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
PurposeDiscuss 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
SafeMedical 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
SafeStandards of quality are consistent across
all days and times of days.
6 Aims for the 21st Century Health Care System

• Better schedule OR time so patient with fracture
  is not waiting for two days.

15
SafePatients and caregivers are informed about
their condition and treatment.
6 Aims for the 21st Century Health Care System

• Of 33 patients in focus groups
• 20 recalled informed consent
• 5 NO informed consent
• 8 silent

16
EffectiveProviding 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-centeredProviding care that is
respectful of and responsive to individual
patient preferences, needs, and values and
ensuring that patient values guide clinical
decisions.
6 Aims for the 21st Century Health Care System

• 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.

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
TimelyReducing waits and sometimes harmful
delays, both for those who receive and give care.
6 Aims for the 21st Century Health Care System

• Care is based on a 'continuous healing
  relationship' where patient can receive care when
  they need it and in many forms

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
EfficientAvoiding waste of equipment,
supplies, ideas, and energy.
6 Aims for the 21st Century Health Care System

• Inventory management
• Confirming appointments
• Communication is efficient both between
  caregivers and between patients and caregivers

22
EquitableProviding care that does not vary in
quality because of personal characteristics, such
as gender, ethnicity, geographic location, and
socioeconomic status.
6 Aims for the 21st Century Health Care System

• Tracking patient care provided - Ryan White
• Outcomes research
• Epidemiological research

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 communitys oral health.