Care ( Project ENGAGE) Amid I. Ismail BDS, MPH, DrPH, MBA Dean and - - PowerPoint PPT Presentation

▶
care project engage
SMART_READER_LITE
LIVE PREVIEW

Care ( Project ENGAGE) Amid I. Ismail BDS, MPH, DrPH, MBA Dean and - - PowerPoint PPT Presentation

Jun 06, 2023 18 likes •373 views

Improving Oral Health through an Integrated Model of Oral Health Care ( Project ENGAGE) Amid I. Ismail BDS, MPH, DrPH, MBA Dean and Laura H. Carnell Professor 215-707-2799 ismailai@temple.edu http://www.temple.edu/dentistry/ 3223 N. Broad

slide-1
SLIDE 1

Improving Oral Health through an Integrated Model of Oral Health Care (Project ENGAGE)

slide-2
SLIDE 2

Amid I. Ismail BDS, MPH, DrPH, MBA Dean and Laura H. Carnell Professor

215-707-2799 ismailai@temple.edu http://www.temple.edu/dentistry/ 3223 N. Broad Street, Philadelphia, Pennsylvania, 19140

2
slide-3
SLIDE 3 LOGO

The dogmas of the quite past are inadequate to the stormy present. The

  • ccasion is piled high with difficulty and we must rise with the occasion.

As our case is new, so we must think anew, and act anew. We must disenthrall ourselves, and then we should save our country. Abraham Lincoln, 1862

3
slide-4
SLIDE 4

Instruments Made by Paul Revere at KSOD

First Dental Chair (US)

  • Dr. Josiah Flagg, 1790
4
slide-5
SLIDE 5 5
slide-6
SLIDE 6 6
slide-7
SLIDE 7 7
slide-8
SLIDE 8 8
slide-9
SLIDE 9

Dental Caries?

Microbiome Dietary sugar and carbohydrates

Tooth structure and saliva

9
slide-10
SLIDE 10

Trends in Dental Caries in the Primary Dentition (dft). United States, from 1970s to 1980s

Mean dft There has been no change since mid 1980s

10

slide-11
SLIDE 11

Mean dfs scores in US Children 2-5 Years of Age

11

Centers for Disease Control and Prevention, 2007

slide-12
SLIDE 12

Untreated Decay in New Zealand, 2009

5 10 15 20 25 30 1 2 3 4 5

Prevalence of Untreated Caries

Prevalence of Untreated Caries

Most Deprived New Zealand Ministry of Health, December 2010

12
slide-13
SLIDE 13

Mean Number of Non-cavitated, Cavitated, and Filled Primary Tooth Surfaces in Children 6-7 Years Old Who were Covered by a Universal Dental Care Program, Nova Scotia, Canada

Ismail AI, Sohn W. JADA 2001;132:295-303.

13
slide-14
SLIDE 14

14

Health

Prenatal Exposures

(stress, fetal growth, nutrition, substance abuse…)

Main Caregivers

(positive parenting practices, stress, employment, child abuse, depression, nutrition…)

Community

family, babysitters, child care, neighbors, pastors (positive and negative role- modeling…)

Peer Group

(reinforce good values, introduce destructive behaviors…)

Housing

(quality and safety, hazards, lead…)

Neighborhood

(safety, violence, play spaces..)

Transportation

(quality and safety, seat belts, car seats…)

Schools

(buildings, violence, quality of instruction…)

Access to Health and Social Services

(medical care, dental care, immunizations, nutrition…)

Policy Decisions

(Medicaid, SCHIP, Head Start, WIC…)

Commercial

(product safety, advertisements…)

Environment

(clean air, water, soil, food availability, power plants, industrial waste…) Yellow- prenatal Silver- People Green - Local Structural Blue - National Structural
slide-15
SLIDE 15
slide-16
SLIDE 16
slide-17
SLIDE 17
  • We pay for procedures, not OUTCOMES
  • We focus on dental care by professional

providers rather than on a system for promoting health

17

slide-18
SLIDE 18 LOGO

The dogmas of the quite past are inadequate to the stormy present. The

  • ccasion is piled high with difficulty and we must rise with the occasion.

As our case is new, so we must think anew, and act anew. We must

disenthrall ourselves, and then we should save our country.

Abraham Lincoln, 1862

18
slide-19
SLIDE 19

The Current Model of Dental Care for Children

What are the
  • utcomes?
Payment per procedure Higher rewards for care under sedation Social and psychosocial determinants are not addressed Current science in caries management is not utilized Care for caregivers is not a priority Children 0-3 years are not a priority

The current MA system for dental care of children pays for procedures without any emphasis on health

  • utcomes and with no

consideration of the social and psychosocial determinants of oral health

slide-20
SLIDE 20

Rationale for Project ENGAGE

slide-21
SLIDE 21

Health Home

slide-22
SLIDE 22
  • Exchanging health information in real-time through the

Project ENGAGE Registry, an innovative online tool designed to store patient data and educational materials.

