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$2.5 Million Grant Results in Improving Dental Patients’ Quality of Health
By Catherine Duncan
In 2012, the UT System Board of Regents approved funding for the Center for Oral Health Care & Research, the School of Dentistry’s first new facility since the original building opened in 1972 on the main campus of the UT Health Science Center San Antonio.
While the $96.5 million facility would boast four floors with the newest technological infrastructure and dental equipment, funds were not provided for the computers needed to support a certified electronic health record system.
With the vision to create a state-of-the-art clinical facility, dental school leaders needed to consider additional funding sources. At this same time, the Affordable Care Act was being implemented with the goals of improving the experience and outcome of health care for patients, and reducing cost of care. The federal government created Delivery System Reform Incentive Payment (DSRIP) programs, which are part of Section 1115 waiver programs. These programs provide funds to states to support hospitals and other providers in changing how they provide care to Medicaid beneficiaries.
In Texas, federal payments for dental care are strictly for children. Because UT Dentistry San Antonio, the clinical practice of the School of Dentistry, provides dental care through Medicaid to those under 18, the school qualified to apply for DSRIP funds.
Improving overall health
Gary Guest, D.D.S., associate dean for patient care, said qualifying projects provide quality care to low-income, Medicaid or uninsured patients. “We have several providers here who qualify,” he said. Dr. Guest applied for the DSRIP funding with the goal of improving dental patients’ overall health through a secure record system.
Now in its fifth year, the $2.5 million project is managed through the Texas Health and Human Services Commission. The school implemented a Certified Electronic Patient Record System during the first project year.
As part of the 1115 Waiver, geographic boundaries were established for Regional Healthcare Partnerships. Each regional partnership developed a plan to identify community needs, proposed projects and funding distribution. In this area, a high prevalence of chronic disease and related health disparities require greater prevention efforts and improved management of patients with chronic conditions. Leading causes of death in this region include cardiovascular disease, cancer and diabetes.
“As part of this project, we had to build history forms in the electronic system. That allowed us to create extra questions related to diabetes and heart disease,” Dr. Guest said. “The system prompts the provider to ask these questions and take note of their answers.”
The system directs the health care provider to inform the patient about the implications of these conditions on their oral health care delivery. “Patients need to be aware of implications of complications that can result from these diseases in an uncontrolled state and ramifications to treatment procedures such as taking certain medicines and what can
happen when they change medicine or are non-complaint with their medications.”
Through this project, “80 percent of our patients with these conditions have received the additional discussion about their overall health. We know we need to reach the other 20 percent. We have made great progress.”
Dr. Guest explained a second part of the project involves training providers on clinical quality improvement and health records. Participating health providers include faculty members, residents, second- through fourth-year dental students, and fourth-year dental hygiene students—all of whom provide care.
Reducing cavities in adults
The third aspect of the project is reducing cavities in the adult population. “We established a baseline for the percentage of our patients with caries or cavities. Our goal was to reduce cavities in the population being treated by 5 percent each year.
“Because we had the electronic system and were involved in this project, it prompted us to be cognizant and dedicated to reducing cavities. The record system reminded us constantly to give better care,” he said.
In 2014, the percentage of adult patients with untreated cavities was 62 percent. That rate dropped to 58 percent in 2015 and down to 54.9 percent in 2016.
“We were fortunate to receive these funds,” Dr. Guest said. “The first step to quality improvement is awareness. This experience made us look at where we could make improvements. It made us implement the record system in a timely manner and track our progress. This process helped us learn how to leverage the electronic record system. We created an internal referral management system to track patients through our specialty practices.”
UT Dentistry is now able to improve not only patients’ oral health but also their overall health, he said.