Robert Wood MPH & Jane E. M. Steffensen MPH, CHES UTHSCSA

1. The Future of the Texas Dental Workforce to Improve Access to CareRobert Wood, MPHBiostatistician, Department of Family and Community Medicine and Regional Center for Health Workforce Studies, University of Texas Health Science Center at San AntonioTexas Oral Health Summit: Advocacy, Equity and Access Austin, TexasSeptember 9-10, 2004

2. Texas Oral Health Summit: Advocacy, Equity & Access Workforce Surveillance: The Border Health Workforce Informatics Initiative Robert Wood MPH & Jane E. M. Steffensen MPH, CHES UTHSCSA Austin, Texas September 2004 RCHWS at CHEP - 2002

3. Mission of RCHWS at CHEP Address U.S.-Mexico Border Health Workforce issues through research and data development projects and serve the workforce information needs of Arkansas, Louisiana, New Mexico, Oklahoma, and Texas. RCHWS at CHEP - 2002

4. Informatics Health workforce “informatics, defined as the systematic application of information and computer science and technology to health practice, research, and learning”. Premise: “..that health outcomes will be improved and health costs lowered by the provision of accurate and timely individual and aggregated information that supports health decision makers at the consumer, provider, community, and national levels.” Adapted from “A National Agenda for Public Health Informatics: Summarized Recommendations from the 2001 AMIA Spring Congress” WILLIAM A. YASNOFF, MD, PHD, J. MARC OVERHAGE, MD, PHD, BETSY L. HUMPHREYS, MLS, MARTIN LAVENTURE, MPH J Am Med Inform Assoc. 2001;8:535–545.

5. From Data to Knowledge

6. County and/or State or even National boundaries aren’t always barriers to those who seek health care

7. Addressing the Information Needs Information Issues: Dental Health Workforce Demographics Age, sex, age, Ethnicity?, FTE in multiple practice sites? Tracking individuals in the workforce across time Retention of ‘legacy’ data in standard format in necessary for true tracking Rational Service areas defined using Multiple Practice site locations? (real addresses for geo-coding) Service area definitions less constrained by County or State (or National) boundaries?

8. Addressing the Information Needs Information Issues: Dental Health Workforce Demographics Age, sex, age, Ethnicity?, FTEs in multiple practice sites?

9. Percentage of Dentists by Age in Texas, 1999 >60% Dentists <50 yrs. Average Age = 48 yrs.

13. Percentage of Dentists & Population by Race / Ethnicity, USA, 1999 Bureau of Labor Statistics, Bureau of the Census * PI – Pacific Islander ** AI–AN – American Indian – Alaska Native

14. Addressing the Information Needs Needs/Recommendations: Partnerships and ongoing communication with professional associations to collect ethnicity and other health workforce data not always available. • Action: Second Border Health Workforce Roundtable in El Paso (July 30, 2003) with Border workforce information stakeholders. Discussed were: • Data exchange and data standardization (within and across states). • Adoption of Geo-coding procedures

15. Addressing the Information Needs Information Issues: Tracking individuals in the workforce across time Retention of ‘legacy’ data in standard format is necessary for tracking

17. Dentists in 43 Border Counties

18. Addressing the Needs Actions: GIS studies are being conducted Dental Workforce migration data between Texas border and non-border regions are available (1995-2000) and will be updated and extended to urban vs. rural areas Need:Development of a centralized information system and a comprehensive mechanism for data collection. Also, defining the border in terms of geography, migration, culture, demographics, and rural versus urban areas.

19. Addressing the Information Needs Information Issues: Rational Service areas defined using Multiple Practice site locations? (real addresses for geo-coding) Service area definitions less constrained by County or State (or National) boundaries?

20. Dental Health Professional Shortage Areas (Dental-HPSAs), Texas 1999 Dental HPSAs: 71 Whole Counties 15 Partial Counties Prepared by: Health Professions Resource Center Office of Policy and Planning Texas Department of Health Data Source: Division of Shortage Designation USDHHS April 20, 1999

26. Addressing the Information Needs • Action: • Discussions with the agencies collecting workforce data in Texas and the Border states toward standardization and inclusion of direct care and FTE data in progress. • (Texas agencies collect and disseminate more information than is done by some other Border states) Need: Data on FTEs and direct care for all health professionals – including Dentists. Also, better information on practice location addresses, FTE at each location and service range (Medicaid, CHIP).

27. Addressing the Information Needs Need: Partnerships and ongoing communication with professional associations to collect ethnicity and other workforce data not available throughout the Border • Action: Second Border Health Workforce Roundtable in El Paso (July 30, 2003) with Border workforce information stakeholders. Initiatives discussed: • Data exchange and data standardization • Geocoding • Proposal for cooperative projects

28. Health Workforce Informatics Policy Goals Long-term Goals: Improving health workforce capacity and quality Strategic Goals:Provide reliable, valid and timely information for internal and external decision making Informatics integrated into Major Outcomes: 1. Beginning the development of an Border region-wide decision support system 2. Beginning the development of an automated statistical ‘surveillance’ system for core health workforce data 3. Developing and maintaining a web-based, interactive, user-friendly data system for workforce tracking and assessment

29. What now? Can we help each other? Data sharing: can we actually exchange data? Defining the minimal data set: is small beautiful? Data standards: the impossible dream? Geo-coding: can we get the point? Longitudinal and tracking capability: can we ever remember? How to sustain the effort: can we survive aging? What else?