Best Practices for State & Local Oral Health Programs ASTDD Best Practices Project March 2010 Introduction to Best Practices Optimal oral health across

Best Practices forState & Local Oral Health Programs

ASTDD Best Practices Project

March 2010

Introduction to Best Practices

Optimal oral health across the lifespan…

Need for Best Practices

Oral Health in America:

A Report of the Surgeon General

Building Infrastructureand Capacity in

State and TerritorialOral Health Programs

Prepared by: ASTDD

National Call To Action To Promote Oral Health

A Public-Private Partnership

Under the leadership of The Office of

the Surgeon General

Need for Best Practices

To improve oral health andgeneral health status

To improve systems of care

Developing Best Practices

What will beyour program’s purpose

for developing best practices?

Association of State & TerritorialState Dental Directors (ASTDD)

Best Practices Project

ASTDD Best Practices ProjectPurpose

Build more effective state, territorial and community oral health programs.

For: Expand Infrastructure & Capacity Respond to National Call to Action Advance Healthy People 2010

ASTDD Best Practices ProjectGoal

Promote the development

of best practices by state,

territorial and community

oral health programs to

enhance the oral health of

Americans and reduce

disparities.

Uses ofBest Practice Information

Use as building blocks

Share ideas & lessons learned

Raise awareness of oral health

Promote collaborations

Update guidelines

End-Users ofBest Practice Information

BestPractices

Dental Directors

Public Health Programs

Coalitions

ConsumersFunders

Professional & Advocacy

Organizations

Government Officials & Staff


Using Best Practice Concepts


Best Practice Concepts

1. A best practice is a methodology that, through experience and research, has proven to reliably lead to a desired result.

2. Using best practices is a commitment to using all the knowledge and technology at one's disposal to ensure success.


3. Best practices do not have one template or form for everyone to follow.

4. “Best practice” does not commit people or organizations to one inflexible, unchanging practice.


5. Best practices is a philosophicalapproach based around continuouslearning & continual improvement.

6. Learning & transfer of best practicesis an interactive, ongoing & dynamicprocess that cannot rest on a staticbody of knowledge.


Best Practice Criteria


“Best Practice”

“Best” from whose perspective

and using what criteria?

Obtain Input from End-Usersfor Best Practice Criteria

Build consensus through selection & ranking of BP criteria

- Early buy-in

Collect additional information to guide selection of BP criteria

- Types of BP information end-users need

- Public health strategies in use

- Self-reported successful practices

Association of State & TerritorialState Dental Directors (ASTDD)

Best Practices Project

Setting Best Practice Criteria

ASTDD Best Practices ProjectInput from States

State surveys: Developed list of BP criteria

Ranked BP criteria

Identified categories of Best Practices information states wanted

Obtained listing of states’ reported top strategies and successful practices

ASTDD Best Practices ProjectBest Practice Criteria

Impact / Effectiveness

Efficiency / Cost Effectiveness

Demonstrated Sustainability

Collaboration / Integration

Objectives / Rationale


Impact / Effectiveness Provided benefits to the oral health care and well-being of certain populations or communities

Efficiency / Cost Effectiveness Showed costs and expenses are appropriate to benefits achieved

Demonstrated Sustainability Demonstrated sustainable benefits and/or demonstrated that the practice been sustainable within populations/communities and/or in states/territories


Collaboration / Integration Built effective partnerships/collaborations among various organizations and integrated oral health with other health projects and issues

Objectives / Rationale Addressed HP 2010 objectives, met the National Call to Action to Promote Oral Health, and/or built basic infrastructure and capacity for oral health programs

ASTDD Best Practices Project“Best Practice” Definition

“Best Practice” is a service, function or

process that has been fine-tuned, improved

and implemented to produce superior results

that demonstrate impact/effectiveness, efficiency,

sustainability, and collaboration/integration, with

appropriate objectives/rationale.


Best Practices Applying the Science


Best PracticeTranslate Research into Practice

■ Research evidence supporting the effectiveness & cost-effectiveness of a dental public health strategy

■ State of the science to design and implement programs and services

Why evidence?

