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Watson RR, Niedziela CJ, Nuzzi LC, Netson RA, McNamara CT, Ayannusi AE, Flanagan S, Massey GG, Labow BI. Impact of Insurance Type on Access to Pediatric Surgical Care. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5831. [PMID: 38798939 PMCID: PMC11124593 DOI: 10.1097/gox.0000000000005831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/01/2024] [Indexed: 05/29/2024]
Abstract
Background This study aimed to measure the impact of insurance type on access to pediatric surgical care, clinical and surgical scheduling decisions, provider-driven cancelations, and missed care opportunities (MCOs). We hypothesize that patients with public health insurance experience longer scheduling delays and more frequently canceled surgical appointments compared with patients with private health insurance. Methods This retrospective study reviewed the demographics and clinical characteristics of patients who underwent a surgical procedure within the plastic and oral surgery department at our institution in 2019. Propensity score matching and linear regressions were used to estimate the effect of insurance type on hospital scheduling and patient access outcomes while controlling for procedure type and sex. Results A total of 457 patients were included in the demographic and clinical characteristics analyses; 354 were included in propensity score matching analyses. No significant differences in the number of days between scheduling and occurrence of initial consultation or number of clinic cancelations were observed between insurance groups (P > 0.05). However, patients with public insurance had a 7.4 times higher hospital MCO rate (95% CI [5.2-9.7]; P < 0.001) and 4.7 times the number of clinic MCOs (P = 0.007). Conclusions No significant differences were found between insurance groups in timely access to surgical treatment or cancelations. Patients with public insurance had more MCOs than patients with private insurance. Future research should investigate how to remove barriers that impact access to care for marginalized patients.
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Affiliation(s)
- Rachel R. Watson
- From the Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Cassi J. Niedziela
- From the Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Laura C. Nuzzi
- From the Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Rebecca A. Netson
- From the Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Catherine T. McNamara
- From the Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Anuoluwa E. Ayannusi
- From the Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Sarah Flanagan
- From the Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Gabrielle G. Massey
- From the Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Brian I. Labow
- From the Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
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Anagha K, Megha M, Karuveettil V, Vijay Kumar S. Perceptions of barriers towards dental appointment keeping among patients of a tertiary care setting: A mixed method exploration. J Oral Biol Craniofac Res 2024; 14:185-191. [PMID: 38405603 PMCID: PMC10891327 DOI: 10.1016/j.jobcr.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/05/2024] [Indexed: 02/27/2024] Open
Abstract
Objectives To explore the barriers governing dental appointment keeping among patients reporting to a tertiary care setting. To assess the prevalence of missed dental appointments in a tertiary care center. Primary To explore the barriers governing dental appointment keeping among patients reporting to a tertiary care setting. Secondary To assess the prevalence of missed dental appointments in a tertiary care center. Methodology The study design adopted is a sequential explanatory mixed method design; here, quantitative data collection and analysis is followed by qualitative data/analysis. The quantitative arm recorded six months of retrospective data on missed appointments in the centre. Prevalence was estimated, and descriptive and inferential statistics were performed. For the qualitative component, focus group discussions and in-depth interviews were conducted among dental health professionals and patients. Data was transcribed, and thematic content analysis was performed using NVivo software. Results The prevalence of missed appointments in the tertiary care centre was 8.4 %. Personal/health issues (30.7 %) were noticed to be the most reported reason for missed appointments. Other causes include distance to the clinic (17.2 %), inflexible work schedule (14.7 %), transportation (12.3 %), dental anxiety (6.7 %), and economic issues (5.5 %). Qualitative data revealed the appointment system, experiences, consequences, responsible factors, management, and prevention of missed appointments in a tertiary care dental centre. Conclusion and recommendations Multiple barriers are identified for dental appointment-keeping behavior. Missed appointments are prevalent in the study setting, as dental treatments require multiple sittings to complete. The study's findings primarily focus on a tertiary care center and may reflect reduced prevalence due to the COVID-19 pandemic. Tailor-made interventions are suggested for tertiary care settings to manage and prevent missed appointments, paving the way for successful health care delivery.
