Examples of Oral Health Objectives from State HP 2010 Plans
District of Columbia
- Increase to at least 85% the proportion of all children entering school programs for the first time who have received an oral health screening.
- Of those children screened and needing referral, increase to at least 25% the proportion receiving a referral for necessary diagnosis, preventive and treatment services.
- Of those children being referred for treatment, increase to at least 30% the proportion beginning treatment within 90 days. (No baseline data)
West Virginia
- Reduce dental caries (cavities) in primary and permanent teeth (mixed dentition) so that the proportion of children who have one or more cavities (filled or unfilled) is no more than 60% among children aged 8 and 60% among adolescents aged 15. (Baseline: age 8, 65.6%; age 15, 66%)
- Increase to 50% the proportion of school-based health centers (pre-kindergarten through grade 12) with an oral health component. (Baseline: 40% in 1998)
Alaska
- Increase the proportion of children and adolescents under age 19 at or below 200% of federal poverty level who received only preventive dental services during the past year to 50%. (Baseline: 24%)
North Carolina
- Increase the proportion of adults who visited a dentist within the past year to 73.9%. (Baseline: 67.2% in 1999 -- based on 10% improvement)
Iowa
- Increase to at least 70% by the year 2010 the proportion of seniors aged 75 and over who have had a dental examination in the previous year. (Baseline: 50% of rural elders in 1992)
- Increase use of topical fluorides in schools to at least 75% of people not receiving optimally fluoridated public water by the year 2010. (Baseline not yet available)
Kentucky
- Increase to at least 70% the proportion of 8 year-olds, 12 year-olds and 15 year-olds who have received protective sealants in permanent molar teeth. (Baseline: 10% of 5-9 year-olds; 7% of 14-17 year-olds)
Summary of Needs Assessment Methods| METHOD | PURPOSE | COST | TIME INVOLVED | ADVANTAGES |
|---|
- Secondary Data From National or Regional Oral Health Surveys
| Needs or problem analysis | Very Inexpensive | Extremely Fast | Data readily available |
|---|
- Other Secondary Data
| Needs or problem analysis | Inexpensive | Fast to Moderate | Data available (self- reported and other fiscal or regulatory information) |
|---|
- Demographic Indicators
| Needs or problem analysis | Inexpensive | Very Fast | Data available from public documents |
|---|
- Analyzing Non-clinical Data
| Resources analysis | Inexpensive to Moderate | Fast | Can also use for annual reports; trend analysis of activities |
|---|
- Analyzing Clinical Program Data
| Resources analysis | Inexpensive to Moderate | Moderate | Can also use for annual reports; understand extent of services provided |
|---|
- Public Comment
| Needs or problem analysis | Inexpensive | Moderate | Invitation of public input and exchange |
|---|
- Informant Groups
| Needs or problem analysis | Inexpensive to Moderate | Fast to Moderate | Minimal preparation time; facilitates communication from providers and consumers |
|---|
- Questionnaire/ Interview Survey
| Needs or problem analysis | Moderate | Moderate | Relatively good way to obtain information about knowledge and behavior |
|---|
- Basic Screening Survey
| Needs or problem analysis | Moderate to Expensive | Moderate to Slow | Assesses individuals; good estimate of population if probability sampling is used |
|---|
Source: ASTDD Seven-Step Model; Step 3, Table 3: Assessing oral health needs.
Setting Target Levels for Objectives
Population Objectives
To support the national goal of eliminating health disparities, a single national target that is applicable to all select populations has been set for each measurable, population-based objective. Three guiding principles were used in setting targets for the measurable, population-based objectives:
- For objectives that address health services and protection (for example, access to prenatal care, health insurance coverage) the targets have been set so that there is an improvement for all racial/ethnic segments of the population (that is, the targets are set "better than the best" racial/ethnic subgroup shown for the objective). Data points for at least two population groups under the race and ethnicity category are needed to use "better than the best" as the target-setting method.
- For objectives that can be influenced in the short term by policy decisions, lifestyle choices, and behaviors (for example, physical activity, diet, smoking, suicide, alcohol-related motor vehicle deaths), the target setting method is also "better than the best" group.
- For objectives that are unlikely to achieve an equal health outcome in the next decade, regardless of the level of investment (for example, occupational exposure and resultant lung cancer), the target represents an improvement for a substantial proportion of the population and is regarded as a minimum acceptable level. Implicit in setting targets for these objectives is the recognition that population groups with baseline rates already better than the identified target should continue to improve.
Beyond this general guidance, the exact target levels were determined by the lead agency workgroups that developed the objectives. The workgroups used various methods for arriving at the target levels, including:
- "Better than the best" (described above)
- "Best of the best", benchmarking against the top 10% in any area of the U.S.
