Pre-Learning Session Survey Highlightsmainequalitycounts.org/wp-content/uploads/2018/01/01-31-18-FTFT... · [email protected] Today’s Speakers . Laura Robbins Laura Robbins works

Mission

Maine Quality Counts is a member driven nonprofit located in Manchester, Maine.

We are working to improve the health of all Maine people (and beyond) by transforming

the way healthcare is delivered.

QC Brings Together the People Who Give, Get and Pay for Healthcare to Address Shared Priorities:

Improve the alignment of heath care systems to transform health for all Maine people • Provide quality improvement

assistance to practices

• Engage consumers in healthcare

• Promote the integration of physical and behavioral health

Priorities

Maine Child Health Improvement Partnership (ME CHIP)

Mission To optimize the health of Maine

children by initiating and supporting measurement-based

efforts to enhance child health care by

fostering public/private partnerships.

Vision

All practices providing health care to children will have the skills,

support, and opportunities

for collaborative learning needed to deliver high quality health care.

ME CHIP is part of the National Improvement Partnership Network (NIPN)

CME

• Disclosure: Today’s speaker does not have any relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity.

• CME will be available for participants who have signed into the live webinar. If there are multiple people at one computer, please type their names and email addresses into the chat box for our attendance records.

• We do not have separate nursing CEUs- but you can get a CME certificate.

• A CME evaluation survey will be sent after the webinar via email.

• Please complete the survey via Survey Monkey within 1 week.

• A CME certificate will be emailed within 1 month of completion of the survey. Please Jackie Tiner ([email protected]) with questions.

Connect With Us

Join our email list mainequalitycounts.org

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Important Webinar Notes

• You are in listen-only mode. Please use the Q&A function to ask questions or make comments.

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• In two days you will receive an email with links to slides and recordings and CME survey.

Jennifer M. Dubail, MD Jennifer M. Dubail, MD is a General Pediatrician in Portland, ME. Dr. Dubail graduated from University of Vermont Larner College of Medicine in 2004. She completed her Pediatric Residency at Maine Medical Center in 2007. She has been in General Pediatric practice for 10 years at Maine Medical Partners Portland Pediatrics. Dr. Dubail is affiliated with Barbara Bush Children’s Hospital at Maine Medical Center.

Today’s Speakers

Eiren Menhennitt Since graduating in 2005 with a BS in Psychology from Springfield College, Eiren has been providing support to local nonprofit and healthcare organizations that focus on improving health in their communities. Over the last 10 years, Eiren has worked with over 50 nonprofit organizations ranging from education, environmental issues to end of life care. Eiren joined the MaineHealth ACO in 2013 as a part of the administrative team, but quickly advanced to her current position within a year. In her role as Pediatric Practice Support Specialist Eiren is responsible for communication and quality improvement support for pediatric and family medicine practices on behalf of the MaineHealth ACO and MaineHealth CHI and CI pediatric related programs. Contact Eiren at [email protected]

Today’s Speakers

Laura Robbins Laura Robbins works at MaineHealth as the Director of both the From the First Tooth and Before the First Tooth statewide initiatives. Laura also works with Emory University with The Diabetes Training and Technical Assistance Center as a National Master Trainer. She previously worked at MaineGeneral Medical Center for 9 years as a Grant Director where she managed multiple federal grants most recently focused on Clinical Community Linkages, working to hardwire provider screening and referrals within primary care, alongside of building capacity within community to foster a referral/linkage from the clinical setting to community evidence based programs. Laura holds her CHES Certification and BS from the University of Maine at Farmington

Today’s Speakers

Healthy Smiles by 2020 – Going the Extra Smile

A Statewide Oral Health Challenge & Recognition Program

Webinar hosted by Maine Quality Counts for Kids & From the First Tooth

Jennifer Dubail, MD, FAAP, Eiren Menhennitt, BS and Laura Robbins, BS, CHES

January 31st, 2018

Learning Objectives

• Explain the From The First Tooth Healthy Smiles 2020 Challenge

• Provide examples for how integrating oral health has impacted a local pediatric practice

