NeedBased Planning Model

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Need-Based Planning Model

• Barry Daneman
• UMKC School of Dentistry
• June 2, 2006

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Purpose

• To develop an area-wide population-based planning
  model, which can be used for projecting
• the need for oral health services within a
  defined region
• the oral health work force required to assure
  access and quality care

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Model Development Process

• SOD Work Group
• Steering Committee
• Delphi Panels
• Need Component
• Productivity Component
• Focus groups

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Methodology

• The model begins with age and gender specific
  dental morbidity data accessed from the third
  National Health and Nutrition Examination Survey
  (NHANES III). 
• Data is assembled for 19 age-gender cohorts and
  three oral health status indicators

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Oral Health Status Indicators

• LOA gt 5mm This is an indicator of severe
  periodontal disease, it means there is a loss of
  attachment (LOA) of teeth to gums which exceeds
  five millimeters
• Coronal caries decay in the crown of the tooth
• Root caries decay in an exposed root

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Assumptions

• Each condition requires dental attention
• Every person requires two (2) preventive/health
  maintenance dental visits per year, regardless of
  their oral health status.
• Persons with LOA gt 5 mm require 2 additional
  visits per year to manage this condition

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Assumptions

• Persons with coronal caries require one
  additional visit
• Persons with root caries require one additional
  visits per year
• Conditions are additive persons with LOA gt 5mm
  may also have dental caries and require dental
  visits for each condition
• Environmental and sociological factors also play
  a role.

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Assumptions -- Poverty

• In Missouri, about 25 of the population has
  income lt175 of FPL. 
• In counties where the low-income rate gt 35 of
  the population but lt 45, we add .1 visits per
  person (to reflect the additional 10 percent of
  the population who is low income and their
  greater level of dental morbidity). 
• In counties where the low-income rate gt 45, we
  add .2 visits per person.

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Assumptions

• Where counties lack water fluoridation, we  add
  30 to the presumed caries rate for each age
  cohort
• Pregnancy 1 additional visit for each pregnancy
  
• Diabetes 2 additional visits case of diabetes
  (computed by multiplying prevalence rate by
  population)

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Projecting Need

• Age/gender visit rates are computed using
  aforementioned assumptions
• Rates are multiplied by the population numbers in
  each age-gender cohort
• We add in the diabetes and pregnancy adjustments
• This provides the total projected visits for the
  population. See Jackson Co. example.

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Determining Workforce Needs

• To derive the need for general dentists, dental
  specialists, dental hygienists and dental
  assistants, we had to do two other things
• determine how general dentists and specialists
  divide the dental workload
• determine the productivity of the oral health
  teams led by these generalists and specialists

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Division of Labor

• The division of labor among generalists and
  specialists was estimated using CDT-2 data from
  ADAs 1999 Survey of Dental Services Rendered.
• Estimation involved two steps.

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Division of Labor

• First, we estimated the distribution of work
  among general dentists and non-orthodontic
  specialists.

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Division of Labor

• Next, we developed an estimate of orthodontic
  visits, based on data from the ADA survey.
• The data suggests orthodontists perform 4.92 of
  all dental procedures.

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Computing the distribution of visits

• For general dentists and non-orthodontic
  specialists, we multiply the appropriate
  distributional percentages times the total number
  of visits projected by the need model.
• For orthodontists, we divide this subtotal by
  .9502 (which makes orthodontics 4.92 of total).
  See Jackson Co. example.

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Productivity and Work Force Needs

• The need for oral health professionals in any
  defined community is a function of
• The number and types of oral health services
  required by the population
• The productivity of oral health teams.

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Productivity and Work Force Needs An Example

• According to our planning model, the population
  of XYZ County needs 1,000,000 dental office
  visits annually to care for its oral health.
• Approximately 86.75 of these visits (867,500)
  will be to the offices of general dentists.
• General dentist teams (consisting of one general
  dentist, one dental hygienist and two chairside
  assistants) can produce 3,893 visits annually, on
  average, according to ADA data.
• XYZ County, therefore, would need approximately
  223 general dentist teams (867,500 / 3,893
  222.8) to care for its oral health.