Systems Change Strategies To Address Commercial Tobacco Treatment - - PowerPoint PPT Presentation

Systems Change Strategies To Address Commercial Tobacco Treatment

The 2017 Minnesota Tobacco Control Conference

January 26, 2017

• St. Paul, MN

Progress Of Apple Tree Dental

Efforts Made Possible By A Health Systems Change Grant

Presentation prepared by Dr. Teresa E Johnson, DDS, MS, MPH, DABSCD

There are no other disclosures indicated, nor any conflicts of interest.

1

About Apple Tree Dental

In our 31st Year!

Apple Tree’s mission is to improve the oral health of all people, including those with special access needs who face barriers to care.

• Low-income children and their

families

• Adults with disabilities
• Elders in long-term care
• Urban and rural communities

Six Minnesota Centers

130 Community Sites

• West Central MN = 16.7%
• Metro Area = 13.6%
• Southeastern MN = 13.0%
• South Central MN = 12.8%

2014 MN Adult Smoking Distribution

Southwest MN = 13.8% Northwest MN = 15.5% Central MN = 17.0% Northeast MN = 18.3%

Three-Way Organizational and Staff Partnerships

2 School

Group Home Nursing Facility Assisted Living

1

Center for Dental Health

3

On-Site Hygienist- Dentist Teams

• 1. Center for Dental Health
• Clinic Designed for Special Care
• Care Coordination Center

Cloud-Based Electronic Health Record Apple Tree has entered into Phase II meaningful use with our customized EHR

2

Our Health Systems Change Initiatives

Tobacco Cessation Planning Team

• One representative from each Center for Dental Health
• Five Hygienists, and one Advanced Dental Therapist
• Leadership representatives
• Dr. Michael Helgeson, Karen Engstrom, Brenda Prosa, Mary Larkin,
• Dr. Teresa E. Johnson

Grant Objectives

• Integrate tobacco dependence diagnosis and

patient education and referral processes using our EHR

• Modify our EHR to go beyond only reporting

smoking status

• Implement quality improvement processes to

monitor and improve tobacco cessation efforts

Goals & Means

• Means
• Staff education and encouragement – leadership-driven to achieve

“buy-in”

• Develop an Integration Plan and Standard Operating Procedures

(SOPs)

• Request EHR program changes tailored to our SOPs
• Pilot testing, staff training, and launching our systems change

program

• Community Outreach Survey
• Goals
• Foster a reduction in tobacco utilization among patients
• Improve our ability to assess patients’ tobacco use and their interest

in quitting, provide patient education, & offer referrals

• Staff “buy-in”

Progress Made To Date

• Developed SOPs and staff and patient education materials
• Open Dental v16.2 (EHR) integrated our tobacco assessment and

intervention documentation needs

• Center Reps pilot tested the SOPs & EHR changes; SOP

modifications made

• Staff Education (four-hour training) - May 2016
• Monitoring Staff Compliance of the SOPs (ongoing)
• Tweaked the SOPs & provided additional staff training (Oct.-Nov.

2016)

• Community outreach initiatives (Fall 2016 to present)

3

Apple Tree’s Standard Operating Procedures

Intent Of Our SOPs

• Facilitate ATD staff education
• Achieve consistency among ATD clinical staff
• Serve as a resource/guide
• Clearly explain:
• what ATD dental health professionals will and will not do
• how patients will be screened and what questions to ask them
• how to provide patient education
• when and how to offer patients a tobacco cessation referral
• how data will be recorded in our EHR
• the patient follow-up process

Team Work

is critical for the success of

• ur health

systems change program!

Emphasis On Team Work

• Tobacco Cessation Patient Encounter Flow Chart
• Used by our dental health professionals to:
• master the 5A’s model
• develop our communication and education approach
• learn how to document pertinent tobacco use data in our EHR
• Tobacco Users Guide: Health Effects & Benefits to

Quitting

• An educational tool
• Tobacco Users Guide: Online Resources & Informative

Links

• An educational resource and a referral option for patients

Forms Used For Our SOPs

5 A’s Model for Tobacco Cessation

• All patients age 13 years and older are assessed for

tobacco use at their first visit and all future recall visits.

