IMPROVING ORAL HEALTH CARE FOR HIV-POSITIVE PATIENTS
The Brooklyn Hospital Center
The PATH Center

Project Background

Project Name: Improving Oral Health Care for HIV-Positive Patients

HIV Caseload: 656 (2001)

Rationale for Selections: Ongoing monitoring of process improvement data for oral health care (i.e. percentage of patients receiving dental referrals and percentage keeping dental appointments) indicated the need for improvement.

Team Members:

The PATH Center (AIDS Center)

• Dan Sendzik, Director
• Edwin Romero, Operations Manager
• Angela Douglas RN, Senior Staff Nurse
• Kathryn Riley, Director, Quality Assurance

Department of Dentistry

• Harry Dym, Chief of Oral and Maxillofacial Surgery
• Dental Residents for 2000-2002

Success Story

Improvement Goals:

• To increase the percentage of patients referred annually for oral health care to 90% (as compared to 27% during 7/97-6/98)
• To increase the percentage of patients referred who receive oral health care annually to 75% (as compared to 18% during 7/97-6/98)

Methodology: Measure impact of changes (see below) through quarterly review of 48 HIV patient medical records, randomly selected, monitoring for the percentage of patients who received annual oral health referral and the percentage who actually received the service.

Changes Tested:

• Incorporate dental hygienist into HIV adult clinic to perform on-site oral health screening. (Began as pilot during one weekly session. Sought and received Ryan White Title III Expansion Grant to expand hygienist to all four weekly sessions.)

• Add information to residents’ orientation package regarding the importance of oral health care for HIV+ patients, thereby encouraging referrals.
• Use rubber stamp to highlight dental notes in medical record so providers and chart reviewers can spot information easily.
• Create HIV Dental Clinic at one of two hospital campuses where dental services are not available. (Requested and received Ryan White Title III Capacity Building funds for creation of HIV Dental Clinic at the Caledonian Campus in Brooklyn’s Flatbush region. Set-up is underway.)

Baseline and Follow-up Data: Baseline data was collected during 7/97-6/98; follow-up data through 2nd Quarter, 2002.

• Oral health referrals increased from 27% to 88%.
• Oral health care for referred patients increased from 18% to 75%.

Click here to view the tables: Percentage of Patients Referred for Oral Health Care and Percentage of Referred Patients Receiving Oral Health Care
http://hivguidelines.org/public_html/center/quality-of-care/qoc_success_stories/submissions/images/brooklyn-hos-oralh-tab1.gif
http://hivguidelines.org/public_html/center/quality-of-care/qoc_success_stories/submissions/images/brooklyn-hos-oralh-tab2.gif

Summary

Lessons Learned: Incorporating oral health care into the HIV clinic setting and educating providers can increase the percentage of HIV-positive patients receiving oral health care.

Advice to Other HIV Programs: Consider incorporating oral health services (at a minimum, oral health screening by a hygienist) into the HIV clinical setting. Grant sources may be available to help with start-up.

Next Steps:

• Complete installation of dental clinic at Caledonian Campus and initiate services (main Downtown Campus already has dental clinic in place).
• Continue to monitor performance through quarterly random chart reviews, reporting in to bimonthly CQI Team and quarterly PI Team meetings.

For more information, please contact:

Dan Sendzik
Director, The PATH Center
dps9001@nyp.org

The Brooklyn Hospital Center
The PATH Center
P.O. Box 197
121 DeKalb Avenue
Brooklyn, NY 11201
718-940-5934 (phone)
718- 940-5515 (fax)