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

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

  • 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

  • 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 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

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


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?

  • 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?

  • 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

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


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

  • 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

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


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

  • 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

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

  • 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

  • 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

  • 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

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

  • What may be your concerns

    about ITRs?

    • Management of patient

    • Coding issues (2940)

    • No anesthesia?

    • Substandard care?


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…

  • 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?


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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