• Review data collection strategies and how MaineHealth was able to improve based on data

• Learn about key resources for your practice

From the First Tooth - History

• The From the First Tooth (FTFT) initiative aims to improve the oral health of Maine’s youngest children, ages birth through 48 months by implementing an evidence-based preventive oral health intervention consisting of four components:

• Oral evaluation

• Application of fluoride varnish

• Health education for parents

• Referral to a dentist

• These services are provided by primary care providers typically as part of well child care. This initiative is funded by the Sadie Harry Davis Foundation and administered by MaineHealth.

From the First Tooth

204 of the targeted 260 primary care practices have been trained in person using the Smiles for Life, Module 6: “Caries Risk Assessment, Counseling and Fluoride Varnish” with additional slides on clinic work flow, EMR documentation, and billing

179 of 204 are implementing

100% of the large pediatric practices with

>500 children ages 12 – 47 months are trained

and implementing From The First Tooth

Over 100 primary care practices have integrated the Maine Oral Health Risk Assessment into the Electronic Medical Record

From The First Tooth

What is the Healthy Smiles 2020 Challenge?

A clinically based challenge and recognition program developed by the Maine From the First Tooth Initiative in place to engage with practices and health systems to integrate the USPSTF Recommendation B - Dental Caries in Children from Birth Through Age 5 Years into all family medicine and pediatric practices in order to improve the quality of children’s oral health in Maine.

All practices in Maine and Memorial Hospital are encouraged to join this friendly Challenge and recognition program!

Why is this Important?

8%

12%

16% 19%

21%

26%

0%

10%

20%

30%

2011 2012 2013 2014 2015 2016

MaineCare 4 by 4 Data Percent of children who have received at least 4 fluoride

applications by 4 yrs. old, by year

Adapting the Process - Well Child Visits

• AAP Bright Futures Guidelines

• Planning for success within your practice

• Identify roles within the practice

• Implementation and sustaining change

• Tools and tips for integration

Bright Futures Periodicity Schedule – Oral Health

Preventing Dental Caries in Children From Birth Through Age Five

Define and Measure Success

• Define an aim statement

• Identify measure and targets • Established dental home

• Oral evaluations completed

• Fluoride varnish applied

• Fluoride varnish applied without a dental home

• 4 by 4 (four fluoride varnish before turning 4 years old)

• Create a measurement plan and data collection

• Demonstrate impact/reporting

MOC Opportunity - AAP

Define Practice Infrastructure

Define Practice Infrastructure

Launching the Challenge within Your Practice

• Engagement within the practice and leadership support

• All staff involved

• Friendly Provider to Provider competition

• Practice competition within a System

• Define Roles:

• Data collection and self-report on the From the First Tooth Website

• Clinical Champion

• Cheerleaders

Example of MMP Pediatric Office Quality Board

From the First Tooth Clinical Champion Support

Dr. Jennifer Dubail, MD, FAAP – MMP Portland Pediatrics; [email protected], (207) 662-1442

Dr. Jeffrey Stone, DO, FAAP – Waterville Pediatrics; [email protected], (207) 873-5437

Dr. Dubail and Dr. Stone available via phone, email and availability for practice site visits.

