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

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. Clinical Data Set 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

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