The Future of the Texas Dental Workforce to Improve Access to Care

Robert Wood, MPHBiostatistician, Department of Family and Community

Medicine and Regional Center for Health Workforce Studies, University of Texas Health Science Center at San Antonio

Texas Oral Health Summit: Advocacy, Equity and Access

Austin, TexasSeptember 9-10, 2004

Robert Wood MPH & Jane E. M. Steffensen MPH, CHESRobert Wood MPH & Jane E. M. Steffensen MPH, CHESUTHSCSAUTHSCSA

RCHWS at CHEP - 2002

Austin, Texas September 2004Austin, Texas September 2004

Workforce Surveillance:Workforce Surveillance:The Border Health The Border Health Workforce InformaticsWorkforce InformaticsInitiativeInitiative

Texas Oral Health Summit:Texas Oral Health Summit:Advocacy, Equity & AccessAdvocacy, Equity & Access

RCHWS at CHEP - 2002

Address U.S.-Mexico Border Health Workforce issuesAddress U.S.-Mexico Border Health Workforce issues through research and data development projectsthrough research and data development projects and serve the workforce information needs of Arkansas,and serve the workforce information needs of Arkansas, Louisiana, New Mexico, Oklahoma, and Texas. Louisiana, New Mexico, Oklahoma, and Texas.

Mission of RCHWS at CHEPMission of RCHWS at CHEP

InformaticsInformatics

Health workforce “informatics, defined as the systematic Health workforce “informatics, defined as the systematic application of information and computer science and application of information and computer science and technology to health practice, research, and learning”.technology to health practice, research, and learning”.

Premise: “..that health outcomes will be improved and Premise: “..that health outcomes will be improved and health costs lowered by the provision of accurate and timely health costs lowered by the provision of accurate and timely individual and aggregated information that supports health individual and aggregated information that supports health decision makers at the consumer, provider, community, and decision makers at the consumer, provider, community, and national levels.”national levels.”

Adapted from “A National Agenda for Public Health Informatics: Summarized Recommendations from the 2001 AMIA Spring Congress” WILLIAM A. YASNOFF, MD, PHD, J. MARC OVERHAGE, MD, PHD, BETSY L. HUMPHREYS, MLS, MARTIN LAVENTURE, MPH J Am Med Inform Assoc. 2001;8:535–545.

From Data to KnowledgeFrom Data to Knowledge

County and/or State or even National boundaries aren’t County and/or State or even National boundaries aren’t always barriers to those who seek health carealways barriers to those who seek health care

Addressing the Information NeedsAddressing the Information Needs

Information Issues:Information Issues:

•Dental Health Workforce DemographicsDental Health Workforce Demographics–Age, sex, age, Ethnicity?, FTE in multiple practice sites?Age, sex, age, Ethnicity?, FTE in multiple practice sites?

•Tracking individuals in the workforce across timeTracking individuals in the workforce across time–Retention of ‘legacy’ data in standard format in necessary for Retention of ‘legacy’ data in standard format in necessary for true trackingtrue tracking

•Rational Service areas defined using Multiple Practice site Rational Service areas defined using Multiple Practice site locations? locations?

–(real addresses for geo-coding)(real addresses for geo-coding)–Service area definitions less constrained by County or State (or Service area definitions less constrained by County or State (or National) boundaries?National) boundaries?

Addressing the Information NeedsAddressing the Information Needs

Information Issues:Information Issues:

•Dental Health Workforce DemographicsDental Health Workforce Demographics–Age, sex, age, Ethnicity?, FTEs in multiple Age, sex, age, Ethnicity?, FTEs in multiple practice sites?practice sites?

Percentage of Dentists by Age in Texas, 1999

0

10

20

30

40

Texas 1999 24.9 35.7 23.1 10.4 4.9

25-39 yrs. 40-49 yrs. 50-59 yrs. 60-69yrs. 70+ yrs.

>60% Dentists <50 yrs. Average Age = 48 yrs.

Percentage of Dentists & Population by Race / Ethnicity, USA, 1999

0102030405060708090

100

Dentists 89 2 4 5 0

Population 72 12 11 4 1

White Black Hispanic Asian / PI* AI - AN**

Bureau of Labor Statistics, Bureau of the Census* PI – Pacific Islander ** AI–AN – American Indian – Alaska Native

Addressing the Information NeedsAddressing the Information Needs

Needs/Recommendations:Needs/Recommendations: Partnerships and ongoing Partnerships and ongoing communication with professional associations to collect communication with professional associations to collect ethnicity and other health workforce data not always ethnicity and other health workforce data not always available.available.

