Center for Oral Health Systems Integration and Improvement

Readiness Assessment: Assessing Capacity to Implement Oral Health Quality Indicators for the Maternal and Child

Health Population

Prepared by:

Dental Quality Alliance

National Maternal and Child Oral Health Resource Center

Section 1: Assessment Overview

PURPOSE AND USE

This tool is designed to help state oral health programs explore the capacity for collection of, access to, and analysis of the data used to calculate maternal and child health (MCH) oral health quality indicators. The indicators were identified by the Center for Oral Health Systems Integration and Improvement (COHSII) project to promote state efforts to monitor and improve the quality of oral health care for the MCH population. For more information, see www.mchoralhealth.org/cohsii/quality.php.

ORGANIZATION

This readiness assessment is organized by the data sources used to calculate the indicators:• Pregnancy Risk Assessment Monitoring System (PRAMS)• Behavioral Risk Factor Surveillance System (BRFSS) • Basic Screening Survey (BSS)• Medicaid administrative claims and enrollment data

BENEFITS OF USING THIS ASSESSMENT

1. Engages key stakeholders. The quality indicators rely on different data sources that are likely governed by different state agencies. Completing this assessment provides the opportunity to build partnerships between state oral health program staff, the state MCH director, Medicaid staff, state epidemiologists/data analysts, and other organizations that serve the MCH population to promote data collection, sharing, and reporting.

2. Provides summary of reporting capacity. After filling out the assessment, you will be provided with a summary of your responses that you can use as a reference document about the status of oral health data collection and reporting in your state.

3. Supports developing an action plan. The findings of the assessment can be used to develop an action plan for reporting indicators with the highest feasibility and to create a longitudinal plan for increasing data collection and reporting capacity. Collaborating on quality indicator reporting can help state programs and other organizations serving the MCH population jointly identify and prioritize areas to target for oral health care quality improvement.

HOW COHSII USES THE DATA

COHSII staff will use data from the completed assessment to identify opportunities to provide technical assistance to state oral health programs to help them improve data collection, sharing, and reporting. State responses will be aggregated to develop a summary of readiness to report indicators and to share promising practices. A summary will be shared with the Maternal and Child Health Bureau (MCHB), Health Resources and Services Administration.

No individual state’s responses will be shared with MCHB or publicly reported.

Please contact us with any questions about this assessment.

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READY TO BEGIN?

1. An online version of this assessment is available. Please contact us to receive an e-mail invitation to complete the online assessment.

2. Each section of the assessment covers a different data source. You may find it most effective to focus on one data source at a time.

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Section 2: Background InformationPlease enter information about the person completing the assessment below.

1. Name:

2. Title/Position:

3. Department/Agency/Organization:(e.g., Department of Health, Medicaid Program)

4. State (where department/agency/organization is located):

5. Date assessment completed:

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Enter your answer

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Enter date using calendar dropdown

Section 3: Readiness to Report Indicators Derived from PRAMS

The next few questions ask about PRAMS administration within your state.

6. Which agency in your state administers PRAMS?

If your state does not currently participate in PRAMS, please indicate this with a brief description of when (if ever) your state last participated in PRAMS. Then Skip to Section 3: Readiness to Report Indicators Derived from BRFSS.

7. PRAMS staff and steering committee members can help you identify the costs and procedures involved with including oral health questions on your state PRAMS questionnaire (e.g., how to submit questions, cost of adding questions, when questions can be added). Do you know who to contact to discuss PRAMS?

☐ Yes☐ No

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The Pregnancy Risk Assessment Monitoring System (PRAMS) is a surveillance project of the Centers for Disease Control and Prevention (CDC) and state health departments. PRAMS collects ongoing, population-based state-specific data that are available at the state level. The PRAMS questionnaire, which is developed in phases, includes core questions that are asked by all states, standard questions that states can choose to select, and state-developed questions. Each state convenes a PRAMS steering committee that advises PRAMS staff on questionnaire development; question selection; and use, dissemination, and application of findings. Learn more at www.cdc.gov/prams/index.htm.

PRAMS is the data source for four of the five MCH oral health quality indicators for women of childbearing age:

W.1. Percentage of pregnant women reporting difficulty getting dental careW.2. Percentage of pregnant women who had insurance to cover dental care during pregnancyW.3. Percentage of pregnant women who reported having their teeth cleaned by a dentist or dental hygienist during pregnancyW.5. Percentage of pregnant women reporting that they needed to see a dentist for a problem during pregnancy

Assessment tip: Find out who the relevant PRAMS contacts are within your state if you don't already know. If your oral health program does not already have a connection to these individuals or to the PRAMS steering committee, identify ways to establish connections.

