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CariedAway in CO, HI, KS, ME, NH September 2012 Supported by NIMHD and NIDCR

CariedAway in CO, HI, KS, ME, NH September 2012 Supported by NIMHD and NIDCR. Richard Niederman Center for Evidence-Based Dentistry Forsyth Institute, Boston, MA. Disclaimers. This is not “the” truth This is how I see it You need to decide for yourself. Plan. Background ForsythKids

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CariedAway in CO, HI, KS, ME, NH September 2012 Supported by NIMHD and NIDCR

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  1. CariedAwayin CO, HI, KS, ME, NHSeptember 2012Supported by NIMHD and NIDCR Richard Niederman Center for Evidence-Based Dentistry Forsyth Institute, Boston, MA

  2. Disclaimers • This is not “the” truth • This is how I see it • You need to decide for yourself

  3. Plan • Background • ForsythKids • Materials and Methods • Glass ionomer • Diagnosis • CariedAway

  4. Background: US Healthy People Goals 10 year goal 10 year goal 10 year goal

  5. ForsythKids School-Based Comprehensive Caries Prevention

  6. ForsythKids Basic Precepts

  7. Evidence Level *from Niederman et al JADA 2011

  8. Implementation Know How Community Participation + Care + Analysis Informed Consent School Recruitment Examination Billing Disparities Equality EB Comprehensive Prevention Data Analysis Medicaid Enrollment DDS/CHC Recruitment

  9. Know How Process • What are we trying to accomplish? • What changes can we make? • How will we measure improvement? Time

  10. Clinical Method: School-based prevention 2x per year Tooth cleaning + Rx Toothbrush + Rx F Toothpaste + Hygiene instruction School-based Care Fluoride Varnish Glass Ionomer: 1. Pit Fissure Sealants + 2. Seal Caries / IRT / ART / Temporary Filling

  11. e Records evolution: Paper, PC pad, Kindle Fire, Android phone

  12. Patient Chart

  13. 21% Each circle = 1 school N = 6 Schools N/school = ~200 Mean of 6 schools 67% Start 2003 End 2010

  14. Mean Visit 1 = 17.5 % Grade: 6 1 2, 5, 4 K, 3 Mean Visit 2 = 4.5 % Each symbol = average of ~2,000 students

  15. ForsythKidsOutcomes Increase access: >50% children on Medicaid Improve health, reduce: Untreated caries from >65% to <25% Acute infections from >15% to <5% Reduce cost: $58/patient/visit Meet national goals: Exceed Healthy People 2020 before 2010

  16. Glass Ionomer

  17. Composite / Glass Ionomer

  18. Diagnosis

  19. Perceived Diagnosis

  20. Actual Diagnosis

  21. Perceived Diagnosis, Treatment, & Predicted Outcome

  22. Perceived Diagnosis, Treatment, & Actual Outcome

  23. Perceived Diagnosis, Treatment, & Actual Outcome

  24. Evidence-Based Guidelines Sealants Beauchamp et al JADA 2008 Gooch et al JADA 2009 IRT AAPD 2001 Medicaid 2004

  25. CariedAway: Goal: Assessment and improvement of school-based caries prevention programs

  26. Definitions of Quality IOM Safe, Effective Efficient, Timely, Patient Centered, Equitable Industrial Reduce variability Reduce waste

  27. Participating Program Variability*

  28. Quality of Programs IOM + Safe ? Effective -? Efficient, Timely, Patient Centered, Equitable Industrial (and IHI.org) - Reduce variability - Reduce waste

  29. PhasesME, NH, CO, KS • Articulate current protocols • Initiate electronic records – on paper • Determine baseline / subsequent untreated decay • Compare baseline / subsequent untreated decay • Offer change package of any/all • Glass ionomer • KindleFire electronic record • Seal some / seal all • IRT • Determine follow-on untreated decay

  30. CariedAway HawaiiNo school-based health 3. Application Evidence Advantage 2. Acceptance Simplicity Compatibility Trust 1. Awareness Choice A. Stakeholder Government Organization Clinician Patients B. Implementation **Adopt from E. Rogers, 2003

  31. Start with After-School ProgramsCategorization of Individuals *Rogers, 2003

  32. Social Network Analysis Hawaii School Principals

  33. Social Network AnalysisHawaii School Principals

  34. Know How • What are we trying to accomplish? • What changes can we make? • How will we measure improvement? Time

  35. Thank you

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