New report identifies key elements for improving oral health quality

Jan. 26, 2012
Study notes that dental expenses are among the highest out-of-pocket health costs to consumers, second only to prescription drug expenditures.

Study notes that dental expenses are among the highest out-of-pocket health cost to consumers,
second only to prescription drug expenditures

The W.K. Kellogg Foundation, which in recent years has supported mid-level dental providers in the United States, offered on Jan. 27 suggestions to make dentistry "similarly accountable" as other health-care professions, as well as ensuring "quality improvement" in the profession through "data collection" and "new ways of delivering oral health care."

The Kellogg Foundation teamed up with DentaQuest Institute to suggest steps such as increased emphasis on electronic health records, further development of diagnostic coding systems, innovative payment and "incentive" mechanisms based on demographics, use of telehealth technologies in rural areas, and the delivery of care in nontraditional settings that would involve new types of allied dental professionals.

Video: DentaQuest executive director discusses key factors of report

A participant in the report, Dr. Paul Glassman of the University of Pacific School of Dentistry, said, "The focus on quality improvement for overall health care is an important opportunity to improve the quality of oral health care. The biggest problem now is we are developing many measures, but they need to be connected to performance of the system. This report provides an opportunity for a new dialogue on how best to collect and use data to improve quality and increase access to affordable dental care.”

The report was titled, "Oral Health Quality Improvement in the Era of Accountability." The Kellogg Foundation's international philanthropic efforts strives to "create conditions that propel vulnerable children to realize their full potential in school, work, and life." The DentaQuest Institute is a nonprofit organization dedicated to "improving efficiency, effectiveness and quality in dental care." The report was unveiled at a national meeting of oral health professionals, government leaders, consumer advocates, and others.

Dr. Glassman, a dentist, said increasing costs of oral health care and "unwarranted variability" in oral care delivery sparked the effort behind the report. But the survey included the government as a factor too, citing the statistic that only 6% of dental nationally is paid through government sources.

“With the current focus on quality improvement in health care, we need to make sure that oral health isn’t left behind,” said Alice Warner, program officer at the W.K. Kellogg Foundation. “Right now, 37% of African American children and 41% of Hispanic children have untreated tooth decay, compared with 25% of white children. We need to do better by all our children and this report provides ideas that can help lead the way.”

We talked to Maria Perno Goldie, RDH, MS, editorial director of RDH eVillage FOCUS e-newsletter and she had this to say: "The report, Oral Health Quality Improvement in the Era of Accountability, provides an overview of current efforts and cites elements that are critical for advancing this agenda. It addresses many aspects of care, including new types of allied dental professionals. There is a bill in California that would allow the state to study the benefits of alternative dental care providers. The California Dental Association (CDA) supports the proposed legislation, but two other groups, the California Academy of General Dentistry (CAGD) and the California Association of Oral and Maxillofacial Surgeons (CALAOMS) oppose the concept of midlevel providers. However, midlevel providers are used very effectively in many parts of the world. SB 694, introduced by state Sen. Alex Padilla (D-San Fernando Valley), would also establish a state dental director. SB 694 also supports a scientific study to assess the safety, quality, and cost-effectiveness of allowing basic preventive and restorative dental procedures to be performed by providers other than dentists. Let’s get the evidence, look at the use of midlevel providers in Alaska and other countries, and then make a decision."

Ann Battrell, MSDH, executive director of the American Dental Hygienists' Association, commented: "The ADHA applauds the Kellogg Foundation and the DentaQuest Institute for addressing the issue of oral health quality improvement and access to care in their report Oral Health Quality Improvement in the Era of Accountability. We’d also like to extend our congratulations to study author Dr. Paul Glassman for his excellent work and dedication to this critical issue. The entire dental profession needs to take steps to establish quality measures that are focused on the overall health outcomes of the public as our fellow health-care providers in medicine have done.”

The report claims that dental expenses are now among the highest out-of-pocket health expenditures for consumers. In 2008, they accounted for $30.7 billion or 22.2% of total out-of-pocket health expenditures, second only to prescription medications, according to the Bureau of Labor Statistics.

“The DentaQuest Institute is working closely with clinical partners to implement quality improvement strategies that emphasize prevention and disease management in dental care,” according to Dr. Mark Doherty, executive director of the DentaQuest Institute. ”We have begun to see success applying a disease management model to the care of chronic disease.”