Enter your answer

8. This question asks about whether your state’s PRAMS survey includes specific questions needed to calculate the MCH oral health quality indicators.

For each PRAMS question below, indicate the years this question was included on your state’s PRAMS survey.

2020 2019 2018 2017 2016Before 2016 None

Phase 8, core question 17: During your most recent pregnancy, did you have your teeth cleaned by a dentist or dental hygienist?

☐ ☐ ☐ ☐ ☐ ☐ ☐

Phase 8, standard question Y6: Did any of the following things make it hard for you to go to a dentist or dental clinic about the problem you had during your most recent pregnancy? [a. could not find dentist/dental clinic that would take pregnant patients; b. could not find dentist/dental clinic that would take Medicaid patients; c. did not think it was safe to go to the dentist; d. could not afford to go to the dentist]

☐ ☐ ☐ ☐ ☐ ☐ ☐

Phase 8, standard question Y7: This question is about the care of your teeth during your most recent pregnancy. [a. knew it was important to care for my teeth/gums; b. dental/health care worker talked with me about how to care for my teeth/gums; c. had insurance to cover dental care; d. needed to see a dentist for a problem; e. went to a dentist or dental clinic about a problem]

☐ ☐ ☐ ☐ ☐ ☐ ☐

The next few questions ask about your program’s access to your state’s PRAMS data and capacity to calculate the MCH oral health quality indicators.

9. Does your program have access to your state’s PRAMS data?

☐ Yes, direct access—can pull data directly from PRAMS database☐ Yes, indirect access—access granted through a memorandum of understanding or collaborative agreement☐ No current access

10. Does your program have the personnel and resources needed to calculate indicator scores from the source 5 | P a g e

Assessment tip: If you are collecting ANY of the 3 PRAMS questions above, you may be able to report on at least one PRAMS-based indicator. If you have data for multiple years, you may be able to evaluate trends over time. Use the next set of questions to assess if (1) you can get access to the data and (2) there is capacity to calculate the indicator.

If your state is not currently collecting all 3 of the above PRAMS questions, reach out to your state's PRAMs coordinator or the oral health contact on your state's PRAMS steering committee to explore opportunities to include these questions in your state's PRAMS survey. Ask about costs of adding questions, submission time frames, and the processes for selecting questions. Find out how your program can be involved in these processes.

data? Resources can be in-house or through partnerships with other state agencies.

When answering this question, you may want to refer to the User Guide, which includes detailed technical specifications for calculating the quality indicators: www.mchoralhealth.org/PDFs/COHSII-user-guide.pdf .

☐ Yes☐ No

11. Please describe any challenges or barriers your state or your program faces related to collecting, accessing, analyzing, and reporting PRAMS questions above that are used to calculate the MCH oral health quality indicators:

12. The COHSII project is compiling strategies that states have found useful related to collecting and reporting on PRAMS oral health questions. Please describe any strategies that help promote communication and coordination between the state oral health program, PRAMS administration within the state, and any other relevant entities serving the MCH population within your state:

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Enter your answer

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Assessment tip: If you do not have access to PRAMS data or do not have the personnel and resources needed to calculate indicator scores from the source data, reach out to the PRAMS contacts you have identified to seek access to data and opportunities for collaboration. Jointly identify shared goals, how indicator reporting can support those goals, whether data sharing agreements are needed, resource requirements, and strategies for securing needed resources.

Section 4: Readiness to Report Indicators Derived from BRFSS

The next two questions ask about administration of BRFSS within your state.

13. Which state agency administers BRFSS?

14. Do you know whom to contact within the state agency to discuss getting access to BRFSS data?

☐ Yes☐ No

The next few questions ask about your program’s access to your state’s BRFSS data and capacity to calculate the MCH oral health quality indicators.

15. Does your program have access to your state’s BRFSS data?

☐ Yes, direct access—can pull data directly from BRFSS database☐ Yes, indirect access—access granted through a memorandum of understanding or collaborative agreement☐ No current access

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The Behavioral Risk Factor Surveillance System (BRFSS) is a system of health-related telephone surveys that collect state data about U.S. residents relating to their health-related risk behaviors, chronic health conditions, and use of preventive services. BRFSS includes an oral health core set of questions asked in even-numbered years. Learn more about BFFSS at www.cdc.gov/brfss and in the BRFSS Data User Guide available at www.cdc.gov/brfss/data_documentation/pdf/UserguideJune2013.pdf.