  • Networking among dentists, physicians, community health

workers, and Managed Care Organizations/Medicaid Funders using the online registry.

  • Guiding the implementation of educational and social

support interventions at the child/family level using motivational and self-efficacy models, And

  • Guiding the implementation of evidence-based

management protocols of existing disease (dental caries) and control of the caries process via coordinated access to dental providers and preventive/educational interventions assisted by novel workforce models (community health workers, public health dental hygienists, and expanded function dental assistants).

slide-23
SLIDE 23
  • Education of the dental team members which includes

dentists, allied dental professionals, and community health workers to prevent caries and arrest early carious lesions .

slide-24
SLIDE 24

Innovation in Temple University’s Project ENGAGE

Registry to aid in creating a HEALTH HOME A dental home that emphasizes prevention Focus on oral health
  • utcomes
A community based team Evidence- based care Protocol to diagnose and manage dental caries Improved Overall Health and Social Wellbeing for each Child
slide-25
SLIDE 25

What Outcomes We Want to Achieve for Children 0-5 Years of Age? Outcomes

Quality of Life

Improve quality of life of children and their families

Oral Health

Lower prevalence of children with dental caries

Dental Access

Higher number of children aged 0-5 years with dental homes

High-caries Children

Decrease the number of children who undergo treatment under IV sedation and general anaesthesia

25
slide-26
SLIDE 26

Final and Process Oral Health Outcomes (similar to NDQA)

Increase in number of children receiving dental care Reduction in restorative care and increased emphasis

  • n prevention

Increase access to dental services Assist patients to establish and maintain a “dental home” Reduce cost of care by reducing the amount of treatment provided under GA/IV sedation

Dental Health

Provide appropriate prevention based on risk status and treatment of carious lesions

slide-27
SLIDE 27
  • Registry
  • Medical and dental record of children with no dental home

and covered by Medical Assistance

  • Dental team
  • Community health workers (CHWs)
  • Public health dental hygienists (PHDH)
  • Dentists
  • Specialists
  • Home and community engagement

(education, barriers, fatalism, literacy, coordination)

  • Clinical care

Project ENGAGE Design

slide-28
SLIDE 28

28

slide-29
SLIDE 29

Project ENGAGE

  • Vaccination record will be

displayed in the Registry for the CHWs to advice and recommend follow-up care

  • Major medical conditions
  • Asthma
  • Diabetes
  • Hypertension (pregnant women)
slide-30
SLIDE 30

Diagnose initial, moderate and extensive decay Prevent caries from developing in sound teeth

ENGAGE

Arrest/re-mineralize initial carious lesions Restore minimal cavities Restore extensive cavities Review and monitor oral health Motivational approaches to promote appropriate access to sugary drinks and

  • ral hygiene practices

Process to Maintain Healthy Teeth in Children

slide-31
SLIDE 31

Project ENGAGE After Care

  • Home dental visits will be offered

to children with high-caries risk or experience

  • A dental hygienist will visit families
  • f children who are at high risk of

developing dental caries

  • Fluoride varnish
  • Dietary and oral hygiene plans
slide-32
SLIDE 32

Savings on treatment of tooth decay, especially of children being treated under GA or IV sedation Savings on cost of repeat dental care provided under GA or IV sedation Income from increased access to dental care by expanding the population served

Sustainability of Project ENGAGE

slide-33
SLIDE 33

FUNNEL SYSTEM of DENTAL CARE for CHILDREN Using a Dental Team A Practice Model under Medicaid

Level I Large patient/population base managed using a team that includes dentists and clinical and community staff Lower cost of care with high return on investment of time. Major contributor to revenues Medium cost and limited return on investment of time Level II Patients in need for simple restorative and surgical care (at a clinic) Level III Hospital-based or surgi-center care Highest cost and highest return on investment of time

33
slide-34
SLIDE 34

OUTCOMES

Sound Teeth Protected (preserved) dental tissues (Arrested or non-restored non-cavitated lesions) Preservative treatment of caviated lesions (Minimal/micro cavity preparations, step-wise caries excavation)

slide-35
SLIDE 35

Health Can Only by Achieved if We Focus on the Final Desired Outcomes in the Design and Operations of a Health System

  • Sound Strategy Starts with having the

Right Goal.

  • Michael Porter