EHR Integration Considerations

• Determine where to embed documentation

• Question considerations: • Dental home established

• Oral Risk Assessment Questions

• Oral Evaluation

• Fluoride Varnish applied/declined

• If given at dental home within

the past 12 months (Meaningful Use)

• Fluoride supplementation

• Oral Health Plan

• After Visit Summary

EHR Integration Example - Centricity

FTFT Data - Pilot

Quality Improvement Strategies

MaineHealth Accountable Care Organization (MHACO)

• Practice Support Specialist

• Quality and Measurement Support

• Technical support

• Data reporting and analysis

• Quarterly Pediatric Quality Dashboard/Transparent Data

• Began distribution August, 2016

• Regional overview

• Practice and provider level reports available

Additional Quality Improvement Strategies

• Engage Leadership

• Identify practice champion(s)

• Embed training and re-training into clinical competences

• Practice coaching, including observation and workflow support/development

MHACO Pediatric Quality Dashboard Fluoride Varnish Trends

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

Fluoride Varnish Applied (12-48 months)

Region 1

Region 2

Region 3

Region 4

Region 5

TOTAL

Trends • Most practices are

exceeding the 33% Target

• Total has improved by 12 percentage points since August, 2016

• Region 5 re-trained all staff between June-October, 2017

Data - Healthy Smiles 2020 Challenge

Measurement Parameters

• Patient Panel: Number of children 6-48 months and have teeth

• Measure: Percent of patients ages 6 through 48 months, with teeth, seen in the measurement period with at least one documented fluoride varnish in the measurement period applied in the office or noted in EHR/other record keeping system - as completed outside of the medical home

• Numerator: Patients in the denominator with at least one fluoride varnish ages 6 through 48 months in the measurement period

• Denominator: Patients ages 6 through 48 months at the beginning of the measurement period, with teeth, with a visit to their PCP office within the measurement period.

• Source: Electronic Health Record or other record keeping system

Annual Metric Challenge Goals:

Metric Calendar Year 2017 - baseline

End of 2018

End of 2019

End of 2020

Percent of any office visit in target age group in which children receive an fluoride varnish, OR noted in EHR/other record as completed outside of the medical home.

30%

40%

50%

60%

Data - Healthy Smiles 2020 Challenge

Reporting

• Baseline: 1/1/2017 through 12/31/2017 - submit during registration process

• Bi-annual and annual roll up data submissions

Data Submission: (Self Report)

Data Date Frames Submission Date

1/1 – 6/29 7/31

Annual Roll Up (1/1– 12/31) 2/15

A. Total Patients in Denominator

B. Patients in Denominator by age category

C. Patients in Numerator by age category

Total # children 6-12 months Children 6-12 months

Total # children 13-24 months Children 13-24 months

Total # children 25-36 months Children 25-36 months

Total # children 37-48 months Children 37-48 months

Recognition Program

Travel to fromthefirsttooth.org/challenge to learn more and register!

Resources for your Practice

From the First Tooth staff will offer technical assistance and quality improvement services to assist your practice in increasing the number of children receiving preventative dental care as part of primary care.

Additional Resources:

Clinical Champion assistance

In person and virtual training for practice staff

Quality Improvement support

Patient education materials and practice resources

Maine Virtual Early Childhood Caries Prevention Training

Early childhood caries prevention focused training on increasing children’s access to preventive oral health services. Objectives of the training include:

• Review the prevalence, etiology and consequences of early childhood caries (ECC)

• How to perform an appropriate oral examination on small children

• How to perform a Caries Risk Assessment • Review the effects, sources, and benefits of

fluoride varnish • How to apply fluoride varnish • Advise families on strategies to prevent caries

After the participant reviews the instructional training and passes the required learning questions, they will receive 1 CME credit.

The virtual training is now live! Travel to http://www.fromthefirsttooth.org/maine/ to access the training.

Smiles for Life – Module 6

www.smilesforlifeoralhealth.org/

Patient Education Materials

http://www.fromthefirsttooth.org/order-materials/

Resources for Your Practice

Quality Improvement

Quality improvement is an effective way to improve patient care. In the primary care setting, there are multiple opportunities to develop, test and optimize processes. Quality improvement should be a continual and integral process.