BRFSS is the data source for one of the five MCH oral health quality indicators for women of child-bearing age:

W.4. Percentage of women of child-bearing age (ages 18–44) who report having a visit to a dentist or dental clinic in the past year

All states collect the question needed to calculate this indicator (in the oral health core set collected in even-number years), which was Question C07.01 in 2018: Including all types of dentists, such as orthodontists, oral surgeons, and all other dental specialists, as well as dental hygienists, how long has it been since you last visited a dentist or a dental clinic for any reason?

Enter your answer

Assessment tip: Find out who the relevant BRFSS contacts are within your state if you don't already know. If your oral health program does not already have a connection to these individuals, identify ways to establish connections.

16. Does your program have the personnel and resources to calculate indicator scores from the source data? Resources can be in-house or through partnerships with other state agencies.

When answering this question, you may want to refer to the User Guide, which includes detailed technical specifications for calculating the quality indicators: www.mchoralhealth.org/PDFs/COHSII-user-guide.pdf.

☐ Yes☐ No

17. Please describe any challenges or barriers your state or your program faces related to collecting, accessing, analyzing, and reporting the BRFSS oral health question identified above:

18. The COHSII project is compiling strategies that different states have found useful related to collecting and reporting oral health information through state BRFSS surveys. Please describe any strategies that help promote communication and coordination between the state oral health program, BRFSS administration within the state, and any other relevant entities serving the MCH population within your state:

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Enter your answer

Enter your answer

Assessment tip: If you do not have access to BRFSS data or the personnel and resources to calculate the indicator score, reach out to identified BRFSS contacts to seek access to data and opportunities for collaboration. Jointly identify shared goals, how indicator reporting can support those goals, whether data sharing agreements are needed, resource requirements, and strategies for securing needed resources. The Association of State and Territorial Dental Directors (ASTDD) may also be able to facilitate access to data and technical assistance.

Section 5: Readiness to Report Indicators Derived from BSS

The next two questions ask about BSS administration within your state.

19. Which state agency administers the BSS?

20. Do you know whom to contact within the state agency to discuss the BSS?

☐ Yes☐ No

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The Association of State and Territorial Dental Directors (ASTDD) developed Basic Screening Survey (BSS) tools to help state and local public health agencies monitor the burden of oral disease. ASTDD provides guidance for conducting, analyzing, and reporting BSS data. ASTDD recommends that the BSS be conducted every 5 years. Learn more at www.astdd.org/basic-screening-survey-too l .

BSS is the data source for four of the MCH oral health quality indicators for children:

C.8. Percentage of kindergarten children with dental caries experience (treated or untreated tooth decay)C.9. Percentage of third-grade children with dental caries experience (treated or untreated tooth decay)C.10. Percentage of kindergarten children with urgent dental treatment needsC.11. Percentage of third-grade children with urgent dental treatment needs

Enter your answer

Assessment tip: Find out who the relevant BSS contacts are within your state if you don't already know. If your oral health program does not already have a connection to these individuals, identify ways to establish connections.

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21. This question asks about whether your state has conducted a BSS for specific populations.

For each population, indicate during which school years your state conducted a BSS.

2019–2020

2018–2019

2017–2018

2016–2017

2015–2016

2014–2015

Before 2014–2015 None

Kindergarten

Note: The kindergarten population is separate from Early Head Start and Head Start. Answer for screening surveys of the kindergarten population only and not those for Early Head Start and Head Start.

☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐

Third Grade ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐Women of Reproductive Age/Pregnant Women

Note: The MCH oral health quality indicators do not rely on BSS data for women of reproductive age/pregnant women, but the COHSII project would like to assess the extent to which these screenings are being conducted.

☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐

The next few questions ask about your program’s access to your state’s BSS data and capacity to calculate the MCH oral health quality indicators.

22. Does your program have access to your state’s BSS data?

☐ Yes, direct access—can pull data directly from BSS database☐ Yes, indirect access—access granted through a memorandum of understanding or collaborative agreement☐ No current access

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Assessment tip: It is recommended that BSS clinical screening surveys be conducted every 5years. These screenings are resource intensive. If your state has difficulty conducting these surveys or conducts them for the third-grade population only, work with BSS contacts and other oral health stakeholders in your state to jointly identify shared goals and to identify additional resources that can be used to conduct these surveys. For example, some states have gained support from their state department of education to support kindergarten and third-grade screenings.

23. Does your program have the personnel and resources needed to calculate indicator scores from the source data? Resources can be in-house or through partnerships with other state agencies.

When answering this question, you may want to refer to the User Guide, which includes detailed technical specifications for calculating the quality indicators: www.mchoralhealth.org/PDFs/COHSII-user-guide.pdf.