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Affiliation(s)
- K.A. Anagha
- Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - M. Megha
- Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Vineetha Karuveettil
- Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - S. Vijay Kumar
- Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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Culmer N, Smith TB, Stager C, Wright A, Fickel A, Tan J, Clark C(T, Meyer H, Grimm K. Asynchronous Telemedicine: A Systematic Literature Review. TELEMEDICINE REPORTS 2023; 4:366-386. [PMID: 38143795 PMCID: PMC10739789 DOI: 10.1089/tmr.2023.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/26/2023]
Abstract
Background Asynchronous telemedicine (ATM), which describes telemedical interaction between a patient and provider where neither party communicates simultaneously, is an important telemedicine modality that is seeing increased use. In this article, we summarize the published peer-reviewed literature specifically related to ATM to (1) identify terms or phrases that are used to describe ATM, (2) ascertain how this research has thus far addressed the various aspects of the quadruple aim of medicine, and (3) assess the methodological rigor of research on ATM. We also divided the literature into pre- and post-COVID-19 onset periods to identify potential variations in the literature between these two periods. Methods This systematic literature review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The literature search, utilizing multiple databases and applying inclusion and exclusion criteria, initially produced 2624 abstracts for review. De-duplication and screening ultimately yielded 104 articles for data extraction. Results "Store-and-forward" and variations of "e-visit" were the most frequently used alternative terms for ATM. Care quality was the most frequently addressed aspect of the Quadruple Aim of Medicine-more than double any other category-followed by patient satisfaction. We separated cost of care into two categories: patients' cost of care and providers' cost to provide care. Patient cost of care was the third most addressed aspect of the Quadruple Aim of Medicine followed by provider well-being and provider's cost to provide care. Methodological rigor of the studies was also addressed, with only 2 quantitative studies ranked "Strong," 5 ranked "Moderate," and 97 ranked "Weak." Qualitative studies were generally acceptable but struggled methodologically with accounting for all participants and articulation of results. Conclusions Although "store-and-forward" is somewhat more frequently used in the studies included in this review, variants of "e-visit," are growing in recent usage. Given the relative newness of modality, it is not surprising that quality of care is the most researched aspect of the Quadruple Aim of Medicine in ATM research. We anticipate more balance between these areas as research in this field matures. Primary areas of research need currently relate to practitioners-specifically their costs of providing care and well-being. Finally, future ATM research needs to address research challenges of selection bias and blinding in quantitative studies and improved participant tracking and articulation of both study design and results in qualitative studies.
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Affiliation(s)
- Nathan Culmer
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Todd Brenton Smith
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Catanya Stager
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Andrea Wright
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | | | - Jet Tan
- The University of Alabama, Tuscaloosa, Alabama, USA
| | | | - Hannah Meyer
- The University of Alabama, Tuscaloosa, Alabama, USA
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Bomfim RA. Last dental visit and severity of tooth loss: a machine learning approach. BMC Res Notes 2023; 16:347. [PMID: 38001552 PMCID: PMC10668397 DOI: 10.1186/s13104-023-06632-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/20/2023] [Indexed: 11/26/2023] Open
Abstract
The aims of the present study were to investigate last dental visit as a mediator in the relationship between socioeconomic status and lack of functional dentition/severe tooth loss and use a machine learning approach to predict those adults and elderly at higher risk of tooth loss. We analyzed data from a representative sample of 88,531 Brazilian individuals aged 18 and over. Tooth loss was the outcome by; (1) functional dentition and (2) severe tooth loss. Structural Equation models were used to find the time of last dental visit associated with the outcomes. Moreover, machine learning was used to train and test predictions to target individuals at higher risk for tooth loss. For 65,803 adults, more than two years of last dental visit was associated with lack of functional dentition. Age was the main contributor in the machine learning approach, with an AUC of 90%, accuracy of 90%, specificity of 97% and sensitivity of 38%. For elders, the last dental visit was associated with higher severe loss. Conclusions. More than two years of last dental visit appears to be associated with a severe loss and lack of functional dentition. The machine learning approach had a good performance to predict those individuals.
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Affiliation(s)
- Rafael Aiello Bomfim
- School of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Brazil.
