ADEA Symposium Alaska Dental Health Aide Therapist Program*

Transcription

1 ADEA Symposium Alaska Dental Health Aide Therapist Program* 10:15 to 11:30 am: Description of the DHAT Program in Alaska 11:30 to 12:15 pm: The Evaluation of the DHAT Program *Supported by grants from: The W.K. Kellogg Foundation in collaboration with the Rasmuson, Bethel Community Services, Murdock, Paul G. Allen and Ford Foundations

2 ADEA Symposium Alaska Dental Health Aide Therapist Program* 10:15 to 11:30 am: Description of the DHAT Program in Alaska 11:30 to 12:15 pm: The Evaluation of the DHAT Program *Supported by grants from: The W.K. Kellogg Foundation in collaboration with the Rasmuson, Bethel Community Services, Murdock, Paul G. Allen and Ford Foundations

3 Description of the Alaska DHAT Program Overview of DHAT Program: Ron Nagel, DDS Education program System of Care Norton Sound Program: Mark Kelso,DDS Unalakleet Therapist: Aurora Johnson, DHAT Questions & Answers: A. Formicola, moderator The Alaska DHAT Program is operated by the Alaska Native Tribal Health Consortium (ANTHC)

4 Dental Health Aide Program Ron Nagel DDS MPH Alaska Native Tribal Health Consortium

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7 Newtok Clinic, Yukon-Kuskokwim

8 Community Health Aide History Developed by physicians some 38 years ago Competency based credentialing Today about 550 CHAs provide primary health care in rural Alaska (350,000 patient encounters annually) Their training starts with EMT or ETT training They are an integrated part of the delivery system working with Doctors, Nurses, and PAs. They are not a second level of care

9 Federal Health Aide Program Certification Board The Community Health Aide Program Certification standards are administrated by a Federal board This standing committee serves to credential providers and to respond to provider issues and patient complaints There are provisions in the standards for discipline, suspension or revocation of a certificate

10 Federal Health Aide Program Certification Board The Community Health Aide Program Certification standards are administrated by a Federal board This standing committee serves to credential providers and to respond to provider issues and patient complaints There are provisions in the standards for discipline, suspension or revocation of a certificate

11 Dental Health Aide Therapists At least 52 countries utilize Dental Therapists IDJ (2008) 58, Function as part of the dental team under the supervision of a dentist New Zealand has 88 yrs experience and Canada has over 38 Exceptional safety record under general supervision for children and adults

12 Dental Health Aide Therapists: Scope Clinic or village based Provide the spectrum of health education and preventive services Restore teeth to function utilizing amalgam and composite materials Provide SSCs and pulp treatment for primary teeth Extract teeth and manage dental emergencies Screen for oral and peri-oral disease They are equipped to help us provide the educational, preventive and safety net services that are most needed

13 Dental Health Aide Model Dental Health Aides Dental Patients Seeking Care Traditional Dentists

14 Clinical Guidance

15 AFHCAN Cart Alaska Federal Health Care Access Network Wireless Networking Touchscreen Mobile Customized Consultation Patient education Provider education WWW. AFHCAN.ORG

16 DHAT Oversight DHATs are assigned to a primary supervising dentist Supervising dentists provide patient consultations and program planning Monitor the referral process and DHATs understanding of their scope Chart reviews, patient satisfaction surveys Standardization of treatment to improve outcomes

17 Quality Assurance Begins with a 400+ hour directly supervised preceptorship DHAs must demonstrate the practical professional competencies for their level of certification throughout their career Every two years each DHA must provide evidence that they completed the CE requirements (24 hrs) Dentists proactively monitor sentinel events and treatment outcomes These administrative controls help to assure quality and that a single standard of care is met in tribal programs

18 Competency Based Credentialing Frequent sampling of knowledge and skills over time not a single event test We look directly at the services that they provide day to day to achieve high predictive validity with this process Each DHAs scope of practice is individually assigned based on competency through standing orders

19 DENTEX training program University of Washington MEDEX Northwest Two year program based on NZ, Canadian, and other models Integration into community based prevention programs throughout training A new mix of skills that includes the behavioral and public health skills needed to affect change The use of simulation and extensive patient contact to develop a high level of skill

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21 ADEA Symposium Alaska Dental Health Aide Therapist Program Mark Kelso, D.D.S. Dental Director Norton Sound Health Corporation Nome, Alaska