- ____ percent improvement
- "Total coverage" or "Total elimination" (for targets like 100 percent,
0 percent, all States, etc.) - Consistent with _____________(another national program, for example, national education goals)
- Retain year 2000 target (the Healthy People 2000 target has been retained).
Health Outcomes and Performance Objectives
The following guidance focuses primarily on setting targets for health outcomes and performance. Formulas and technical examples are given in the Healthy People 2010 Toolkit referenced in Chapter 1.
Using an absolute percent decline
Some Healthy People objectives use an absolute percent decline based on "best guesses"/expert opinion to indicate a "reasonable" change over time. Calculations can be made based on the percent of the target population reached and change expected. For example, an absolute decline of 1% of the current level adds to 10% over the decade. Be careful to calculate the percentage for the numbers from the beginning of the decade or it will be a compounded percentage achieved.
Using peer communities
You can set targets by comparing your community to others like it. Age and poverty distribution and population size and diversity may define peer communities. The following may be used to describe one’s peers: typical values for a specific objective, means or medians, or the variation among peers.
Using the pared-mean method to set data driven benchmarks
The pared-mean method determines "top performance." This is defined as the best outcome accomplished for at least 10 percent of the population. Data sources to use for the pared-mean method include vital statistics and the Behavioral Risk Factor Surveillance System. This method is not feasible for all Healthy People objectives. Data may not be available for some objectives, or the nature of the objective may not lend itself to using the pared-mean method. For example, access to preventive care should be available for 100 percent of the population, regardless of what the data show.
Source:Allison J., Kiefe C.I., Weissman N.W. "Can Data-Driven Benchmarks be Used to Set the Goals of Healthy People 2010?" American Journal of Public Health, 89(1):61-5, 1999.
- What if areas in the state have already achieved or surpassed the national Healthy People target for an objective?
You can calculate a new, higher state target that will be challenging for local areas that have achieved or surpassed the national target. You also may wish to note in your plan the jurisdictions that have not achieved your previous targets and redouble your efforts in these areas as well as set equally ambitious targets for year 2010.
Process Objectives
Many process objectives, particularly those that pertain to infrastructure (e.g., data systems, workforce) are new for Healthy People 2010. These should be examined carefully to determine their applicability to the state or community plan. Setting measurable targets for process objectives requires judgment and is not an exact science. To set process targets, planners should consider the current status (baseline) of the state/community's public health infrastructure, seek stakeholder input on the desired level of improvement, and make a realistic assessment of what can be accomplished given past experience and current resources, political opportunities, and partner commitment.
Annual percentage change
This measure can be used to track whether progress is on course and to determine if the HP 2010 objectives will be reached. It provides the amount of decline each year that is needed to reach the target.
Using performance measures
"Performance measurement responds to the need to ensure efficient and effective use of resources, particularly financial resources. It links the use of resources with health improvements and the accountability of individual partners." (Prevention Report, Winter 1997) This is of particular importance since the inception of the Government Performance and Results Act of 1993, which aims at holding federal agencies accountable for spending public dollars. This extends to states, local jurisdictions, and other organizations that receive federal funding. Performance measures can be incorporated into or based upon Healthy People objectives.
Source: Adapted from Setting Targets and Measuring Progess. Healthy People 2010 Toolkit. pages 93-94.
Indian Health Service Tracking Health Indicators| INDICATOR | DATA SOURCE | LOGIC | Consistent with GPRA+? |
|---|
| Oral Health | | | |
|---|
| Indicator 11: During FY 2002, increase the proportion of AI/AN population receiving optimally fluoridated water by 5% over the FY 2001 levels for all IHS Areas. | WFRS (CDC) and reports from Area Fluoridation Coordinators | | |
|---|
| Indicator 12: During FY 2002, increase the proportion of the AI/AN population who obtain access to dental services by 1% over the FY 2001 level. | Numerator – NPIRS data Denominator – official user population count | | |
|---|
| Indicator 13: During FY 2002, increase the number of sealants placed per year in AI/AN children by 2.5% over the FY 2001 level. | NPIRS data | | |
|---|
| Indicator 14: During FY 2002, increase the proportion of the AI/AN population diagnosed with diabetes who obtain access to dental services by 2% over the FY 2001 level. | IHS Diabetes Care and Outcomes Audit | | |
|---|
Characteristics of High-Quality and Effective Data for Policy Making
Technical Characteristics | Content | Cover one or more major health policy or program concerns with sufficient detail to clarify the implications of alternative policy choices. |
|---|
| Currency (Timeliness) | Appear on a sufficiently timely basis and with the appropriate frequencies that they provide a relatively current profile and can be credibly used. |
|---|
| Completeness | Achieve sufficiently high submissions, reporting, or response rates and item completion, to limit biases leading to distorted conclusions. |
|---|
| Reliability | Provide classification and coding consistency to enhance interpretability and reduce confusion. |
|---|
| Analytical Flexibility | Support both routine and special analyses, particularly on an interactive or real-time basis. |
|---|
Strategic Characteristics | Cross-System Flexibility | Allow users to merge, compare, or jointly use data from complementary systems; include compatible and consistent variable definitions, coding categories, and a linkage mechanism. |
|---|
| Adaptability | Allow data content and/or reporting to be readily modified to address changing needs. |
|---|
| Accessibility | Provide clear reports to a non-technical audience; make available diverse reports or information tailored to different decision needs or users, and provide access to public-use data sets at a reasonable cost so they can be independently analyzed. |
|---|
| Translation and Policy Applicability | Effectively translate technical data to policy-relevant information. |
|---|
| Dissemination | Accurately and fully inform potential users or decision-makers about the resources and how to access it effectively. |
|---|
Source: Feldman P., Gold M., Chu K. "Enhancing Information for State Health Policy." Health Affairs, 13(3):238, 1994.