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Discepolo K, Melvin P, Ghazarians M, Tennermann N, Ward VL. Socioeconomic and Clinical Demography of Dental Missed Care Opportunities. JDR Clin Trans Res 2023; 8:356-366. [PMID: 35722931 DOI: 10.1177/23800844221104790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Missed care opportunities (MCOs) contribute to poor health outcomes, and pediatric dental patients are particularly vulnerable; identifying associated patient characteristics will help inform development of targeted interventional programs. OBJECTIVE To assess socioeconomic and demographic disparities associated with MCOs among children in an urban pediatric hospital's dental clinic. MCOs lead to a lack of continuous care and increased emergent needs, so understanding MCOs is required to achieve equitable pediatric dental health. METHODS A retrospective 2-y (2019-2020) cohort of MCOs in children 1 to 17 y old, with scheduled dental visits. MCOs were defined as appointments not attended or canceled and not rescheduled prior to initial scheduled visit. Multivariable mixed-effects logistic regression models with patient-level clustering assessed the associations of demographics, neighborhood-level socioeconomic factors (using social vulnerability index [SVI]), and clinic characteristics with MCOs. RESULTS Of 30,095 visits, 30.9% were MCOs. Multivariable logistic regression estimated increased likelihood of MCOs in Black/non-Hispanic (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.09-1.32) and Hispanic (OR, 1.18; 95% CI, 1.06-1.31) patients, patients with public insurance (OR, 1.25; 95% CI, 1.15-1.36) or no insurance (OR, 1.46; 95% CI, 1.15-1.85), patients with complex chronic conditions (OR, 1.11; 95% CI, 1.03-1.19), visits scheduled during the COVID-19 pandemic (OR, 9.48; 95% CI, 8.89-10.11), appointments with wait days over 21 d (OR, 4.07; 95% CI, 3.49-4.74), and children from neighborhoods of high social vulnerability (75th percentile SVI) (OR, 1.08; 95% CI, 1.01-1.16). CONCLUSIONS Children with highest dental MCOs were from neighborhoods with high SVI, had public insurance, and were from marginalized populations. MCOs contribute to inequities in overall health; hence, interventions that address barriers related to characteristics associated with pediatric dental MCOs are needed. KNOWLEDGE TRANSFER STATEMENT Missed care opportunities contribute to poor health outcomes; identifying associated patient characteristics will help inform development of targeted interventional programs. Providing these findings to stakeholders will better impart understanding access barriers and drive research and program development. Dissemination of this information in the form of altering appointment practices will better accommodate specific patient population needs.
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Affiliation(s)
- K Discepolo
- Department of Dentistry, Boston Children's Hospital, Boston, MA, USA
| | - P Melvin
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
| | - M Ghazarians
- Department of Dentistry, Boston Children's Hospital, Boston, MA, USA
| | - N Tennermann
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
| | - V L Ward
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Karuveettil V, Sapna S, Jain P, Samad F. Barriers and facilitators to attending dental care appointments among adults in low- and middle-income countries: a scoping review protocol. JBI Evid Synth 2022; 20:2536-2542. [PMID: 35972057 DOI: 10.11124/jbies-22-00063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this scoping review is to identify the barriers and facilitators to attending dental care appointments among adults in low- and middle-income countries. INTRODUCTION Missed dental appointments are a well-recognized problem in dental care, widely contributing to adverse health care outcomes. Patients' adherence to dental appointments plays a vital role in improving and maintaining oral health. This scoping review will identify and synthesize barriers and facilitators that influence adults in keeping dental appointments. INCLUSION CRITERIA Studies focusing on barriers and facilitators to dental appointment attendance among adults will be included. The study will include public, private, and university-based dental clinical settings and will be limited to low- and middle-income countries. There will be no restrictions on the source of evidence (primary studies or text/opinion studies) or study design (qualitative or quantitative studies). METHODS The review will follow the JBI methodology for scoping reviews. Studies will be searched in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Dentistry and Oral Sciences Source, and Scopus. Databases will be searched from inception until the present. ProQuest Dissertations and Theses, OAIster, International Association for Dental Research conference abstracts, and Google Scholar will be searched for unpublished studies. Study screening will be performed by two reviewers, and data extraction will be done using a customized data extraction form. Barriers and facilitators will be categorized based on the Theoretical Domains Framework. The tabulated data and figures will be accompanied by a narrative summary of barriers and facilitators to attending dental care appointments, which may be used to guide further research. SCOPING REVIEW PROTOCOL REGISTRATION Open Science Framework osf.io/mny8h.