• Ask patient’s about tobacco use
• Advise patients to quit (patient education)
• Assess patients’ interest in quitting tobacco use now (1-

10 readiness ruler)

• Assist those ready to make a quit attempt now (RR > 8)
• Referral to “Call It Quits” or
• Referral to a MD or
• On-line Resources (to make a quit attempt on their own)
• Arrange for patient follow-up for those patients choosing

to make a quit attempt

Our SOPs Do Not Include

• Questioning of patients about e-cigarettes
• Cessation counseling to patients by our dental

healthcare team

• Prescribing NRT medications

EHR Enhancements

• Duration of tobacco use (approximate start date is entered,

then the years & months are automatically calculated)

• Document the forms/referrals given to tobacco users
• Record the readiness to quit tobacco use today (scale 1-

10)

• Record the referral intervention that tobacco users choose
• Record when tobacco users decline referral interventions
• Assist with patient follow-up at future appointments

4

A closer look at our Forms

Tobacco Cessation Patient Encounter Flow Chart

Multifunctional:

• a script to use in communicating with patients
• directions on how to document tobacco use data into the

EHR

• prompts when to provide educational handouts and or

referrals

Two Versions of the Flow Chart

Tobacco Users Guide: Health Effects & Benefits to Quitting

Tobacco & The Mouth

Tobacco Users Guide: Online Resources & Informative Links

4

Community Partners

Outreach Efforts

• Contact our community partners (where we provide
• n-site dental services)
• Inquire about their tobacco cessation efforts for

residents/clients

• Inform partners about our systems change strategies

to address patients’ commercial tobacco use

• Is there interest in learning more about our patient

education materials?

Community Partners Surveyed By Phone

• 1. Do you allow residents/clients/staff to use tobacco products on site? Y or N
• 2. Do you have designated places for smokers? Y or N
• 3. Where are your designated smoking locations/spaces?
• a. None (no designated smoking area) b. Outdoors
• c. Indoors d. Outdoors and indoors
• 4. Approximately what percentage of your residents use tobacco? ________
• 5. Have you implemented a tobacco cessation program? Y or N
• 6. Do you routinely ask your residents who use tobacco if they are interested in

quitting? Y or N

Preliminary Outreach Data

As of January 11, 2017

Data from 86 of 100 Outreach Facilities

• 1. Do you allow residents/clients/staff to use tobacco products on site? Y = 52% N = 48%
• 2. Do you have designated places for smokers? Y = 66% N = 34%
• 3. Where are your designated smoking locations/spaces? None = 29% Outdoors = 64%

Indoors = ? Outdoors and indoors = 6% (1% not answered)

• 4. Approximately what percentage of your residents use tobacco? 0% = 49% <5% = 11%

5%-<10% = 12% 10%-<25% = 7% 25% = 17% 35% = 1% 50% = 1% ? = 2%

• 5. Have you implemented a tobacco cessation program? Y = 31% N = 69%
• 6. Do you routinely ask your residents who use tobacco if they are interested in quitting?

Y = 23% N = 77%

Face To Face Meetings With Two Community Partners

After asking the first six questions (previous slide,) a ATD Center Representative from the Tobacco Cessation Planning Team takes a few moments to describe Apple Tree Dental’s tobacco cessation efforts and review our custom made patient education form. Then asks:

• 7. How we can support one another in our efforts to reduce tobacco use among
• ur mutual patients/residents?
• 8. Are there any steps we can take to achieve consistency with the messages we

are both giving our mutual patients/residents about tobacco use?

6

Quality Monitoring

EHR Monitoring Data

May 27, 2016 - December 31, 2016

EHR ACTIVITY TOTALS

Number of Patient Assessments Entered 6,362 Number of Tobacco Users 1,584 Percentage of Tobacco Users 25% Total Number of Referrals Made 188 Number of Call It Quits Referrals (% of referrals) 123 (65%) Number of MD Referrals (% of referrals) 27 (14%) Number of Online-Resources Referrals (% of referrals) 38 (20%) Number of Tobacco Cessation Follow-ups Completed 27 Number of Tobacco Cessation Failures Recorded 12 Number of Tobacco Cessation Successes Recorded Note: Data includes anticipated staff recording errors or omissions

Thank You!

www.appletreedental.org