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28 ADEA Symposium Alaska Dental Health Aide Therapist Program Aurora Johnson Dental Health Aide Therapist Unalakleet, Alaska

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39 The Evaluation Plan for the Alaska DHAT Program National Advisory Committee for the DHAT Evaluation: Caswell Evans, DDS, MPH Chairman of the NAC The Evaluation Plan: Scott Weatherhall, MD, MPH Senior Program Director Research Triangle International Questions & Answers: Caswell Evans, moderator

40 Members of the National Advisory Committee for the DHAT Evaluation Myron Alukian Jr Robert Brandjord George Brenneman L. Jackson Brown Dominick DePaola Caswell Evans (chair) Chris Halliday Lawrence Hill Raymond Lala Shelia Riggs Stephen Schroeder Mary Smith Andrew Snyder Richard Valachovic Brad Whistler Doug White Berda Willson

41 Evaluation of the Dental Health Aide Therapist Model American Dental Education Association March 16, 2009 Scott F. Wetterhall, MD, MPH RTI International is a trade name of Research Triangle Institute

42 Background on RTI International RTI International Second largest non-profit research group in U.S. Based in North Carolina, offices worldwide Life and social science work in wide range of areas Experience in program evaluation and health services research

43 Framework for evaluation

44 Overview of evaluation process

45 1. Engage stakeholders Persons served by the DHAT program Alaska Native Tribal Health Consortium DHAT Evaluation Tribal Coordinating Committee National Advisory Committee W.W. Kellogg Foundation Rasmuson Foundation Bethel Community Services Foundation Indian Health Service Others

46 2. Describe the program Reviewed background material and literature Met with AK Tribal Coordinating Committee Met with National Advisory Committee Made 3 site visits in 2008 Consulted with knowledgable stakeholders

47 3. Focus the evaluation: specific objectives Examine patient access to care and satisfaction Assess quality of preventive and restorative treatment Examine implementation of community-based prevention plans and programs Assess practices procedures

48 3. Focus the evaluation stages in program development Program Planning Program Implementation Program Effects

49 3. Focus the evaluation Evaluate villages served by DHATs in all five tribal health areas Focus on program implementation Provide baseline for future assessment of program impact

50 4. Gather credible evidence Implementation assessment Integrity of implementation compared to program model Differences/similarities across DHATs Barriers/facilitators of implementation Health outcomes assessment Safety (including adverse outcomes) Quality Patient-oriented outcomes (e.g., pt. satisfaction)

51 4. Gather credible evidence: methods Key informant interviews Patient surveys Patient examinations Direct observation of treatment Patient record audit Direct observation of practice procedures

52 Key informant interviews DHAT Supervisory dentist Community Health Aide Clinic manager School personnel Village elders

53 Patient surveys AHRQ s CAHPS (Consumer Assessment of Healthcare Providers and Systems) for pt. satisfaction Oral quality of life Oral Health Impact Profile-14 (Slade) in adults Early Child Oral Health Impact Scale (ECOHIS) (Pahel)

54 Patient examinations Random sample of village residents Calibrated dental inspectors Summary of community oral health WHO Oral Health Survey methods DMFT Community Periodontal Index for >18 years old Quality of prior restorative treatment using Ryge- Snyder criteria

55 Direct observation of treatment Class II amalgam and composite preparation Stainless steel crown preparation Provision of oral health instruction

56 Patient record audit Systematic sample of DHAT-treated patients Quality of preventive treatment (6 measures) Effectiveness of care (5 measures) (Bader et al., 1999) Use of services (receipt of prophylaxis, preventive:restorative treatment ratio) Adequacy of record keeping

57 Direct observation of practice procedures Use of modified Met Life practice assessment tool Facilities, equipment, administration, infection control

58 Timeline Mar 2009: Obtain AK IRB approval May 2009: Calibrate 2 dental inspectors May 2009: Field data collection in one site Sept 2009: Data collection in four other sites May 2010: Repeat visits to 5 sites

59 5. State conclusions and recommendations Uses of evaluation of data data from this evaluation Gain insights Change practices Assess effects Affect participants

60 6. Disseminate results: data sharing Update funders and coordinating committees on a regular basis Study findings will be presented to the foundations and coordinating committees for review prior to any further dissemination Oral presentations and peer-reviewed journal articles

61 For more information Scott F. Wetterhall, MD, MPH RTI International