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Affiliation(s)
- Vineetha Karuveettil
- Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.,Amrita Centre for Evidence Based Oral Health: A JBI Affiliated Group, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | | | - Praneetha Jain
- LearnByResearch, Pune, Maharashtra, India.,Department of Pharmacy Practice, P.A. College of Pharmacy, Mangalore, Karnataka, India
| | - Fozia Samad
- LearnByResearch, Pune, Maharashtra, India.,Clybay Private Limited, Bangalore, Karnataka, India
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da Cunha IP, de Lacerda VR, da Silveira Gaspar G, de Lucena EHG, Mialhe FL, de Goes PSA, Leite HQNC, Bomfim RA. Factors associated with the absence of Brazilians in specialized dental centers. BMC Oral Health 2022; 22:364. [PMID: 36028829 PMCID: PMC9419406 DOI: 10.1186/s12903-022-02402-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/22/2022] [Indexed: 11/25/2022] Open
Abstract
Aim To identify the individual and contextual factors associated with the absence of Brazilians at a scheduled appointment in Dental Specialties Centers (DSC). Methods This cross-sectional design uses the National Program for Improving Access and Quality of Dental Specialties Centers database, 2018. The outcome was the users' lack of at least one of the scheduled appointments. Contextual and individual independent variables were used, considering Andersen's behavioural model. The analyses were performed with the R Core Team and SAS (Studio 3.8, Institute Inc, North Carolina, U.S, 2019) programs. Results Of the 10,391 patients interviewed, 27.7% missed at least one of the consultations. In the adjusted multivariate model, the interpretation based on the effect size and 95% CI showed that the behaviour individual predisposing factors such as age ≤ 42 years (OR = 1.10; 95%CI:1.01–1.21), individual need factors such as participation in the “Bolsa Família” program (OR = 1,14; 95%CI:1.02–1.27), not being covered by the Family Health Strategy (OR = 1.15; 95% CI:1.02–1.30), and users of periodontics services (OR = 1.22;95%CI:1.05–1.40) were associated with absences. The behavioural factor associated with the outcome was that the DSC facilities were not in good condition (OR = 1.18; 95%CI:1.03–1.34). DSC located in the capital (OR = 1.12; 95% CI: 0.92–1.48) were 12% more likely to have dental absences than those in the interior region. Conclusion There are individual and contextual barriers associated with patients not attending specialised public dental consultations. DSC should offer adequate hours to patients, especially young adults and vulnerable people.
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Affiliation(s)
- Inara Pereira da Cunha
- Public Health School Dr. Jorge David Nasser, Av. Sen. Filinto Müler, 1480 - Pioneiros, Campo Grande, MS, 79074-460, Brazil.
| | | | | | | | - Fábio Luiz Mialhe
- Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
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Baherimoghadam T, Naseri N, Hamedani S, Nikmehr S, Mokhtar M. Influence of Multimedia Reminders on Oral Hygiene Status During Removable Orthodontic Treatment: A Randomized Controlled Trial. J Orthod Sci 2022; 11:27. [PMID: 35754419 PMCID: PMC9214445 DOI: 10.4103/jos.jos_193_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction: Orthodontic appliances complicate daily oral hygiene maintenance and enhance the formation of microbial biofilm on tooth surfaces and orthodontic appliances. Objective: This trial was conducted to assess the effect of reminders on oral hygiene of patients during removable orthodontic treatment. Methods: In this 2-arm parallel randomized controlled trial, 66 orthodontic patients with removable maxillary appliance were randomly allocated with 1:1 ratio to message reminders and the control group. The patients in the messaging group received one or two message reminders and educational videos weekly during the course of treatment. A single blinded examiner measured the plaque index (PI), gingival index (GI), and dental caries index of patients in both groups at baseline (T0) and one (T1), three (T2), and six (T3) months after the first day of treatment to assess their oral hygiene status during treatment. Results: A total of 30 patients in control group and 28 in reminder group completed the study. The PI and GI scores were increased neither in control group nor in message reminder group during T0 and T1, significantly. The PI and GI scores in message reminder group were significantly lower than those in the control group at T2 (PI: P = 0.001, GI: P = 0.003) and T3 (PI: P = 0.024, GI: P = 0.022). Slight significant increasing in the PI and GI score were found during T2 and T3 in message reminder group. Caries index showed no significant difference between two groups during study. Conclusion: It seems that reminders can efficiently promote oral hygiene of patients undergoing removable orthodontic treatment.
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Bomfim RA, da Cunha IP, Lacerda VRD. Health ombudsman and racial inequities in Dental Specialities Centers performance in Brazil: A multilevel analysis. Community Dent Oral Epidemiol 2021; 50:11-18. [PMID: 34870337 DOI: 10.1111/cdoe.12713] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/22/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study aimed to verify racial differences in the performance of Dental Specialities Centers in Brazil, according to the presence of active health ombudsman on four primary outcomes: (1) access and dental appointment, (2) reception services, (3) bond and responsibility, and (4) social participation. METHODS Data came from the PMAQ-CEO national evaluation of public healthcare services, 2018-2019. The two main explanatory variables were the self-classified race at the individual level and the presence of the health ombudsman at the second level (level of services provision). Individual covariates included age, sex and schooling. Multilevel logistic regression was used to calculate the OR (Odds Ratios) in racial gaps according to the primary outcomes with individuals at the first level and public health services at the second level. RESULTS The analytical sample comprised of 8993 respondents. Brown people were less likely to report better Access (27%), good reception services (31%), bond and responsibility (30%) and social participation (22%) than Whites. Black people showed similar patterns. Dental Specialities Centers that use health ombudsman for planning have attenuated racial inequities in all analysed dimensions. CONCLUSIONS Dental Specialities Centers that use active health ombudsman for planning showed lower racial inequities in access, reception, bond and responsibility and social participation than those who did not use. Therefore, the health ombudsman should be implemented and used for planning better specialized dental services in Brazil.
