Transcript The Escambia Dental Cooperative

Paige Collier, MS,West Florida AHEC
Ann Papadelias, BS, Escambia Dental Cooperative, Community Health
Information Network (CHIN) of Escambia and Santa Rosa Counties
Seminar #167
 Founded in 1993
 Serves Walton, Okaloosa, Santa Rosa and
Escambia Counties
 Center affiliated with University of Florida
and Florida State University AHEC Program
Offices
The Florida AHEC Network
MISSION : To create community and academic
partnerships for the health of underserved communities
 5 Program Offices
 10 Centers
 Federal and State
Funded
 Associated with Schools
of Medicine in Florida
Escambia Dental Cooperative (EDC)
A collaborative community partnership of:
 West Florida Area Health Education Center (West
Florida AHEC)
 Pensacola Junior College
 Sacred Heart Health System
The Florida Department of Health, Escambia County Health
Department, is acknowledged for its administration of the grant funds
that were appropriated by the Florida Legislature for use in meeting
the dental needs of the underserved population of the area.
Escambia Dental Cooperative
Pensacola Junior College
Escambia Dental Cooperative
Provides basic emergency dental services for patients
under 200% of the federal poverty guidelines, who are
without medical insurance, and who are not eligible for
any other government assistance.
Eligibility:
 Escambia County, Santa Rosa County Residents ages 19-64.
 Patients must be under 200% Federal Poverty Level.
 Patients must NOT have Medicaid or any other medical or dental
coverage.
 Patients must be financially screened and seen by a medical
provider prior to a referral being made to the EDC.
 Patients must need dental extractions and have dental infection.
 Some Santa Rosa County Residents screened through Santa Rosa
Community Clinic are referred to EDC.
Crisis in our Community:
Few resources for low income, uninsured adults to
gain access to dental care.
 Area Emergency Rooms seeing hundreds of patients with
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dental pain and infection, with no place to send them.
Patients being seen in Primary Care Clinics and FaithBased Clinics for dental infections.
Limited number of volunteer dentists who will see charity
care patients in their private offices.
Patients coming back to Emergency Rooms or Primary
Care Clinics when dental infection reoccurs.
No resolution of dental problem for most patients.
EDC Referral Sites
Baptist ER
St. Joseph’s Medical Clinic
Sacred Heart ER
Escambia Community Clinics
The Uninsured
• Escambia County is the 15th most populous county in the state of Florida
but ranks 28th among 67 counties in per capita income and 66th among
the 67 Florida counties in spending for health and human services.
• More than 66,000 of the 313,000 residents of Escambia County, Florida,
have no health insurance coverage and are not eligible for any publiclyfunded program.
• This means 1 out of every 5 residents has no health insurance.
• The percentage of Escambia County residents without health coverage is
over 20% and exceeds the national average of 16%.
• Half Cent sales tax proposal to subsidize healthcare for the uninsured
was voted down during election in 2007.
Who are EDC Patients?
 80% of our patients have no one person that they consider
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their personal doctor or healthcare provider
50% have used an Emergency Room for a dental problem
65% currently smoke tobacco products daily
60% have lost more than one tooth due to decay
65% have not visited the dentist in the past two years
15% never had their teeth cleaned by a dental hygienist
50% have not had their teeth cleaned in the past five years
Many have chronic diseases such as diabetes, hypertension
and cardiovascular disease, many have one or more chronic
diseases
Who are EDC patients?
Dental Assessment Questionnaire:
• How were you referred to the dental clinic?
• Do you have one person you think of as your personal doctor or health care
provider?
• Have you ever visited the Emergency Room for a dental problem? If yes, where?
• How long has it been since you last visited a dentist or dental clinic for any
reason?
• How many of your permanent teeth have been removed because of tooth decay
or gum disease? (Include only teeth lost to infection)
• How long has it been since you had your teeth cleaned by a dentist or dental
hygienist?
• How would you rate your overall general health?
• Do you currently smoke or use tobacco? (Refer to AHEC Cessation Program)
• How did you get to the dental clinic today?
• If you need to return for additional dental appointments, will you have trouble
finding transportation? (Bus passes provided)
• Do you have a chronic disease that requires medical clearance from your
physician? (Seek Medical Clearance from Primary Care Physician at Clinic)
Several of these questions taken from the Behavioral Risk Factor Surveillance System Questionnaire (BRFSS)
Care for our Clients:
 Referrals are sent electronically via CareScope to schedulers
at Sacred Heart Call Center, and patients are contacted by
schedulers to set up their dental appointment.
 Care is provided free of charge to our clients once they
have been established as eligible for the program.
 Patients may be seen more than one time at the clinic if the
dentist determines that they need additional care.
 Preventive and Dental Hygiene services are available in the
PJC Dental Hygiene Clinic, and appropriate referrals are
made to that program at no cost to the patient.
Scope of Care
• Procedures performed at the clinic include
dental extractions, treatment of dental
infections, oral evaluations and x-rays.
• Limited restorative work (fillings) is done, due
to the great need for emergency extractions in
the majority of referred patients.
• No specialty dental care is provided at the clinic (Root Canals, Crowns).
