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Quality Initiatives in Oral Health. A topic you can sink your teeth into!! Suzanne Boulter , MD South Carolina Chapter Meeting July 23, 2011. Bright Futures Recommendations. Oral health risk assessment performed Anticipatory guidance given Fluoride modalities addressed

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quality initiatives in oral health

Quality Initiatives in Oral Health

A topic you can sink your teeth into!!

Suzanne Boulter, MD

South Carolina Chapter Meeting

July 23, 2011

bright futures recommendations
Bright Futures Recommendations
  • Oral health risk assessment performed
  • Anticipatory guidance given
  • Fluoride modalities addressed
  • Referral to dental home make
measures for sc project
Measures for SC Project
  • Was an oral health risk assessment done and documented between 12 and 36 months?
  • Did you refer the patient to a dental home?
  • Did you apply fluoride varnish to a high risk patient between 12 and 36 months of age?
  • Have you documented a discussion about fluoride in the family’s water source?
defining an aim examples in oral health for sc
Defining an Aim: Examples in Oral Health for SC
  • By December 1st 2011, using an oral health risk assessment tool, screen 100% of 12 to 36 month old patients at health supervision visits to identify those at high risk.
  • By December 1st 2011, refer 100% of high risk patients to a dental home with tracking of compliance
more examples
More Examples
  • By December 1st 2011, perform fluoride varnish application on 75% of high risk children as identified by the oral health risk assessment.
  • By December 1st 2011, test and document all well water fluoride levels in households without public water supply
pick a measurement then brainstorm and map process
Pick a Measurement then Brainstorm and Map Process
  • Oral Health Risk Assessment screening done
  • Fluoride varnish applied
  • Referral to dental home
  • Order and track well water fluoride test results
example of mapping process
Example of Mapping Process

MA puts


in room

Patient calls

For appt.



MA rooms


MA gives



about OHRA

Provider visit

with patient

Fluoride varnish

applied if OHRA


Patient leaves




List of



1 was oral health risk assessment done
1) Was Oral Health Risk Assessment Done?
  • Caries Risk Assessment Tools:

- Bright Futures CAT tool

    • AAPD CAT www.aapd.org
    • American Dental Association CAT (not finalized yet) www.ada.org
  • AAP Policy Statements on Oral Health
    • Pediatrics May 2003
    • Pediatrics December, 2008

On line trainings:

  • www.aap.org/oralhealth/smilesforlife
    • Free on line training
    • Endorsed by AAP
    • Six chapters; 3 of importance for pediatricians
    • www.aap.org/oralhealth/pact/index
eqipp module on bright futures
eQIPP Module on Bright Futures

Released August 2010

QI areas recommended

Elicit and Address Patient/Family Concerns and Needs

Perform Risk Assessment and Medical Screening

Perform Developmental Surveillance and Screening

Address maternal depression (birth -36)

Promote Oral Health (birth -36)

eqipp module on bright futures1
eQIPP Module on Bright Futures

Screen for Chlamydia

Implement a strength based approach

Provide Anticipatory Guidance

Utilize a Recall Reminder System

Promote Community Relationships and Resource

Case Studies: Oral Health, Teen Driving, Foster Care

data collection tools some examples
Data Collection Tools – Some Examples
  • Paper chart tools
  • Electronic Medical

Record tools

2 was the patient referred to a dental home
2) Was the Patient Referred to a Dental Home?
  • First dental visit should take place at 1 year; earlier if patient is at high risk
  • Develop list of dentists who will accept patients this age
  • Include office phone numbers and addresses
  • Refer Medicaid patients to state web site or phone line if no access
3 was fluoride varnish applied
3) Was Fluoride Varnish Applied?
  • Offer to patients at high risk
  • Evidence for up to 35% decreased caries
  • Apply and bill per your state Medicaid guidelines
  • Give information sheet about what to do after application
medicaid codes and reimbursement
Medicaid Codes and Reimbursement
  • Fluoride varnish D 1206 $12 - $53
  • Oral evaluation new pt D 0145 $29 - $56
  • Oral evaluation estpt D 0120 $20 - $27
  • Age limit – varies; ages 6 months to 5 years
  • Number of varnish applications reimbursed annually – 2- 4
  • Training required – varies; state specific
  • Delegation of procedure (NP, RN, LPN, CMA) about 2/3 of states allow
identify potential systems solutions
Identify Potential Systems Solutions
  • Train everyone in practice on OHRA
  • Choose coordinator
  • Determine staff roles for screening, counseling, referral and varnish
  • Have supplies in kit
  • Store kit in central location
  • Screen for needed services at every visit
    • Close K, Rozier G, Zeldin L, Gilbert A.Barriers to the adoption and implementation of preventive dental services in primary medical care. Pediatrics 2010;125:509-517
pilot study results
Pilot Study Results
  • Brightening Oral Health Bright Futures Implementation Project 2010
  • Funded by Proctor & Gamble
project details
Project Details
  • Initial QUINN practice pilot done
  • 10 sites chosen to test OHRA tool as part of QI Brightening Oral Health project
  • Pre test survey of practices
  • Post project survey of data completed
practice has a system to document ohra
Practice Has a System to Document OHRA
  • Our practice has a system in place to document oral health risk assessment.
practice has a system and can identify high risk patients
Practice Has a System and Can Identify High Risk Patients
  • My practice has a system to identify high risk patients for an oral health referral
responsible for regularly updating
Responsible for Regularly Updating

Someone responsible for regularly updating practice’s oral health list

brightening oral health study conclusions
Brightening Oral Health Study Conclusions
  • Practice teams employing a system to document oral health risk assessments increased significantly
  • Practice teams utilizing a system to identify high risk patients for an oral health referral increased significantly
  • Bright Futures and AAP Policy Statements recommend:
    • OHRA
    • Anticipatory guidance
    • Assessment of fluoride modalities
    • Referral to dental home

South Carolina data will help determine feasibility of including oral health recommendations in a busy practice setting!!!