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Affiliation(s)
- Rafael Aiello Bomfim
- School of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
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Kottek AM, Hoeft KS, White JM, Simmons K, Mertz EA. Implementing care coordination in a large dental care organization in the United States by upskilling front office personnel. HUMAN RESOURCES FOR HEALTH 2021; 19:48. [PMID: 33827583 PMCID: PMC8028788 DOI: 10.1186/s12960-021-00593-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/25/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Care coordination is a key strategy used to improve health outcomes and efficiency, yet there are limited examples in dentistry. A large dental accountable care organization piloted care coordination by retraining existing administrative staff to coordinate the care of high-risk patients. Following the pilot's success, a formal "dental care advocate" (DCA) role was integrated system-wide. The goal of this new role is to improve care, patient engagement, and health outcomes while integrating staff into the clinical care team. We aim to describe the process of DCA role implementation and assess staff and clinician perceptions about the role pre- and post-implementation. METHODS Guided by the Consolidated Framework for Implementation Research, semi-structured interviews with clinical and operational administrative staff and observation at the company-wide training session were combined with pre- and post-implementation electronic surveys. Descriptive statistics and mean scores were tested for significance between each survey sample (t-tests), and qualitative data were thematically analyzed. RESULTS With preliminary evidence from the pilot and strong executive support, a dedicated leadership team executed a stepwise rollout of the DCA role over 6 months. Success was facilitated by an organizational culture of frequent interventions deployed rapidly through a centralized system, along with supportive buy-in from managerial teams and high staff acceptance and enthusiasm for the DCA role before implementation. Following implementation, significant changes in attitudes and beliefs about the role were measured, though managers held stronger positive impressions than DCAs. DCAs reported high confidence in new skills and dental knowledge post-implementation, including motivational interviewing and the ability to confidently answer patients' questions about their oral health. Overall, the fast-paced implementation of this new role was well received, although consistent and significant differences in mean attitudes between managers and DCAs indicate more work to fine-tune the role is needed. CONCLUSIONS Successful implementation of the new DCA role was facilitated by a strong organizational commitment to team-based dentistry and positive impressions of care coordination among staff and managers. Upskilling existing administrative staff with the necessary training to manage some high-risk patient needs is one method that can be used to implement care coordination efforts in dentistry.
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Affiliation(s)
- Aubri M. Kottek
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, 490 Illinois Street, Floor 11, Box 1242, San Francisco, CA 94143 United States of America
- Healthforce Center at UCSF, School of Dentistry, University of California, San Francisco, 490 Illinois Street, Floor 11, Box 1242, San Francisco, CA 94143 United States of America
| | - Kristin S. Hoeft
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, 490 Illinois Street, Floor 11, Box 1242, San Francisco, CA 94143 United States of America
| | - Joel M. White
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, 490 Illinois Street, Floor 11, Box 1242, San Francisco, CA 94143 United States of America
| | - Kristen Simmons
- Willamette Dental Group, P.C., 6950 NE Campus Way, Hillsboro, OR 97124 United States of America
- Skourtes Institute, 6950 NE Campus Way, Hillsboro, OR 97124 United States of America
| | - Elizabeth A. Mertz
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, 490 Illinois Street, Floor 11, Box 1242, San Francisco, CA 94143 United States of America
- Healthforce Center at UCSF, School of Dentistry, University of California, San Francisco, 490 Illinois Street, Floor 11, Box 1242, San Francisco, CA 94143 United States of America
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Okunseri C, Boss D, Jacobson N, Wang MV, Szabo A, Okunseri E, Molfenter T. Test of an organizational change model to reduce no-shows in dental care settings. J Public Health Dent 2021; 81:261-269. [PMID: 33569828 DOI: 10.1111/jphd.12440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 12/03/2020] [Accepted: 12/14/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To test the feasibility and preliminary effectiveness of the NIATx model for organizational change to reduce appointment no-shows in dental care settings. METHODS The NIATx Dental Pilot Study used a clustered prepost interventional design and a mixed-methods approach. Five independent dental clinics serving Medicaid enrollees were recruited. Quantitative data on the impact of the NIATx model were complemented by qualitative assessment information collected from dental staff. The NIATx model was applied through a multisite learning collaborative that engaged participating organizations in adopting targeted no-show best practices. The primary outcome measure was no-show data collected at the preintervention phase (5 months), intervention phase (7 months), and postintervention phase (3 months). RESULTS Female patients were in the majority (median 54.5 percent). Mean age ranged from 8 to 50 (median 35.2) years. The median percentage for Hispanics was 11.0 percent, and the proportion of uninsured patients was 25 percent. Preintervention no-show rates ranged from 14 percent (clinic B) to 38 percent (clinic E). All clinics had lower no-show rates during the postintervention period, with decreases ranging from 1 percent (clinic B) to 13 percent (clinic E). Overall, the no-show rates decreased in the study. CONCLUSIONS The study demonstrated the feasibility of applying the NIATx model to reduce no-show rates, with some difficulty observed with sustainability across dental practices during the postintervention period.
