Enter your email to receive the CareQuest newsletter:
June 20, 2023
A picture may be worth a thousand words, but for two oral health care teams in North Carolina, it’s the numbers that are invaluable.
“Data gives you a concrete picture of your practice,” says Rebecca Sykes, DDS, the dental director for Wake County Department of Health and Human Services Dental Clinic, a local health department, in North Carolina.
Sykes has been with Wake County since 2010, when she started as a dentist, before becoming the dental director in 2017. Sykes says the clinic has been capturing data with two electronic health record (EHR) systems for years.
“Typically, we would utilize the data more for operational decisions, like if we needed expansion requests for additional positions, or things of that nature,” Sykes says.
Although gathering and analyzing data is not a new concept in Wake County, CareQuest Institute’s Community Oral Health Transformation (COrHT) Initiative has shown the clinic how it can use certain data to further improve patient care. The initiative is a partnership between CareQuest Institute, the Blue Cross Blue Shield of North Carolina Foundation and the North Carolina Oral Health Collaborative (NCOHC), a program of the Foundation for Health Leadership and Innovation. COrHT kicked off last year in North Carolina and runs through September of this year.
When each of the 13 teams joined the cohort, they met with CareQuest Institute data specialists to explore initiative quality measures; what clinical, demographic, and financial data fields were available in their electronic dental or health records; and how regular data reporting is foundational for quality improvement and transition to equitable, value-based care.
“Some of the data that COrHT was interested in showed that, yes, those operational decisions are important,” Sykes says. “But you can also use the data to help drive treatment approaches and clinical decisions on a more personalized level for your patients.”
Crunching Numbers with CareQuest Institute
COrHT features a learning community for dental teams that helps them share best practices, discuss ongoing challenges, and collaborate on solutions. With a focus on the shift to value-based care (VBC) in dentistry, the initiative focuses on teledentistry, minimally invasive care (non-surgical treatment of disease), and integration of oral health with overall health care.
“Implementing this care model requires dental teams to make incremental steps toward value,” says Caroline McLeod, RDH, MS, the value-based care solutions manager at CareQuest Institute. “Data collection supports exploration of opportunities for improvement, evidence-based decision-making, and progress toward goals that improve health outcomes.”
Through this learning community, CareQuest Institute asks COrHT participants to review clinical, demographic, and financial and operational data. This combination of data allows participants to understand how changes made in clinical care processes affect their operations, bottom line, and — most importantly — their patient population.
“To impact change and drive insights with clinical decision-making, we needed to collect data at the most granular level from the EHR,” says Dustin Holloway, MPH, health informatics manager at CareQuest Institute. “By working with strong clinic champions, we were able to analyze data at the tooth level to better understand the procedure codes used and to provide a feedback loop for COrHT participants and CareQuest Institute.”
Those connections helped the clinic discover data they hadn’t looked at in the past.
“Based off the two frameworks in COrHT, the integrated and personalized care and the minimally invasive care, one thing we started implementing was caries risk assessments for all of our recall patients and new patients,” Sykes says. The county can use the data to analyze patterns of disease risk in the community. “You’re able to see the procedures you’re providing, the frequency of those procedures, along with any other trends you’re interested in,” Sykes says. And, in turn, providers can give patients better care. “Based on those caries risk assessments, we can modify treatment approaches to get better long-term outcomes,” Sykes says. “So, because of that, our use of silver diamine fluoride in our practice has increased since participation in COrHT. If a patient is a high caries risk, we ask what we can do minimally invasive-wise to get them to a caries control state so that we can focus some attention on behavior modifications — whether it’s improvements in their oral hygiene or dietary changes that they need — before we just drill, fill, recurrent caries, drill, fill. That’s one thing, from a clinical approach, COrHT has helped with.”
Data Shapes Change
AppHealthCare in Jefferson, another safety net clinic in rural North Carolina, is also participating in COrHT. Like Wake County, AppHealthCare was collecting some data, but it wasn’t collecting it in an efficient and effective way.
“It wasn’t really doing anything for us,” says Alexandria Barker, the office administration specialist at AppHealthCare. Barker formerly worked at AppHealthCare as a dental assistant.
She says the health center would only run reports to look at their data every couple of months.
“Through COrHT, we learned that doing them monthly has been helpful,” Barker says. “Also, having a dashboard . . . where we can visually see what that trend looks like has been great.”
Barker says the numbers AppHealthCare collects help tell a story — one that can be told to their funders and community.
“Our board members have enjoyed seeing the data and seeing where we were, where we are now, and where we hope to be,” Barker says. “It’s a better flow and track of that versus, whenever someone asks us a question, trying to run that report and then figure that part out.”
She also appreciates the data from patient surveys.
“What was good for a patient? What worked well? What made them more comfortable? Because there’s little things that we do throughout an appointment that we probably don’t realize we’re doing,” Barker says. “Then we can be more intentional whenever we’ve read a review.”
Data Advice for Any Organization
Both Sykes and Barker recognize that not every health center is at the same stage in their data journey.
“As safety nets, we have tremendous support from other health centers, whether they’re Federally Qualified Health Centers, nonprofits, or local health departments,” Sykes says. “We have a strong network of colleagues, and that’s been another valuable asset of COrHT.”
They have advice for health centers who don’t have the setup or the staff to collect and use data the way they’d like to.
“Don’t get discouraged,” Barker says. “It’s a journey.”
Sykes adds, “Reach out to colleagues, because maybe they’ve been through similar struggles and they can share with you what’s worked for them. And then be willing to get creative. If it’s funding or finances that are the hurdle, there might be a grant opportunity that you qualify for. Look at the data that you’re wanting to collect and capture because that’s going to allow you to make the most educated decision regarding which systems will best meet your clinic’s needs.”
The COrHT Initiative in North Carolina wraps up in September. NCOHC and CareQuest Institute will later develop a comprehensive impact report to help participating safety net clinics sustain their work and influence long-term reform.
Barker adds that following participation in COrHT, she’ll have more than just a better understanding of how to use data.
“It’s been a great networking experience,” Barker says. “I have learned a lot, met a lot of really great people who I feel like I’ll be able to reach out to after the initiative.”
Sykes agrees on the value of camaraderie and shared learning.
“It was refreshing to have that networking opportunity with other clinics that faced the same or similar challenges because we can all learn from each other,” Sykes says. “Even if your approaches are slightly different, it’s nice to know that you’re not facing things alone, and that other clinics are facing similar situations. You’re not on an island by yourself.”