Using Information Technology and Community-based Research to Improve the Dental Health Care System

1. Using Information Technology and Community-based Research to Improve theDental Health Care System Kathryn A. Atchison, DDS, MPHProfessor, Division of Public Health and Community DentistryUCLA School of Dentistry

2. Introduction

3. Crossing the Quality Chasm: A New Health System for the 21st Century, Committee on Quality Health Care in America, Institute of Medicine; National Academy Press, 2001.

4. Definition of Quality: • The degree to which health care services for individual and populations increase the likelihood of desired outcomes and are consistent with professional knowledge. Crossing the Quality Chasm: A New Health System for the 21st Century, Committee on Quality Health Care in America, Institute of Medicine; National Academy Press, 2001.

5. Underlying Reasons for Inadequate Quality of Care • growing complexity of science and technology • increase in chronic conditions • poorly organized care delivery system (that often results in many underserved individuals) • constraints on our use of information technology

6. “If we want safer, higher-quality care, we will need to have redesigned systems of care, including the use of information technology to support clinical and administrative processes.” • Crossing the Quality Chasm: A New Health System for the 21st Century, Committee on Quality Health Care in America, Institute of Medicine; National Academy Press, 2001.

7. 6 Aims for the 21st Century Health Care System • Safe • Effective • Patient-centered • Timely • Efficient • Equitable

8. Woven in to their recommendations to achieve these goals are specific suggestions on increased use of Information Technology.

9. Does Dentistry fit with these objectives? • Emphasis on need for better information to manage chronic diseases • Chronic disease management: care must be ongoing, collaborative and multidisciplinary to be effective • Communication between providers is imperative for high quality care • Personal health information must accompany patients as they transition from home to various health professions' offices

10. Purpose:Discuss uses of Information Technology that could improve community health through: • Quality Assurance • Case reports • Program evaluation • Clinical decision-making • Outcomes research • Epidemiological research • Clinical Trials • Stronger Evidence base!!

11. Community-based Research • Setting: King-Drew Medical Center • Purpose: to better understand patient preferences for surgical or non-surgical treatment for mandibular fracture. • Fracture treatment cost: Non-surgical - $2000; Surgical - $20,000 • Complications: course of antibiotics ($100) to retreatment ($20,000) permanent disfigurement of keloid affected scar (priceless). • Sample: Hispanics and African American disenfranchised individuals. • Really tiny use acknowledgement for grant to NIDCR #1RO1DE13839.

12. Safe:Avoiding injury to patients from care that is intended to help them. 6 Aims for the 21st Century Health Care System

13. Safe:Medical history and treatment information is available to all treating providers. • Flashing alert on electronic record that patient is allergic to codeine. • Chart is readable to all providers from emergency room to OR to outpatient clinic. • Doctor can contact pharmacy to alert them patient needs non-formulary drug or liquid version of antibiotics and pain pills. 6 Aims for the 21st Century Health Care System

14. Safe:Standards of quality are consistent across all days and times of days. • Better schedule OR time so patient with fracture is not waiting for two days. 6 Aims for the 21st Century Health Care System

15. Safe:Patients and caregivers are informed about their condition and treatment. Of 33 patients in focus groups: • 20 recalled informed consent • 5 NO informed consent • 8 silent 6 Aims for the 21st Century Health Care System

16. Effective:Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit. • Patient information is portable so patient information is available to all treating members of the health care team. • Anticipation of needs: recall systems anticipate the patient's need for a return visit. • Post-operative return to clinic for follow-up month recall. • Catching patients who FAILED to return for wire removal. 6 Aims for the 21st Century Health Care System

17. Patient-centered:Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide clinical decisions. • Care must be based on a ‘continuous healing relationship’ where the patient can receive care when he needs it and in many forms, including electronic health education, communications with the health care provider, and laboratory results. 6 Aims for the 21st Century Health Care System

18. Patient-centered:(continued) • Coordination and integration of care • Information, education and communication • Physical and emotional support • Culturally competent 6 Aims for the 21st Century Health Care System

19. Timely:Reducing waits and sometimes harmful delays, both for those who receive and give care. • Care is based on a 'continuous healing relationship' where patient can receive care when they need it and in many forms 6 Aims for the 21st Century Health Care System

20. Timely:(continued) • OR / clinic time • Email of lab results or consults • Communication between providers • Communication between providers and patients 6 Aims for the 21st Century Health Care System

21. Efficient:Avoiding waste of equipment, supplies, ideas, and energy. • Inventory management • Confirming appointments • Communication is efficient both between caregivers and between patients and caregivers 6 Aims for the 21st Century Health Care System

22. Equitable:Providing care that does not vary in quality because of personal characteristics, such as gender, ethnicity, geographic location, and socioeconomic status. • Tracking patient care provided - Ryan White • Outcomes research • Epidemiological research 6 Aims for the 21st Century Health Care System

23. Conclusion: • IOM recommendations are appropriate and timely as the profession is moving to electronic patient records. • In keeping with overall guidelines, the profession, with this conference as a steppingstone, should build on these guides to apply them to dentistry and establish means for IT to improve the community’s oral health.