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Affiliation(s)
| | - Deanne Boss
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA
| | - Nora Jacobson
- Institute for Clinical and Translational Research and School of Nursing, University of Wisconsin-Madison, WI, USA
| | - Ming Veronica Wang
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, Madison, WI, USA
| | - Aniko Szabo
- Institute for Health & Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Elaye Okunseri
- Clinical Services, Marquette University School of Dentistry, Milwaukee, WI, USA
| | - Todd Molfenter
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, USA
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Weber K, DaSilva AF, Dault JT, Eber R, Huner K, Jones D, Kornman K, Ramaswamy V, Snyder M, Ward BB, Nalliah RP. Using business intelligence and data visualization to understand the characteristics of failed appointments in dental school clinics. J Dent Educ 2021; 85:521-530. [PMID: 33508149 DOI: 10.1002/jdd.12538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVES Broken appointments are an important cause of waste in health care. Patients who fail to attend incur costs to providers, deny trainees learning opportunities, and impact their own health as well as that of other patients who are waiting for care. METHODS A total of 410,000 appointment records over 3 years were extracted from our electronic health record. We conducted exploratory data analysis and assessed correlations between appointment no-shows and other attributes of the appointment and the patient. The University of Michigan Medical School's Committee on Human Research reviewed the study and deemed that no Institutional Review Board oversight was necessary for this quality improvement project that was, retrospectively, turned into a study with previously de-identified data. RESULTS The patient's previous attendance record is the single most significant correlation with attendance. We found that patients who said they are "scared" of dental visits were 62% as likely to attend as someone reporting "no problem." Patients over 65 years of age have better attendance rates. There was a positive association between receiving email/text confirmation and attendance. A total of 94.9% of those emailed a reminder and 92.2% of those who were texted attended their appointment. CONCLUSION(S) We were able to identify relationships of several variables to failed and attended appointments that we were previously unknown to us. This knowledge enabled us to implement interventions to support better attendance at Dental Clinics at the University of Michigan, improving patient health, student training, and efficient use of resources.
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Affiliation(s)
- Kate Weber
- Health Infrastructures and Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Alexandre F DaSilva
- Dental, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Jean T Dault
- University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Robert Eber
- Dental, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Kim Huner
- University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Darlene Jones
- Dental Hygiene, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Kenneth Kornman
- Dental, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Vidya Ramaswamy
- Assessment, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Mark Snyder
- Vertically Integrated Clinic, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Brent B Ward
- Oral Maxillofacial Surgery, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Romesh P Nalliah
- Patient Services, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Wang TT, Mehta H, Myers D, Uberoi V. Applying behavioral economics to reduce broken dental appointments. J Am Dent Assoc 2021; 152:3-7. [PMID: 33413850 DOI: 10.1016/j.adaj.2020.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/29/2020] [Accepted: 07/28/2020] [Indexed: 11/27/2022]
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Shadrav A, Kalenderian E, Roig P. "7/12" patient touch point strategy: a novel method to increase patient attendance and recommendation. BDJ Open 2019; 5:14. [PMID: 31632693 PMCID: PMC6795842 DOI: 10.1038/s41405-019-0023-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/15/2019] [Accepted: 08/21/2019] [Indexed: 11/23/2022] Open
Abstract
The US dental system is not likely to see major expansions in dental care use in the foreseeable future. The rise of dental care utilization among low-income children as well as wealthy seniors did not offset flat dental utilization among adults since the Great Recession. Similarly in Spain, the increase in the number of dental practitioners surpasses the rate of population growth. Hence, in order to remain economically viable in this competitive market, one important aspect for every dental office is to retain patients besides attracting new ones. Patients may be lost to follow-up due to a number of factors, including a lack of attention from the dental practice or a lack of trust in the provider. The “7/12" patient touch point strategy of marketing builds consumer loyalty as a result of a strong patient–provider relationship. Furthermore, this method aims to facilitate the patient’s decision to visit their dentist when it is time for preventative treatments. The purpose of this study was to measure the efficacy of a “7/12” patient touch point strategy when compared to the traditional annual recall with respect to number of active patients, percentage of word-of-mouth-recommended patients, and overall number of first-visit patients. We executed the relationship marketing concept through a novel “7/12” patient touch point approach, in which the patient was exposed to seven separate exposures in a period of 12 months. The efficacy of the “7/12” patient touch point was analyzed for 48 months across 10 clinics (24 months before and 24 months after the “7/12” strategy implementation). The “7/12” patient touch point strategy resources consisted of online and printed materials with a focus on oral health knowledge. fter analyzing the efficacy of the “7/12” patient touch point, we found an average increase of 86.91% in the number of active patients, 24.12% in the number of word-of-mouth-recommended patients, and 38.05% in the number of first visits across all clinics. This novel “7/12” patient touch point approach may be successful in increasing the retention of existing patients and generating new patients. Furthermore, this method promotes preventative care and oral health maintanance for patients and economic progress for the dental clinic.
