columbus, OH), NeighborCare Health (Seattle, WA), Native American Health Center (San Francisco, CA), St. Joseph's Health Services of RI(Providence, RI), and University Pediatric Dentistry (Buffalo, NY).
Using a modified CAMBRA approach, teams at each site collected data monthly and quarterly about risk, pain due to untreated decay, and new cavitation. Each test site focused on individual system changes, such as hanging posters in exam rooms, engaging and educating front office staff in the importance of scheduling the recall visit within the recommended timeframe (1 month for high risk, 3 months for medium risk, and six months for low risk), and identifying self-management goals with the patient's caregivers.
Through Phase II these sites successfully demonstrated that a disease management and prevention model in oral health care can improve outcomes, reduce disease, and control cost. The data and evidence collected will lead to expanded adoption among oral health providers. Evidence produced by the ECC collaborative has been cited in several national journals and publications, including the Journal for Healthcare for the Poor and Underserved, the Dental Clinics of North America, the Boston Globe and the New York Times.
The Principal Investigator for Phase II was Dr. Man Wai Ng, Dentist-in-Chief at Boston Children's Hospital. Phase II was also guided by an Expert Faculty Group that included; Dr. Man Wai Ng, Boston Children's Hospital; Dr. Richard Scoville, Quality Improvement Advisor; Dr. Marty Lieberman, NeighborCare Health; Dr. Francisco Ramos-Gomez, UCLA; Dr. Jessica Lee, University of North Carolina; and Dr. Peter Maramaldi, Simmons School of Social Work and Harvard School of Dental Medicine.
What We Found
Analysis of Phase I data showed very positive results.
Phase II continued with positive results.
Results reflect random sample of 438 children/families drawn from a total ECC Collaborative population of 3,030.
Where We Are Going
"The importance of having reliable delivery of care for these young and vulnerable patients is critical," explained Dr. Rob Compton, Executive Director of the DentaQuest Institute. "We are building a body of evidence that this protocol is an efficient and effective way of treating and controlling early childhood caries as a chronic disease. We are also putting equal emphasis on education and that is helping to establish essential systems that will help these children avoid recurrence of the disease as they grow into adolescence." To learn more about the Early Childhood Caries Collaborative, contact Palmer Corson, Manager of Programs and Operations at email@example.com.