■ Constant or diminishing resources require that public health programs focus on effective and efficient practices

■ “Evidence-based” approaches incorporate the best available scientific information into decision-making*

*Based on Sackett et al., BMJ 1996

Systematic Reviews

■ Preferred method for identifying available knowledge; determining what is “best”; and summarizing it in a useful manner*

■ Rule-based process reduces bias and error in reviewing and summarizing findings

Bader J et al., J Am Dent Assoc 2004;Mulrow C et al., American College of Physicians 1998

Process in Analyzing aBest Practice Approach

■ Describe the public health strategy

■ Evaluate the evidence for effectiveness and cost effectiveness of the strategy

■ Set initial review standards for Best Practice criteria

■ Learn from state/community practices that show successful implementation methods

In the Absence ofResearch Evidence

■ Realize that the intervention may or may not be effective

■ Review available information (e.g., related policies and position statements; theoretical rationale; consensus of expert opinion; descriptive data)

■ Identify and implement evaluative measures

■ Consider any unintended harms that could result from the intervention

ASTDD Best Practices ProjectUse of Evidence-Based Information

BP Project uses evidence-based information:

■ In analyzing a Best Practice Approach

■ In promoting its use for program development, implementation, and evaluation

■ In sharing state of the science information on the ASTDD Website

Best Practice ApproachEvaluation of Evidence

Promising Proven Approaches ............................……..........… Approaches

Strength of Evidence

Research + Research +++

Expert Opinion + Expert Opinion +++

Field Lessons + Field Lessons +++

Theoretical Rationale +++ Theoretical Rationale +++

A Best Practice Approach ReportA Best Practice Approach Report

Research Evidence

Summary of Research Evidence


Best Practices Field Lessons & Support Network


Successful PracticesProject’s Database

48 states and 2 territories provided submissions

230+ successful practices described

An expanding collection

Successful Practice DescriptionContent

History Justification Inputs, Activities, Outputs & Outcomes Budget Estimates Lessons Learned/Plans for Improvement Available Information Resources Best Practice Criteria Contact Persons for Inquiries

Successful Practice Descriptions

Nevada’s State Oral Health Plan

Ongoing and DynamicDevelopment of Best Practices

IdentifyBest Practices

Cultivate Best Practices

PromoteBest Practices

CollaborationIntegration

Science & Artof Successful

Implementation

Supportive Environment

Project’s Developing Role:Building a Supportive Environment

A support network

Partners’ support

Building of evidence

State of the science

Capacity building tools

Program & policy evaluation


Using Best Practice toBuild Infrastructure & Capacity


Build Infrastructure & Capacity

1999 ASTDD Project

State dental directors from 43 states participated

10 essential elements identified

Build Infrastructure & Capacity Essential Elements

Surveillance System

Leadership

State Plan

Policies

Communication & Education

Linkages / Partnerships

Population-based interventions

Community capacity Health systems

interventions Leveraging

resources

Best Practice Approach Reports

1. State Oral Health Surveillance System

2. State Oral Health Coalitions

3. State Oral Health Plans

4. Mandate for a State Oral Health Program

5. Community Water Fluoridation

6. School Sealant Programs

7. School Fluoride Programs

8. Workforce Development

9. Oral Health of Individuals with SHCN

Best Practice Approach Reports(continued)

10. Improving Children’s Oral Health through Coordinated School Health Programs (released March 2010)

11. Prevention and Control of Early Childhood Tooth Decay (released March 2010)

Building Infrastructure1999 to 2007 Comparison

State oral health surveillance systems 8 to 30 states

State oral health coalitions 20 to 41 states

State oral health plans 7 to 23 (33) states; 5 in development

Best Practices

ASTDD Best Practices Project


The Journey Continues

Documents

Best Practices for State & Local Oral Health Programs ASTDD Best Practices Project March 2010 Introduction to Best Practices Optimal oral health across