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Oral Health

TITLE I HIV QUALITY MANAGEMENT PROGRAM

QUALITY PERFORMANCE INDICATORS FOR ORAL HEALTH

The following indicators were selected as the most important for measuring the quality of oral health services provided by dentists or other oral health providers for persons with HIV.

1. A health history assessment should be obtained annually, and include the following:

  • Contact information for primary care provider, and whether patient is receiving care
  • Current medications and changes in regimen
  • Allergies (baseline)
  • Laboratory data
    • Hepatitis B & C status (baseline)
    • CD4 and viral load results
2. An intraoral exam should be performed annually and include the following components:
  • Dental caries examination
  • Soft tissue examination
Documentation regarding any of the following will be sufficient to generate a ‘YES” response for soft tissue examination: pathology of cheeks, tongue, palate, gingiva, mucosa, pharynx, frenum, or floor of mouth.
3. A periodontal exam should be performed annually.

Documentation regarding any of the following will be sufficient to generate a “YES” response for a periodontal exam having been performed: examination of pocket depths, gingival inflammation, plaque index, fremitus, recession, bleeding assessment, or tooth mobility.

4. An extraoral (head and neck) exam should be performed annually.

Documentation for any of the following will be sufficient to generate a “YES” response for an extraoral exam having been performed: examination of facial symmetry, lymph nodes, thyroid glands, or lips.

5. A written treatment plan should be updated annually.

Documentation showing evidence of a treatment plan should include a summary of existing conditions, problems, course of action, and a maintenance program.

6. Oral health education should be provided to the patient annually, and include the following components:
  • Caries prevention (e.g., oral hygiene instruction, dietary counseling)
  • Smoking cessation
Primary Care Indicators
1. Access to Primary Care
Clients should have one visit with their primary care provider at least every six months.
  • For clients who have not had a visit with their primary care provider in the first or last six months of the calendar year, there should be documentation of referral to primary care
  • For patients with a referral to primary care, there should be documentation of follow up within 30 days to determine whether the primary care appointment was kept
  • If documentation of follow up exists, there should be documentation that the client kept the appointment
2. Assessment of whether clients eligible for ARV Therapy are receiving it.
Clients will be reassessed for ARV status at least once every six months.
  • For clients not on ARV, is there information on viral load or CD4 test results?
  • If yes, is the patient eligible for therapy based on viral load (>100,000 copies) or CD4 count (< 350 cells)?
  • If yes, is the patient referred to primary care for assessment of treatment eligibility?
  • If yes, is there documentation of follow up on patient’s status within 30 days?
  • If yes, was the patient placed on ART?
3. Viral load and CD4 Counts
Clients will have lab work completed to assess their viral load and CD4 counts at least once every six months.
  • For clients who have not had a CD4 or viral load test performed in the first or last six months of the calendar year, is there documentation of referral to primary care for these tests?
  • For patients with a referral to primary care, was there documentation of follow up within 30 days to determine whether the laboratory tests were performed?
  • If documentation of follow up exists, is there documentation that the client received the viral load and/or CD4 tests?