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Affiliation(s)
- Aida Shadrav
- 1Harvard School of Dental Medicine, Boston, MA USA
| | - Elsbeth Kalenderian
- 2Department of Preventive and Restorative Dental Sciences, University of California at San Francisco, San Francisco, CA USA
| | - Primitivo Roig
- 1Harvard School of Dental Medicine, Boston, MA USA.,dentalDoctors Institute of Management, Valencia, Spain
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Goldthorpe J, Sanders C, Macey R, Gough L, Rogers J, Tickle M, Pretty I. Exploring implementation of an electronic referral management system and enhanced primary care service for oral surgery: perspectives of patients, providers and practitioners. BMC Health Serv Res 2018; 18:646. [PMID: 30126391 PMCID: PMC6102936 DOI: 10.1186/s12913-018-3424-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/26/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A specialist primary care oral surgery service combined with an electronic referral management and triage system was developed in response to concerns raised around overburdened secondary care services in the UK. Whilst the system has the potential to manage conflicting demand for oral surgery services against an objective need, the new pathway represents a number of challenges to existing working practices and could compromise the sustainability of existing hospital services. The aim of this research was to carry out a qualitative exploration of implementation of a new intervention to gain insight into how these challenges have manifested and been addressed. METHODS Views were sought from stakeholders (dentists, hospital staff, commissioners and patients) at various time points over 3 years during and after implementation using semi-structured interviews. Normalization Process Theory informed a qualitative thematic analysis which was carried out using data from interview transcripts to identify important emerging issues. RESULTS Themes emerging from the data were; amenability to change and assimilation into practice (primary care dentists), compliance and governance, changing perceptions of impact (secondary care staff and commissioners) understanding change in service provision and priorities for treatment (patients). The new pathway impacted stakeholders at different stages of implementation. CONCLUSION Electronic referral management with a primary care advanced service for oral surgery was successfully implemented in a specific area of the UK. The service model evaluated has the potential to be expanded across a wider geographical footprint and to support demand management in other specialist services.
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Affiliation(s)
- Joanna Goldthorpe
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Coupland 1 Building, Manchester, M13 9PL UK
| | - Caroline Sanders
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Williamson Building, Manchester, M13 9PL UK
| | - Richard Macey
- Division of Dentistry, University of Manchester, J R Moore Building, Manchester, M13 9PL UK
| | - Lesley Gough
- Public Health England, Cheshire and Merseyside PHE Centre 5th Floor, Rail House Lord Nelson Street, Liverpool, L1 1JF UK
| | - Jean Rogers
- NHS England North, Regatta Place, Brunswick Business Park, Summers Road, Liverpool, L3 4BL UK
| | - Martin Tickle
- Division of Dentistry, University of Manchester, J R Moore Building, Manchester, M13 9PL UK
| | - Iain Pretty
- Colgate Palmolive/ University of Manchester Dental Health Unit, Williams House, Manchester Science Park, Manchester, M15 6SE UK
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Shabbir A, Alzahrani M, Abu Khalid A. Why Do Patients Miss Dental Appointments in Eastern Province Military Hospitals, Kingdom of Saudi Arabia? Cureus 2018; 10:e2355. [PMID: 29805924 PMCID: PMC5963945 DOI: 10.7759/cureus.2355] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
No-shows for scheduled appointments are a frequent occurrence, creating unused appointment slots and reducing patient quality of care and access to services while increasing loss to follow-up and medical costs. The aim of our study was to determine the factors that lead to patients missing their dental appointments in Eastern Province Military Hospitals, Kingdom of Saudi Arabia. The study population included military personnel and their families attending the dental clinics of these hospitals. In our study, the percentage of missed appointments was 58.1%, while 54.4% of participants canceled dental appointments in the past. Thirty-six percent preferred morning appointments while 56% preferred an afternoon appointment and were likely to miss a morning appointment if given one. The most common reasons for missing an appointment were forgetting about it (24.3%) and the inability to get time off either from work or school (15.4%); 1.5% of patients stated they had a bad dental experience and feared dental treatment while the unavailability of transport accounted for 0.7% of patients. Of the reasons given for canceling an appointment, the inability to get time off from work/school was the most common (22.1%) while a dislike for treatment was the least common (0.7%). Canceling an appointment was significantly correlated with missing an appointment among the surveyed sample (P=0.00). In our research, 60.3% of participants still relied on their personal diary to remember appointments, which could be a reason for the high rate of missed appointments. Fifty-nine percent of respondents felt that missing an appointment was important to them, while 72% stated that missed appointments could affect the work of the clinic but still believed that automatic appointments should be given to patients who missed them and a change be made accordingly. Since major factors included a lack of a reminder message and appointments scheduled at inconvenient timings, some steps that can help reduce the frequency of missed appointments include sending a reminder message to patients, giving preference to their schedules for appointments, giving patients shorter appointments, reducing intervals between subsequent appointments, and educating patients regarding the treatment plan, to reduce anxiety.
