The Escambia Dental Cooperative A Model Community Collaboration

The Escambia Dental Cooperative: A Model Community Collaboration 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 dental pain and infection, with no place to send them. Patients being seen in Primary Care Clinics and Faith. Based 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 Sacred Heart ER St. Joseph’s Medical Clinic Escambia Community Clinics

The Uninsured • Escambia County is the 15 th most populous county in the state of Florida but ranks 28 th among 67 counties in per capita income and 66 th 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 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 Care. Scope 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 14 no cost to the patient.

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 Number of Patient Visits Amount of Care Provided 2006 2007 657 820 $276, 362 $457, 477 2008 2009 2010 (1 st Qtr only) 907 1266 299 $397, 488 $494, 029 $116, 933

Overall EDC Statistics (2/6/06 through 3/31/10) 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 -120 K per year Expenses: Staff Ø Dentist, Dental Assistants, Program Manager and Supplies are low cost Ø anesthesia, x-ray film, disposables gauze, paper goods 400% Return on Investment Financial savings to Hospitals and Clinics Ø ~$500 per ER visit for taking dental patients out of primary care/ER setting.

Funding Sources for EDC West Florida AHEC Ø $250, 000 over a 3 year period to pay for personnel, equipment, and supplies Sacred Heart Health System Ø Legislative dollars allocated that pay for Program Manager, supplies, and medications Pensacola Junior College Ø In kind support of facilities and faculty

EDC Volunteer Dentists Enhance Care for our Patients Efforts have been made to gain volunteers from the Esca. Rosa 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 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 Network (CHIN) of Escambia and Santa Rosa Counties Received HCAP Federal Grant 2006 GO LIVE in June, 2007 Hospital, Community Clinic and Faith Based Clinic usage. 32, 000+ patient records in Care. Scope 111, 000 + treatments 17, 000 + service referrals Interfaces with Hospital ER systems, clinics and Pharmacy Assistance Program (Med. Data) County Health Dept. using Care. Scope/CHIN as specialty care referral/tracking system (We. Care) 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 • 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 • • 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 • • Common system/database used at multiple provider sites Interfaces link PAP data with other treatment data in system Care. Scope used for Case Management program at Escambia Community Clinics CHIN used as Specialty Care Referral and Tracking system for Escambia County Health Dept (We. Care)