• EDC dentists refer patients who need additional medical attention to
Escambia Community Clinics, the primary “medical home” in our
county for the charity care patients, or the patient’s other primary care
provider.
• Preventive and Dental Hygiene services are available in the PJC Dental
Hygiene Clinic, and appropriate referrals are made to that program at
no cost to the patient.
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Scope of Care (cont’d)
• AHEC has provided the EDC with specialized equipment
(VELscope)for use in oral cancer screening. VELscope’s fluorescence
technology is noninvasive and aids in the early visualization of mucosal
diseases and enhances effective oral mucosal screening.
**Further information on VELscope available at poster presentation:
Your Mouth: The First
Stop on the Road to Health
• Screening for tobacco use and referral to the AHEC Tobacco Cessation
Program.
Service Learning for PJC Students
Student Training/Clinical Contact Hours
PJC Dental Hygiene Students are afforded student training hours, as
dental clinic patients are referred for dental hygiene services if the
dentist determines need. Contact hours are tracked for all dental
hygiene students treating EDC patients. Statistics are provided
quarterly to West Florida AHEC.
Fiscal Year
2005-06
2006-07
2007-08
2008-09
2009-10
Total Training Hours
701
902
369
590
725
Staff and Clinic Hours
 Clinic is open two full days per
week, presently all day Tuesday,
and Thursday mornings
 Volunteer dentists supplement
hours on Wednesday mornings
 Clinic staff consists of dentist, two
dental assistants, and program
manager
EDC Clinic Statistics
Year
2006
2007
2008
2009
2010
(1st Qtr only)
Number of
Patient Visits
657
Amount of
Care Provided
$276,362
820
907
$457,477
$397,488
1266
299
$494,029
$116,933
Overall EDC Statistics
(2/6/06 through 3/31/10)
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Total Patient Visits: 3,650
$1,742,289 in care provided
Average of $477 per patient
Average Visit: Exam, Full Mouth X-Ray, two to three
extractions
65% New patient visits, 35% Established patient
visits, 5% Post op visits each month
Costs and Benefits
 Cost average $100-120K per year
 Expenses: Staff
 Dentist, Dental Assistants, Program Manager and
Supplies
 Supplies are low cost
 anesthesia, x-ray film, disposables gauze, paper goods
 400% Return on Investment
 Financial savings to Hospitals and Clinics
 ~$500 per ER visit for taking dental patients out of
primary care/ER setting.
Funding Sources for EDC
 West Florida AHEC
 $250,000 over a 3 year period to pay for personnel,
equipment, and supplies
 Sacred Heart Health System
 Legislative dollars allocated that pay for Program
Manager, supplies, and medications
 Pensacola Junior College
 In kind support of facilities and faculty
EDC Volunteer Dentists
Enhance Care for our Patients
 Efforts have been made to gain volunteers from the
EscaRosa Dental Society, with visits to several of the
group’s monthly meetings to give updates on clinic
operations. Messages on volunteer opportunities with the
clinic also run frequently in the Dental Society newsletter.
Currently, there are two active volunteers providing care to
patients.
 Volunteers are under contract with the State of Florida
Volunteer Health Care Provider Program (VHCPP), which
provides sovereign immunity coverage (liability).
Northwest Florida RHIO
Community Health Information Network
(CHIN) of Escambia and Santa Rosa Counties
 Service Referrals from hospitals and clinics are sent to central
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location for scheduling after financial screening and exam are done
Patient information is entered in intake templates at referral sites
Dental Assessment entered into system at dental clinic
Dental Treatment is entered into system at end of visit
Dental Treatment also shows up in medical treatment lookup
Medications entered into system if prescribed by dentist
Completion of Service referral outcome to “complete” upon patient
visit
If additional visits are required, Service Referral is sent to schedulers.
Referral to dental hygiene or primary care is also done if patient
requires further care
Community Health Information
Community Health Information Network
(CHIN) of Escambia and Santa Rosa Counties
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Received HCAP Federal Grant 2006
GO LIVE in June, 2007
Hospital, Community Clinic and Faith Based Clinic usage.
32,000+ patient records in CareScope
111,000 + treatments
17,000 + service referrals
Interfaces with Hospital ER systems, clinics and Pharmacy
Assistance Program (MedData)
 County Health Dept. using CareScope/CHIN as specialty care
referral/tracking system (WeCare) linking physician practices
and partner facilities
CHIN – Where are we now?
Daily utilization of ESHIN systems by 12 independent providers for
enrollment, eligibility, and referral tracking
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Shared Data includes: Patient ID and Demographics, Financial Status, Program
Eligibility, Referral, Episodes of Care/Services Provided, Pharmacy Assistance ,
Valuation of Services
Regular sharing of patient data using automated, electronic systems
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Episode of Care data from providers (site, date, problem, treatment, allergies,
medication)
Merged Pharmacy Assistance Program data (medication, site, primary care
providers)
Access to Community-wide Pharmacy Assistance Program
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Common system/database used at multiple provider sites
Interfaces link PAP data with other treatment data in system
CareScope used for Case Management program at Escambia
Community Clinics
CHIN used as Specialty Care Referral and Tracking system for
Escambia County Health Dept (WeCare)