Action: Action: Second Border Health Workforce Roundtable in El Second Border Health Workforce Roundtable in El Paso (July 30, 2003) with Border workforce information Paso (July 30, 2003) with Border workforce information stakeholders. Discussed were:stakeholders. Discussed were:

• Data exchange and data standardization (within and Data exchange and data standardization (within and across states).across states).• Adoption of Geo-coding proceduresAdoption of Geo-coding procedures

Addressing the Information NeedsAddressing the Information Needs

Information Issues:Information Issues:

•Tracking individuals in the workforce Tracking individuals in the workforce across timeacross time

–Retention of ‘legacy’ data in standard format Retention of ‘legacy’ data in standard format is necessary for trackingis necessary for tracking

Dentists in43 Border Counties

Addressing the NeedsAddressing the Needs

Need:Need: Development of a centralized information system and Development of a centralized information system and a comprehensive mechanism for data collection. Also, a comprehensive mechanism for data collection. Also, defining the border in terms of geography, migration, defining the border in terms of geography, migration, culture, demographics, and rural versus urban areas.culture, demographics, and rural versus urban areas.

Actions: Actions: GIS studies are being conducted GIS studies are being conducted Dental Workforce migration data between Texas Dental Workforce migration data between Texas

border and non-border regions are available (1995-2000) border and non-border regions are available (1995-2000) and will be updated and extended to urban vs. rural areas and will be updated and extended to urban vs. rural areas

Addressing the Information NeedsAddressing the Information Needs

Information Issues:Information Issues:•Rational Service areas defined using Rational Service areas defined using Multiple Practice site locations? Multiple Practice site locations?

–(real addresses for geo-coding)(real addresses for geo-coding)–Service area definitions less constrained by Service area definitions less constrained by County or State (or National) boundaries?County or State (or National) boundaries?

Dental Health Professional Shortage Areas (Dental-HPSAs), Texas 1999

Dental HPSAs:

71 Whole Counties

15 Partial Counties

Prepared by: Health Professions Resource Center Office of Policy and Planning Texas Department of Health

Data Source: Division of Shortage Designation USDHHS

April 20, 1999

Addressing the Information NeedsAddressing the Information Needs

Need:Need: Data on FTEs and direct care for all health Data on FTEs and direct care for all health professionals – including Dentists. Also, better information professionals – including Dentists. Also, better information on practice location addresses, FTE at each location and on practice location addresses, FTE at each location and service range (Medicaid, CHIP). service range (Medicaid, CHIP).

Action: Action: • Discussions with the agencies collecting workforce data Discussions with the agencies collecting workforce data in Texas and the Border states toward standardization and in Texas and the Border states toward standardization and inclusion of direct care and FTE data in progress. inclusion of direct care and FTE data in progress. (Texas agencies collect and disseminate more information (Texas agencies collect and disseminate more information than is done by some other Border states)than is done by some other Border states)

Addressing the Information NeedsAddressing the Information Needs

Need:Need: Partnerships and ongoing communication with Partnerships and ongoing communication with professional associations to collect ethnicity and other professional associations to collect ethnicity and other workforce data not available throughout the Borderworkforce data not available throughout the Border

Action: Action: Second Border Health Workforce Roundtable in El Second Border Health Workforce Roundtable in El Paso (July 30, 2003) with Border workforce information Paso (July 30, 2003) with Border workforce information stakeholders. Initiatives discussed:stakeholders. Initiatives discussed:

• Data exchange and data standardizationData exchange and data standardization• GeocodingGeocoding• Proposal for cooperative projects Proposal for cooperative projects

Health Workforce Informatics Policy GoalsHealth Workforce Informatics Policy Goals

Long-term Goals: Long-term Goals: Improving health workforce capacity and quality

Strategic Goals:Strategic Goals: Provide reliable, valid and timely information for internal and external decision making

Informatics integrated into Major OutcomesInformatics integrated into Major Outcomes: :

1. Beginning the development of an Border region-wide decision support system

2. Beginning the development of an automated statistical ‘surveillance’ system for core health workforce data

3. Developing and maintaining a web-based, interactive, user-friendly data system for workforce tracking and assessment

What now? Can we help each other?What now? Can we help each other?

Data sharing: can we actually exchange data?Data sharing: can we actually exchange data?

Defining the minimal data set: is small beautiful?Defining the minimal data set: is small beautiful?

Data standards: the impossible dream?Data standards: the impossible dream?

Geo-coding: can we get the point? Geo-coding: can we get the point?

Longitudinal and tracking capability: can we Longitudinal and tracking capability: can we ever remember?ever remember?

How to sustain the effort: can we survive aging?How to sustain the effort: can we survive aging?

What else?What else?