☐ Yes☐ No

24. Please describe any challenges or barriers your state or your program faces related to conducting oral health BSSs for the kindergarten and third-grade populations as well as any challenges related to accessing, analyzing, and reporting data collected from the screening surveys:

25. The COHSII project is compiling strategies that different states have found useful related to collecting and reporting on BSS data. Please describe any strategies that your state uses to secure the funding and coordination needed to conduct BSSs for the kindergarten and third-grade populations, as well as any strategic partnerships formed. In addition, if you conduct a BSS for women of reproductive age or pregnant women, please share information about how the screening is funded and information about sampling and site selection.

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Assessment tip: Most states conduct the third-grade screening survey. Seek to calculate the indicator score for the most recent year this survey was conducted. If you do not have access to BSS data or the personnel and resources to calculate the indicator score, reach out to BSS contacts to seek access to data and opportunities for collaboration. Jointly identify shared goals, how indicator reporting can support those goals, whether data-sharing agreements are needed, resource requirements, and strategies for securing needed resources. The Association of State and Territorial Dental Directors (ASTDD) may also be able to facilitate access to data and technical assistance.

Enter your answer

Enter your answer

Section 6: Readiness to Report Indicators Derived from Medicaid Administrative Data

Medicaid provides health coverage to people with low incomes and is one of the largest payers for health care in the United States. Medicaid is administered by states, within federal guidelines. The Centers for Medicare & Medicaid Services’ Center for Medicaid and CHIP Services serves as the focal point for national program policies. Medicaid administrative and enrollment claims data are typically housed within the state agencies (or agency) that oversee(s) the administration of the state’s Medicaid program and Children’s Health Insurance Program (CHIP) or through their contracted managed care organizations. Other state agencies may have difficulty accessing these data. Although CMS-416 data are derived from Medicaid claims data, they do not have enough detail to calculate the validated MCH oral health quality indicators.

Medicaid/CHIP administrative data are the data used for seven of the MCH oral health quality indicators for children, six of which were developed by the Dental Quality Alliance (DQA) (www.ada.org/en/science-research/dental-quality-alliance):

C.1. Dentists who actively participate in Medicaid per 1,000 EPSDT-eligible enrolled childrenC.2. Percentage of children who had a dental visit in the last 12 monthsC.3. Percentage of children at elevated risk receiving preventive dental servicesC.4. Percentage of children at elevated risk receiving at least two topical fluoride applications as a dental serviceC.5. Percentage of children at elevated risk receiving at least two topical fluoride applications as an oral health serviceC.6. Percentage of children who have received sealants on permanent first molar teeth: (1) at least one sealant and (2) all four molars sealed by the 10th birthdateC.7. Percentage of children who have received sealants on permanent second molar teeth: (1) at least one sealant and (2) all four molars sealed by the 15th birthdate

The next two questions ask about administration of the Medicaid and CHIP programs within your state.

26. Which state agencies (or agency) administer(s) the Medicaid and CHIP programs?

27. Do you know whom to contact at your state Medicaid/CHIP program to discuss oral health quality measures and request data reports?

☐ Yes☐ No

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Enter your answer

Assessment tip: Find out who the relevant Medicaid and CHIP program contacts are within your state if you don't already know, especially those involved with assessing quality of care. If your oral health program does not already have a connection to these individuals, identify ways to establish connections.

28. This question asks about specific DQA measures that are included in the MCH oral health quality indicators set. Measures that are endorsed by the National Quality Forum (NQF) are noted in parentheses with the NQF number indicated.

For each measure, indicate the years your state Medicaid or CHIP program reported it.

2020 2019 2018 2017 2016Before 2016 None

Utilization of Services, Dental Services (NQF #2511) ☐ ☐ ☐ ☐ ☐ ☐ ☐

Preventive Services for Children at Elevated Caries Risk, Dental Services ☐ ☐ ☐ ☐ ☐ ☐ ☐

Topical Fluoride for Children at Elevated Caries Risk, Dental Services (NQF #2528) ☐ ☐ ☐ ☐ ☐ ☐ ☐

Topical Fluoride for Children at Elevated Caries Risk, Oral Health Services ☐ ☐ ☐ ☐ ☐ ☐ ☐

Receipt of Sealants on First Permanent Molars (Note: New measure as of 2020) ☐ ☐ ☐ ☐ ☐ ☐ ☐

Receipt of Sealants on Second Permanent Molars (Note: New measure as of 2020) ☐ ☐ ☐ ☐ ☐ ☐ ☐

The next two questions ask about your program's access to your state's Medicaid data and capacity to calculate the MCH oral health quality indicators.

