Oral Health Community Action Planning Team

December 16, 2015

Present: Heidi Selberg-HSHS; Bonnie Kuhr, Cathy Therrien—NEW Community Clinic, Chris Vandenhouten, UWGB;, Carrie Stempski, OHP; Jody Wilmett, Bellin Health(by phone , Erin Bongers, De Pere Public Health; Debbie Armbruster, Brown County Public Health; Elaine Doxtator, HSHS St Mary’s Hospital; Mary Gehm, Head Start

1. Reflection

Heidi shared a reflection.

2. Updates

Heidi announced that Stacy Ross has resigned from this committee and the OHP board because she has taken a position outside of public health. We are delighted that Debbie Armbruster from Brown County Health will be continuing on the committee representing Brown County Public Health.

Heidi reported that she has invited the state director of oral health to attend our January meeting—the invitation was actually submitted on our behalf by the regional office of the health department. Should that materialize, we could use it as an opportunity to share our advocacy agenda. In addition, we could offer him a tour of NEW Community Clinic dental program and OHP, should he want to do that.

Cathy shared how the teeth the oral surgeons are extracting are being autoclaved and then shared with the dental students at NWTC. The instructors are using them to help students do identification, and then will have them learn how to do root planning.

Heidi shared a story about a patient in western Wisconsin who has serious dental conditions that are actually significantly impacting his general health.

3. Data review

Heidi shared the analysis of Brown County use rates, with comparisons to Milwaukee and Dane Counties, based on the Health Affairs article. Based on that, Brown is below the expected rate published in the article, but well above the rates for Milwaukee and Dane Counties. Committee concluded that this reinforces the need we all see.

Heidi also shared the time of day analysis the group discussed previously. The conclusion is that while a number of dental visits occur outside regular business hours, they follow the same pattern as ED visits for other conditions.

Follow up:

· Heidi to discuss with CHIP steering committee if they are aware of any successful and consistent interventions that match MA patients with medical resources in a way that reduces the use of the ED for non-emergent conditions. Heidi has explored some hospital based case management programs, but is there anything else out there?

Heidi shared the data for the short term indicators the group listed on the plan. ED visits continue to rise, after a decline after the NEW dental clinic opened. Heidi speculated that the only thing that will start bringing the numbers down again is increased capacity; even the oral surgeons are encouraging expansion of the adult dental clinic. Scott suggested that we enlist help in determining what amount of increased capacity would lead to what levels of reduction of ED use. Heidi talked about a vision for a shared OHP/NEW dental facility including other medical services, but has also wondered if the two populations are compatible because of some of the mental/emotional challenges of the adult population.

Other indicators seem to be on track. Some indicators were not included in the report.

Cathy remarked that they are now receiving the referral forms from the ED, and are seeing that a good share of those referred never follow up with an appointment or other contact with the clinic.

Follow up:

· Scott suggested that we identify an expert who can assist in determining capacity needed—statistician, epidemiologist? Scott will look within the college, Chris within UWGB, and Bonnie will contact Wi Primary Care Association.

· NEW Dental asked Elaine to have the EDs have the patient make the follow up appointments themselves, even if ED staff call, as this seems to be a better indication of someone who will follow through. Appointments made by ED staff seem to result in a greater likelihood of no-show.

· Cathy will provide year end data as soon as possible so that we can make our report to the CHIP committee.

· Cathy will begin to report number of ED referrals (one of our short term indicators); Carrie will provide the sealant info on the short term indicators.

4. Other business

Carrie reported on a dentist that has an interest in opening a dental ED (to operate between 4-8pme) and is exploring locations. He had worked for a while at the dental clinic in Oconto but is now providing services at OHP and has an interest in this idea. He needs some flexibility in his practice because he flies home to Texas at least once per month to help ill family members. He would accept MA and uninsured. Group discussed and thought that if the private sector wants to pursue it, that this should be encouraged as not all solutions need to be handled by the not for profit sector. Heidi volunteered to meet with him to discuss what the group is doing, if that would be of value. Group also discussed the concept of a dental ED.

Follow up:

· Chris is going to explore whether a reseach project on models for dental emergency departments might be a good student project.

· Heidi will wait to see if a meeting with the individual Carrie knows is of interest.

Elaine reported on the meeting between the ED physicians and OHP and NEW Dental. It went well. She also reported on some of the challenges with patients presenting with dental pain wanting narcotics. Group discussed the issue of narcotics, and how EPIC is now permitting NEW Clinic and all local healthcare providers to view who has been where for what purpose. Group also discussed that dental offices tell patients to go to the ED after hours for dental issues, and how that is not a helpful referral for either the patient or the ED.