Four general areas for consideration:

Defining an Aim Statement

Identify Measures and Targets

Creating a Measurement Plan/Data Collection

Demonstrating Impact/Reporting

MOC Opportunity through AAP

• No Cost for AAP Members; $199 for non members • 3 data cycles; Enter data on 20 charts a cycle • Collect 14 data points around oral health to enter into EQIPP • Analyze Data and Identify Gaps • Provides QI Resources

Ready, Set, Go – Fluoride Varnish!!

You can DO this – we are here to help and support your practice!

Next steps:

Identify practice roles and support

Register your practice for the Challenge

Upload your practice 2017 baseline data

Contact us when you need help! [email protected]

(207) 662-6296

Partnership for Children’s Oral Health Becca Matusovich, Executive Director

Quality Counts Webinar - Jan 31, 2018

Partnership for Children’s Oral Health

A network of Maine organizations and individuals united by a shared mission:

To eradicate dental disease in Maine children

Goal: Catalyze collaborative action and innovation

Initial multi-year funding committed by the Sadie and Harry Davis Foundation, additional investments will come from a range of sources

Current status of oral health among Maine children: improving, but more work remains

Great progress has been made through From the First Tooth and other efforts, and more is still needed to ensure that all children have the tools for good oral health. The majority of children with MaineCare are not

accessing preventive dental services regularly 4 out of 10 Maine children have cavities by 3rd

grade

About 1/4 of Maine 3rd graders have no sealants on any of their permanent molars

Sources:

www.medicaid.gov/medicaid/benefits/epsdt/index.html www.cdc.gov/oralhealthdata/

What will it take to ensure that all children can have the good oral health they deserve?

Culture that promotes

oral health

Disease management

methods

Policies that impact oral

health

Navigation support

roles

School-based Oral

Health Programs

Data tracking &

trends over time

From the First Tooth

(& BTFT)

Community Outreach & education

Dental Homes

Initial work: 4 Action Teams forming in 2018 Partnership Council coordinates and provides collaborative leadership across the network

Interested in getting involved?

Contact:

Becca Matusovich, Executive Director

[email protected]

207-805-4243

Contact Information:

From The First Tooth - Maine – Laura Robbins, CHES, Director, From the First Tooth and Before the First Tooth;

[email protected]

– Susan Cote, RDH, MS, Program Manager, From The First Tooth; [email protected]

– Wendie Lagasse, MCHES; [email protected] – FTFT Central Maine Region

– Kellie Stanhope, RDH; [email protected] – FTFT Northern Eastern Region

– Kayla Cole, Quality Counts, Program Director; [email protected]

Eiren Menhennitt, Pediatric Practice Support Specialist; [email protected]

Dr. Jennifer Dubail, MD, FAAP, From the First Tooth Clinical Champion; [email protected]

Dr. Jeffrey Stone, DO, FAAP, From the First Tooth Clinical Champion; [email protected]

https://www.facebook.com/fromthefirsttooth

Questions and Thank You!

https://www.youtube.com/channel/UC9aqDPL6pYIVDsBOCjIHJkQ

www.fromthefirsttooth.org

Acknowledgements

Discussion

Q&A

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Please join us for future QC Webinars:

54

February 6, 2018

Alternative Treatments to Pain

Speaker: Elisabeth Fowlie Mock

February 8, 2018

MAAP Collaborative ADHD Learning in Maine (CALM)

ADHD and Clinical Topics

Speaker: Carol Hubbard, MD

March 8, 2018

Collaborative and Proactive Solutions for Children with Challenging Behavior: Lives in the Balance

Speaker: Ross Greene, MD

March 13, 2018

Snuggle ME Guidelines - What's New?

Speaker: Kelly Bowden

Contact Information

• Amy Belisle, MD, Director of Child Health Quality Improvement, Maine Quality Counts, [email protected] 207-620-8526, x1002

• Kayla Cole, Project Manager, QC for Kids, 207-620-8526 x1027

[email protected]

• Jackie Tiner, QC for Kids Administrative Coordinator, 207-620-8526 x1036

[email protected]

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