Health Services Research

1. Dental Informatics and Dental Research Conference National Institutes of Health June 12-13, 2003 Health Services Research Howard Bailit, DMD, PhD University of Connecticut

2. Organization • HSR Definition • Data Sources • Data Collection Barriers • Pipeline Project • Conclusions

3. Definition HSR examines how people get access to health care, how much care costs, and what happens to patients as a result of this care. The main goals of health services research are to identify the most effective ways to organize, manage, finance, and deliver high quality care; reduce medical errors; and improve patient safety. --Agency for Healthcare Research and Quality, 2002

4. Dental HSR • Interest Area within HSR • Recognized Group in IADR/AADR • Limited Number of Investigators • No Current Training Grants/Programs • Notable Research Groups • ADA, UNC, Michigan, UCLA, UWash

5. Data Sources • Secondary Data Sets • Federal health, utilization, expenditure surveys • Paid insurance claims • State and regional surveys • ADA practitioner surveys • Dental items in medical surveys

6. Data Sources • Primary Data Sets: Community, Practice, Patient • Oral health • Patient satisfaction • Provider satisfaction • Utilization • Expenditures

7. Barriers: Service/Charge Data • Technical • Standard dental record • Standard electronic record • Diagnosis codes • Nomenclature

8. Barriers: Service/Charge Data • Organizational • Dental insurance penetration • Dental insurance industry • Market share • Standardization • Claims clearinghouses

9. Barriers: Service/Charge Data • Social • Limited experience of most dentists with research e.g., practice research networks • Approval to link patient or provider demographic, practice organization, utilization, charge, and oral health data

10. Dental HSR Project • “Pipeline, Profession and Practice: Community-Based Dental Education” • Support • Robert Wood Johnson Foundation • The California Endowment • The Kellogg Foundation • Goal – Increase Access for Underserved

11. Pipeline Objectives • 60 days community clinics/practices • Recruitment URM/LI students • Courses prepare students treat underserved • Independent Evaluation - UCLA

12. Pipeline & Informatics • Measure Student/Resident Performance in 150 Community “Patient-Centered” Clinics and Practices • Evaluation program impact • Management of program

13. Pipeline & Informatics • Problems • No common data system • No standard data set • Varied student input devices • No system transfer data to school/project • IRB/HIPAA

14. Pipeline & Informatics • Workgroup • Minimal Data Set • System Design • Manuals/Training Program • Pilot Test • Implement

15. Service Date (week) Age Gender Race Payer School ID Facility ID Student ID Visit Type Service Completion Treatment Plan Status Service Codes School Options Patient ID Preceptor ID Other Clinical Data Set

16. Data System Advantages • Uniform Demographic and Clinical Data • Data on Site, Student Performance • Benchmarks and Norms • Management Reports • Research Potential

17. Conclusions • Dental HSR Important Area Research • Limited Capacity But Growing • Data Sets: Secondary & Primary • Barriers • Pipeline: Overcoming Barriers

18. Conclusions • HSR Long-Term Future Bright • Technology reduce cost of standard data • Investigate key issues • Association services and outcomes • Factors responsible for service variation