2017 HSR&D/QUERI National Conference

4065 — Accelerating the Implementation of an Oral Health Education Tool within the VA Oral Health System

Lead/Presenter: Molly Simmons, COIN - Bedford/Boston
All Authors: Simmons MM (HSR&D Center for Healthcare Organization and Implementation Research (CHOIR), Bedford/Boston, MA) Skolnik A (CHOIR) Wehler C (VA Oral Health Quality Group) Smelson D (CHOIR) Jurasic M (VA Oral Health Quality Group) Jones J (University of Deleware Mercy) Gibson G (VA Oral Health Quality Group)

The Patient Oral Health Report (POHR) is a personalized education tool that details the Veterans' oral health concerns and possible solutions based on information collected during routine oral health exams. The report intends to increase Veteran engagement and improve patient self-care, yet provider utilization rates are low. We aim to assist VA Office of Dentistry in determining reasons for under-utilization and to explore strategies to accelerate system-wide implementation.

We conducted a formative evaluation (FE) using in-depth interviews with Department of Veterans Affairs (VA) oral health care providers. Data were coded iteratively using content analysis and reassembled according to themes.

We interviewed 15 dental providers who utilized the report at varying rates. Four themes were identified. 1) Reasons for not using the POHR: lack of knowledge of the report; lack of longitudinal data; perception of inaccuracy; computer logistics difficulties; time deficits. 2) Reasons for using the POHR: patient's interest; easy to understand; gives Veterans agency. 3) Why and how POHR is used: some providers prepared reports prior to seeing Veterans for the day; told to use it by Chief Dentist; and some felt it more effective if administered by hygienists and if delivered annually/with new patients. 4) We explored potential strategies to increase utilization: a pop-up window to remind providers garnered mixed reactions; consistent users also indicated that they used the report because they believed it was mandatory.

Provider under-utilization occurred mostly because of technical and logistical issues, while providers endorsed the report itself positively. Thus, use of the POHR should increase if technical issues are addressed. Making the report mandatory during one encounter per year also shows some promise. Likewise, we also saw most consistent use in clinics where the Chief was committed to POHR utilization, suggesting that an internal champion is essential for uptake.

FEs, which involve studying the implementation context so as to improve uptake of interventions, have the potential to increase implementation of the POHR and other oral health interventions more widely. FEs are worthwhile investments which, when paired with evidence based interventions, will increase patient engagement and improve Veteran oral health.