ASTHO
ASSOCIATION OF STATE AND TERRITORIAL HEALTH OFFICIALS
Health Care Safety Net Amendments of 2002
On Saturday, October 26, 2003, President Bush signed into law the Health Care Safety Net Amendments of 2002, which reauthorized both the consolidated Community Health Center program and the National Health Service Corps. The law also includes several additional provisions that may be of interest to state health agencies. It is important to note that most of these programs are authorizations and that funding levels, if any, will be determined through the appropriations process, which has not been completed for the current fiscal year.
Highlights of the legislation include:
- Reauthorizes the Consolidated Community Health Center Program to Provide More Care for the Uninsured
The bill strengthens the federal Community Heath Centers program, the key federal effort to expand care for the uninsured. In signing the bill, the Administration reaffirmed its goal to create 1,200 new or expanded health centers by 2006. The law authorizes the Health Centers program through FY 2006; raises the authorization level to $1.3 billion; and maintains the program’s core principles: to target resources to high need areas, deliver health care regardless of ability to pay, and gives the community being served a voice in the governance of the health center. It also encourages initiatives to hold down costs and ensure high quality care, and authorizes grants to eligible health centers with a substantial number of clients with limited English speaking proficiency to provide translation, interpretation, and other such services.
- Reauthorizes the National Health Service Corps to Support More Doctors, Nurses, and Dentists
The bill revises and continues funding for the National Health Services Corps and includes a provision to automatically designate all federally qualified health centers and rural health clinics that meet specific criteria as having shortage. The law also directs the Health Resources and Services Administration to revise the criteria used to designate dental health professional shortage areas to provide a more accurate reflection of oral health care need, particularly in rural areas. A provision directs this to be done in consultation with the Association of State and Territorial Dental Directors, dental societies, and other interested parties. The law raises the overall authorization level of the Corps to $146 million and includes authorization of $12 million for grants to states to support loan repayment programs.
- Expands Availability of Dental Services
The law authorizes a grant program to help states in the development and implementation of innovative programs to address the dental workforce needs of designated dental health professional shortage areas in a manner that is appropriate to the states’ individual needs. States would be able to use funds for the development of a state dental officer position or the augmentation of a state dental office to coordinate oral health and access issues in each state.
Association of State and Territorial Health, Officials
Fall 2002
Legislative Updates
107th Congress
Health Care Safety Net Amendents
(Loan Repayment Reports)
P.L. 107-251 (H.R. 3450, S. 1533/S. Report 107-83)
Impact of Public Law
P.L. 107-251, the Health Care Safety Net Amendments, repeals the requirement for the Health Resources and Services Administration loan repayment program (LRP) reporting requirements, which also repeals the National Institutes of Health LRP reporting requirements, which were mandated under the National Health Service (NHS) authorities. Specifically, this repeals Section 338B(i) of the Public Health Service Act, which required an annual report to Congress on the NHS Corps Loan Repayment Program.
Legislative History
P.L. 107-251 reauthorizes the Community Health Center program, the National Health Service Corps (NHSC), and rural outreach grants to ensure that both the uninsured and the underinsured have access to quality health care services. The legislation increases the funding authorization for health centers to $1.293 billion and includes language allowing health centers to provide behavioral, mental health, and substance abuse services if they choose. The legislation also reauthorizes NHSC, which serves as a pipeline for health care facilities that have trouble attracting health professionals, and strengthens the service obligation requirements of the program. By strengthening this provision, health care facilities using program graduates can be certain that health corps personnel will fulfill their entire service contract.
