Part III – The journey of D4C dental brands
This is the third part of a three-part series on the essential role that quality measurement will play in dentistry and oral health.
As we have seen in Parts I and II of this series, dentistry is in the nascent stage of developing and implementing the quality measures that have increasingly become the standard in clinical medicine today. ‘hui. In our final installment, I will examine a company’s approach to establishing itself as a leader in dental quality.
D4C Dental Brands is the largest pediatric dental and orthodontic network in the United States. The company’s journey to quality officially began in 2018. Since then, D4C has worked with its Dedicated Quality Care Team (QCT), made up of pediatric dentists and orthodontists from across the country, who provide clinical advice. and disseminate information to support dental practices to help raise the standard of children’s oral health.
[Disclosure: D4C is a portfolio company of Cressey & Co., where I serve as Special Partner]
Historically, for a multitude of reasons but largely due to the nature of reimbursement, dental spaces have lagged behind other medical and hospital sectors in the development of specific quality measures. In the absence of meaningful and nationally accepted quality measures, D4C proactively committed in 2018 to establishing a formal quality program that could lead the way.
The D4C team has worked with its pediatric dentists and orthodontists to develop an exclusive set of quality measures reflecting the dental care provided to patients. The initial set of quality measures in 2018 included a dozen measures. Once these initial parameters were defined, the required data was extracted from the D4C electronic medical record system. The QCT then reviewed the data, meticulously refined metric definitions, and assessed potential distribution methods.
Through collaboration within the company, the next step was to create easy-to-use and informative dashboards for the entire network of supported dentists. Dentists could then confidentially compare their own measurements with the average measurements of other company-backed dentists across the country. From the outset, the critical importance of continuous compilation, monitoring and quarterly reporting was emphasized.
The newly compiled data has led to ongoing company-wide collaboration and training for continuous quality improvement. The physician leadership team used the dashboards to engage regularly with individual providers on the substantive quality aspects underlying each of the metrics. These quality priority areas have been reinforced by formal continuing education events sponsored by D4C. The continuous cycle of quality improvement was underway.
And the quality has been improved! Quantifiable improvements were seen in individual provider averages and across the company, resulting in patients receiving better quality dental care.
An illustration: one of the measures is defined as “Total pulsotomies during the period as a percentage of the total number of crowns during the period. Stainless steel crowns are a common procedure in pediatric dentistry used to restore teeth with extensive decay. Pulpotomies, defined as a partial nervous treatment, have been performed routinely to treat deep caries (cavities) near the nerve, before the crown is placed. However, the latest research generally shows higher success rates for crown-treated teeth when the nerve is preserved and a pulpotomy is not performed.
The measurement data was shared on the dashboard with each dentist for self-comparison. For the first time, they could see how their practice differed from others. Importantly, the company has also supported the metric by providing strong educational opportunities for physicians regarding the latest literature on pulpotomy treatments.
And the result: Over the next 12 months, the average company-wide pulpotomy use has decreased by 5%, simply by educating, communicating and sharing with physicians their own and their own data. ‘company.
And the quality program continues to progress. In 2019 the company started to develop Quality indicators 2.0, additional clinical measures further promoting high quality dentistry. This second generation built on the first ones by moving from measures based primarily on usage (for example, whether a preventative sealant was placed on the tooth) to the quality of the procedure itself (for example, how many time the sealer lasted or the effectiveness of a restoration).
The QCT continually challenges its associate dentists to recommend new, state-of-the-art quality measures. This community-wide commitment has become an integral part of the culture of the physicians supported by D4C, all committed to providing the best possible care for every patient.
The journey of developing quality metrics is not without limits and challenges. For example, not all offices supported by D4C use the same DME system. It can be intimidating to create standard definitions for quality measures in every single EMR, requiring data extraction and then integration for presentation in a consistent format. Additionally, the first iterations of the quality metrics required significant manual work to extract, compile, and format. The data analysis team now has most of the metrics fully automated and accessible to chief physicians with a single click.
Culture change can be difficult. Overall, the service providers received were very positive. Clinicians want to do the best they can for their patients. They value the opportunity and the tools to collaborate with their leading physicians on quality and see how they fare compared to other specialists in their field.
And this effort supported D4C’s retention and recruitment efforts. Clinicians, especially specialists, have found it rewarding to work for an organization that doesn’t just talk about quality, but leads the country and the field in its definition. As D4C continues to grow and seeks to affiliate with more dental practices, physicians interested in transitioning their practices are particularly interested in partnering with an organization that is fundamentally committed to and actively demonstrates care of the highest level. quality.
The D4C Dental Brands team continues to explore how best to develop its metrics into industry-wide standards, identifying opportunities to both publish its quality data in peer-reviewed journals and to partner with payers, especially as part of the shift to value and more integrated whole body care continues. Quality has become a central part of the culture that defines the organization and the people.
This change in practice and mindset has taken years, but is increasing dramatically in efficiency and provider involvement. D4C Dental Brands offers an approach that a dental services organization can take to advance the movement to boldly advance dentistry into quality care.
In part 1, we examined why the field of dentistry has fallen behind in measuring quality. In part 2, we examined the history of quality measurement in the medical field and how the oral health field can benefit from the learnings of quality measurement from other industries.