29. Does your program have access to your state's Medicaid/CHIP data?

☐ Yes, direct access—can pull data directly from Medicaid/CHIP database☐ Yes, indirect access—access granted through a memorandum of understanding or collaborative agreement☐ No current access

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Assessment tip: If you are collecting ANY of the DQA indicators above, you may be able to report on at least one COHSII indicator. If you have data for multiple years, you may be able to evaluate trends over time. Use the next set of questions to assess whether (1) you can get access to the data and (2) there is capacity to calculate the indicator.

If your state is not currently collecting the six DQA indicators above, reach out to your state Medicaid/CHIP contacts to explore opportunities to collaborate on identifying a set of mutually beneficial oral health quality indicators that can be calculated using Medicaid/CHIP claims and enrollment data.

30. Does your program have the personnel and resources needed to calculate indicator scores from Medicaid/CHIP administrative enrollment and claims data if you were granted access? Resources can be in-house or through partnerships with others.

When answering this question, you may want to refer to the User Guide, which includes detailed technical specifications for calculating the quality indicators: www.mchoralhealth.org/PDFs/COHSII-user-guide.pdf.

☐ Yes☐ No

31. Please describe any challenges or barriers your state or your program faces related to collecting, accessing, analyzing, and reporting the DQA measures above:

32. The COHSII project is compiling strategies that different state oral health programs have found useful related to collecting and reporting on measures based on Medicaid/CHIP claims and administrative data. Please describe any strategies that your state or program uses to promote communication and coordination between the state oral health program, the Medicaid/CHIP agency, and any other relevant entities serving MCH populations within the state. Please include how data sharing is handled:

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Enter your answer

Enter your answer

Assessment tip: If you do not have access to Medicaid/CHIP data or the personnel and resources needed to calculate indicator scores, reach out to your Medicaid/CHIP contacts to seek access to data and opportunities for collaboration. Jointly identify shared goals, how indicator reporting can support those goals, whether data sharing agreements are needed, resource requirements, and strategies for securing needed resources. Medicaid/CHIP programs are more likely to share data reports than raw data. Find out how to submit data requests to the Medicaid/CHIP program to calculate specific indicators. Test the process with C.2. Percentage of children who had a dental visit in the last 12 months (DQA Utilization of Services measure).

Section 7: Feedback on Readiness AssessmentPlease provide some brief feedback on your experience with completing this readiness assessment.

33. Please indicate your agreement with the following statements.

Strongly agree Agree

Neither agree nor disagree Disagree

Strongly disagree

The readiness assessment helped with understanding our current capability to report the MCH oral health quality indicators.

☐ ☐ ☐ ☐ ☐

The readiness assessment helped identify what actions we need to take to be able to report MCH oral health quality indicators.

☐ ☐ ☐ ☐ ☐

The readiness assessment helped identify contacts and resources in the state that can assist with data collection and indicator reporting.

☐ ☐ ☐ ☐ ☐

The readiness assessment helped engage other stakeholders involved with oral health quality assessment and improvement.

☐ ☐ ☐ ☐ ☐

I would recommend this readiness assessment to other state oral health programs.

☐ ☐ ☐ ☐ ☐

34. Overall, how useful was this readiness assessment?

☐ Extremely useful☐ Very useful☐ Somewhat useful☐ Not so useful☐ Not at all useful

35. Please provide any additional feedback:

This is the end of the assessment.

THANK YOU!

Enter your answer

Citation and Copyright Information

National Maternal and Child Oral Health Resource Center, Georgetown University and Dental Quality Alliance. 2020. Readiness Assessment: Assessing Capacity to Implement Oral Health Quality Indicators for the Maternal and Child Health (MCH) Population. Washington, DC: National Maternal and Child Oral Health Resource Center; Chicago, IL: Dental Quality Alliance.

Readiness Assessment: Assessing Capacity to Implement Oral Health Quality Indicators for the Maternal and Child Health (MCH)Population © 2020 by National Maternal and Child Oral Health Resource Center, Georgetown University, and Dental Quality Alliance.

This publication was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an annual award totaling $1,000,000 with no funding from nongovernmental sources. This information or content and conclusions are those of the authors and should not be construed as the official policy of HRSA, HHS, or the U.S. government, nor should any endorsements be inferred.

Permission is given to save and print this publication and to forward it, in its entirety, to others. Requests for permission to use all or part of the information contained in this publication in other ways should be sent to the address below.

National Maternal and Child Oral Health Resource Center Georgetown UniversityBox 571272Washington, DC 20057-1272(202) 784-9771E-mail: OHRCinfo@georgetown.edu Website: www.mchoralhealth.org