Since its creation in 1972, NHSC operates two programs to help meet the needs of underserved communities: the scholarship program, which provides funds to students for educational living expenses during health care practitioner training, and the LRP, which provides financial assistance to help newly graduated practitioners repay their educational loans. For each year that the NHSC scholarship program or LRP provides support, participants are obligated to provide 1 year of medical care in underserved communities.
S. 1533, the Health Care Safety Net Amendments, was introduced on October 11, 2001, by Senator Edward M. Kennedy (D-MA) and was referred to the Senate Health, Education, Labor and Pensions Committee. The bill was reported out of that Committee on the same day and passed in the Senate on April 16, 2002, by unanimous consent.
H.R. 3450, the Health Care Safety Net Improvement Act, was introduced on December 11, 2001, by Representative Michael Bilirakis (R-FL) and was referred to the House Energy and Commerce Subcommittee on Health. On October 1, 2002, the bill passed the House by a voice vote. The bill, as amended, passed the House on October 16, and the Senate concurred with the House-amended bill on October 17. The legislation was signed by the President on October 26 as P.L. 107-251.
Source: http://olpa.od.nih.gov/legislation/107/publiclaws/healthcare.asp
References: Setting Health Priorities, Establishing Oral Health Objectives and Obtaining Baseline Information
Arizona Department of Health Services. Guidelines for Oral Health Screening. Phoenix, AZ: ADHS. 1999. (AZ Oral Health Program 602-542-1866)
Association of State and Territorial Dental Directors. Assessing Oral Health Needs. ASTDD Seven-Step Model. Columbus, OH: ASTDD. 1995. www.astdd.org
Association of State and Territorial Dental Directors. Basic Screening Surveys: An Approach to Monitoring Community Oral Health (manual and video). Columbus, Ohio: ASTDD. 1999.
(same Web site as above)
Beltrán-Aguilar ED, Goldstein, JW, Lockwood, SA. Fluoride Varnishes: A Review of Their Clinical Mechanism, Efficacy, and Safety. J Am Dent Assn (131):589-596, 2000.
Centers for Disease Control and Prevention. Health, United States, 2002. Atlanta, GA: CDC. 2002. www.cdc.gov/nchs/hus.htm.
Centers for Disease Control and Prevention. Investment in Tobacco Control: State Highlights 2001 Atlanta, GA: CDC. 2001. www.cdc.gov/tobacco
Centers for Disease Control and Prevention. The national tobacco control program. Chronic Disease Notes & Reports. 14(3):whole issue, 2001. www.cdc.gov/nccdphp
Folse GJ. National MDS and dental deficiency data reported by the US Health Care Financing Administration. Special Care Dentistry. 21(1):37-8, 2001.
Gaffield ML, Colley Gilbert BJ, Malvitz DM, Romaguera R. Oral health during pregnancy: An analysis of information collected by the Pregnancy Risk Assessment Monitoring System. J Am Dent Assn (132):1009-1016, 2001.
Geurink KV. Community Oral Health Practice for the Dental Hygienist. Philadelphia, PA: W B Saunders. 2002.
Health Division. Oregon Department of Human Resources. 1992-93 Oral Health Needs Assessment. Portland, OR: 1993.
Indian Health Service. Regional Differences in Indian Health 1998-99. Rockville, MD: Indian Health Service. 2000.
Manski RJ and Moeller JF. Use of dental services. An analysis of visits, procedures and providers, 1996. J Am Dent Assn. 133(2):167-75, 2002.
NCCDPHP. Searchable Internet based databases enhance accessibility and usefulness of NCCDPHP data. Chronic Disease Notes & Reports. 14(2):whole issue, 2001.
Pan American Health Organization. Oral Health Bibliography. No. 1. Washington, DC: PAHO. 2001. www.paho.org.
Populations Receiving Optimally Fluoridated Public Drinking Water -- United States, 2000. MMWR, February 22, 2002;51(7):144-147.
Proceedings: NIH Consensus Development Conference on Diagnosis and Management of Dental Caries Throughout Life. Journal of Dental Education, October 2001.
Promoting Oral Health: Interventions for Preventing Dental Caries, Oral and Pharyngeal Cancers, and Sports-related Craniofacial Injuries: A Report on the Recommendations of the Task Force on Community Preventive Services. MMWR. 50(RR-21):1–13, November 30, 2001. www.cdc.gov/OralHealth/guidelines.htm.
Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States. MMWR, August 17, 2001;50(RR-14):1–42. Also available as a PDF file (PDF-373K). www.cdc.gov/OralHealth/guidelines.htm.
Surveillance for Use of Preventive Health-Care Services by Older Adults, 1995-1997. MMWR. 48(SS08):51-88. December 17, 199.9
Vargas CM, Kramarow EA and Yellowitz JA. The oral health of older Americans. Aging Trends. No. 3. CDC, NHHS. March 2001.