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Affiliation(s)
- Ambreen Shabbir
- Pathology, Prince Sultan Military College of Health Sciences, Dhahran, Kingdom of Saudi Arabia
| | - Mohammad Alzahrani
- Vice Dean for Development and Quality, Department of Dental and Oral Health, Prince Sultan Military College of Health Sciences, Dhahran, Kingdom of Saudi Arabia
| | - Areej Abu Khalid
- Chairperson, Department of Dental and Oral Health, Prince Sultan Military College of Health Sciences, Dhahran, Kingdom of Saudi Arabia
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Lapidos A, Shaefer H, Gwozdek A. Factors associated with appointment-keeping in an American University's dental clinic system: toward practice-based population health. Public Health 2017; 151:59-62. [DOI: 10.1016/j.puhe.2017.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/28/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
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Nayor J, Maniar S, Chan WW. Appointment-keeping behaviors and procedure day are associated with colonoscopy attendance in a patient navigator population. Prev Med 2017; 97:8-12. [PMID: 28024864 DOI: 10.1016/j.ypmed.2016.12.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/15/2016] [Accepted: 12/18/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patient navigator programs (PNP) have been shown to improve colonoscopy completion with demonstrated cost-effectiveness. Despite additional resources available to these patients, many still do not attend their colonoscopies. The aim of this study was to determine factors associated with colonoscopy attendance amongst patients in whom logistical barriers to attendance have been minimized through enrollment in a PNP. METHODS Retrospective case-control study of patients enrolled in a PNP for colonoscopy performed at a tertiary endoscopy center from 2009 to 2014. Cases were defined as patients who did not attend their first scheduled colonoscopy after PNP enrollment. Age- and gender-matched controls completed their first scheduled colonoscopy after PNP enrollment. RESULTS 514 subjects (257 cases, mean age 57.1years, 36.6% males) were included. Patients who attended their colonoscopy were less likely to be Spanish-speaking (64.6% vs 78.2%, p=0.0003) and uninsured (0.4% vs 3.9%, p=0.006). Attendance rates were significantly lower for screening colonoscopies compared to an indication of surveillance or diagnostic (45.5% vs 65.3%, p<0.0001). Fewer patients attended colonoscopies scheduled on Monday (39.2% vs 52.1%, p=0.04) and in December (10.7% vs 52.3%, p<0.0001). On multivariate analysis, poor appointment-keeping behaviors, including a prior missed colonoscopy (OR 0.20, 95% CI 0.10-0.39) or missed office visit (OR 0.44, 95% CI 0.26-0.73) and procedures scheduled on Mondays (OR 0.51, 95% CI 0.27-0.94) were negatively associated with attendance. CONCLUSIONS Appointment-keeping behaviors, in addition to insurance-status, language-barriers and medical comorbidities, influence colonoscopy attendance in a PNP population. Patients scheduled for colonoscopies on Mondays or in December may require more resources to ensure attendance.
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Affiliation(s)
- Jennifer Nayor
- Brigham and Women's Hospital, Division of Gastroenterology, Hepatology and Endoscopy, 75 Francis Street, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA.
| | - Swapnil Maniar
- Brigham and Women's Hospital, Division of General Internal Medicine, 801 Massachusetts Ave, Suite 610, Boston, MA 02118, USA.
| | - Walter W Chan
- Brigham and Women's Hospital, Division of Gastroenterology, Hepatology and Endoscopy, 75 Francis Street, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA.
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