Update on the ihs ecc collaborative virtual learning community program vlcp a call to action
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April 25 , 2012 Albuquerque Area Dental Meeting PowerPoint PPT Presentation


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Update on the IHS ECC Collaborative & Virtual Learning Community Program (VLCP ) & A Call to Action. April 25 , 2012 Albuquerque Area Dental Meeting. ECC has different levels of severity, from non- cavitated lesions to multiple surfaces. Stages of ECC. Overall Goal.

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April 25 , 2012 Albuquerque Area Dental Meeting

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Update on the ihs ecc collaborative virtual learning community program vlcp a call to action

Update on the IHS ECC Collaborative&Virtual Learning Community Program (VLCP)& A Call to Action

April 25, 2012

Albuquerque Area Dental Meeting


Stages of ecc

ECC has different levels of severity, from non-cavitated lesions to multiple surfaces

Stages of ECC


Overall goal

Overall Goal

  • Reduce ECC prevalence by 25% in 5 years

  • 2010 BSS in the Albuquerque Area:

    • 5.7 average teeth decayed (2nd highest)

    • 77.7% of 2-5 year-olds had experienced caries (2nd highest)/IHS average was 62.3%


Ecc collaborative objectives

ECC Collaborative Objectives

  • Increase dental access for 0-5 year old AI/AN children 25% in five years.

  • Increase the number of children 0-5 years old who received a fluoride varnish treatment by 25% in five years.


Ecc collaborative objectives1

ECC Collaborative Objectives

  • Increase the number of sealants among children 0-5 years old by 25% in five years.

  • Increase the number ITRs provided for children ages 0-5 by 50% in five years.


Vlcp goal

VLCP Goal

The goal of the Virtual Learning Community is to increase awareness and knowledge about ECC and ECC best practices throughout IHS, Tribal, and Urban (I/T/U) dental programs.

Jicarilla/Dulce is the only Albuquerque Area program that applied for the VLCP (39 sites participating nationwide)


National data

National Data


Vlcp champions highlighted on march vlcp call

VLCP “Champions”:Highlighted on March VLCP call

  • Increased dental access from 47-103% in the first quarter.

  • Increased fluoride varnish by medical providers by 125 applications.

  • Increased ITRs by 295% for 0-2 year olds and 1000% percent for 0-5 year olds


Best practices what works

Best Practices: What Works?

  • Identifying local champions: examples included dental staff, public health nurses, and tribal policy makers.

  • A dedicated case manager.

  • Marketing ITRs to your own dental staff and getting them comfortable with young children.

  • Working routinely with the well-child or WIC clinics.


How is the albuquerque area doing

How is the Albuquerque Area doing?

  • Data reports run from National Dental Data Mart

    • Albuquerque Indian Dental Clinic (AIDC)

    • Albuquerque 1 (Sandia, Zia Pueblo)

    • ACL

    • Mescalero

    • Santa Fe (Santa Fe, Santa Clara, Santo Domingo, Cochiti, San Felipe)

    • Zuni (separate for Zuni and Pine Hill)

    • Southern Colorado (Southern Colorado and Towaoc)

    • Jicarilla (Dulce)

    • Taos

    • Albuquerque 2 (Iselta, Jemez, Alamo)

    • Ysleta


0 5 access to care albuquerque area

0-5 Access to Care, Albuquerque Area

  • 9% increase in 0-5 year-old access since 2009


0 2 year old access

0-2 year-old access

Zuni (116% increase) is the only clinic in the Area that has shown continuous improvement in access. What are they doing that we can all learn from?


0 5 sealants albuquerque area

0-5 Sealants, Albuquerque Area

  • 13% increase in 0-5 year-old sealants since 2009

  • 47% increase in 0-2 year-old sealants since 2009

    (but very small numbers, from 99 to 159)


0 2 year old sealants

0-2 year-old sealants

Only AIDC and Santa Fe have had significant increases in 0-2 year-old sealants (by 21 and 30, respectively). Why?


Glass ionomer sealants

Glass ionomer Sealants

  • Endorsed by the IHS Division of Oral Health

  • Poulsen Study – 50% of sealants in primary 1st molars, and 75% of sealants in primary 2nd molars, were retained after 12 months in young children (see attached study)

  • With a caries rate of 77.7% in the Area, and with almost half of children experiencing caries by age two, shouldn’t we be doing GI sealants on just about every 0-2 year-old we see?


0 5 fluoride patients albuquerque area

0-5 Fluoride Patients, Albuquerque Area

  • 9% increase in 0-5 year-old sealants since 2009

  • 13% increase in 0-2 year-old sealants since 2009


0 2 year olds receiving fluoride varnish

0-2 year-olds receiving fluoride varnish

Everyone except Southern Colorado decreased from 2010-2011. Why?


Of 0 2 year old children accessing dental care in 2011 who did not receive fluoride varnish

% of 0-2 year-old children accessing dental care in 2011 who did not receive fluoride varnish

  • AIDC: 5% (21/409)

  • Alb 1: 50% (14/28)

  • Mescalero: 94% (30/32)

  • Santa Fe: 18% (41/232)

  • Zuni: 7% (29/420)

  • Southern Colorado: 31% (18/59)

  • Jicarilla: 17% (19/112)

  • Taos: 24% (5/21)

  • Alb 2: 56% (69/124)

  • Ysleta: 0% (0/1)

  • Pine Hill: 57% (27/47)

  • We recommend that all 0-2 year-old children accessing care receive fluoride varnish.


Other recommendations on fluoride varnish

Other recommendations on fluoride varnish

  • Provide fluoride varnish to every 0-5 year-old that you see either in a clinic or community setting.

  • Enter fluoride varnish codes in RPMS or the EDR as you complete them; if applied in a community setting, enter those applications as well.

  • Work with your clinic’s site manager to learn how to enter fluoride data from community settings.

  • Allow open access for 0-5 year-olds to apply fluoride varnish by any dental staff.

  • Apply fluoride varnish 3-4 times annually to increase effectiveness.


0 5 itrs albuquerque area

0-5 ITRs, Albuquerque Area

  • 33% increase in 0-5 year-old sealants since 2009

  • 318% increase in 0-2 year-old sealants since 2009 (small numbers, from 11 to 67)


Itrs 0 5 year olds albuquerque area

ITRs, 0-5 year-olds, Albuquerque Area

Mescalero (increase from 0 to 27) and AIDC (increase from 0 to 171) have the biggest improvements. How have they embraced ITRs?


The only thing we have to fear is fear itself fdr

“The only thing we have to fear is fear itself” - FDR

  • What may be your concerns

    about ITRs?

    • Management of patient

    • Coding issues (2940)

    • No anesthesia?

    • Substandard care?


Look at the numbers

Look at the numbers…

  • According to the 2010 BSS of 0-5 year-olds:

    • 57.1% of 2-5 year-olds in the Albuquerque Area had untreated decay

    • This was the 3rd highest in the country, and 14% higher than the national average

  • The average fee of a pediatric dentist is 150% higher. The average cost of OR treatment may be as high as $8,000 per case.

  • Is it better to do nothing or try something?


In addition

In addition…

  • ITRs are endorsed by the American Academy of Pediatric Dentistry (AAPD)

    Reference: AAPD “Policy on Interim Therapeutic Restorations”

  • The long-term success of ITRs is comparable to amalgams

    See attached Mandari article


Questions

Questions?


April 25 2012 albuquerque area dental meeting

Together, we can make a difference!

Thanks for all you are doing to promote oral health in 0-5 year-olds!


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