Surveillance

 

What is surveillance and why is it important to oral health?   

Surveillance involves ongoing, systematic collection, analysis, and interpretation of data essential to the planning, implementation, and evaluation of public health practice. Surveillance:

  • identifies public health emergencies/issues; provides data that informs policy;
  • documents the impact of interventions and progress towards specified public health targets/goals; and
  • allows for public health officials to understand/monitor the epidemiology of a condition to set priorities and guide public health policy and strategies.

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Are states required to collect oral health surveillance data?   

States are required to collect Annual Early and Periodic Screening and Diagnostic Testing (EPSDT) data to fulfill Medicaid/CHIP requirements. Otherwise, there are no nation-wide requirements placed on states to collect oral health surveillance data.

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Does Florida utilize the Basic Screening Survey statewide to track basic screening data on children’s health?  

No. Florida is one of only 13 states (+ D.C.) that do not submit basic screening data to the National Oral Health Surveillance System.

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What are the major Florida state oral health surveillance systems and what kinds of information are collected?  

  • Florida Behavioral Risk Factor Surveillance System (BRFSS): A state-based, ongoing data collection program designed to measure behavioral risk factors in the adult, non-institutionalized population 18 years of age or older. Every month, the state selects a random sample of adults for a telephone interview. This selection process results in a representative sample so that statistical inferences can be made from the information collected. Information from the survey is used for health planning, program evaluation, and monitoring health objectives within the Florida State Department of Health. The survey is conducted by the University of Florida with its College of Dentistry overseeing questions related to oral health.
  • Florida Cancer Data System (FCDS): A statewide, population-based cancer registry that has been collecting incidence data since 1981. It has been maintained by the University of Miami’s Miller School of Medicine since its design was contracted out by the Florida Department of Health in 1978. The FCDS is wholly supported by the State of Florida Department of Health, the National Program of Cancer Registries (NPCR) of the Centers for Disease Control and Prevention (CDC) and the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine. The FCDS collects data on all oral cancer surgeries performed in the state.
  • State Oral Health Improvement Plan for Disadvantaged Floridians (SOHIP): Provides county and statewide profiles of various components of oral health care and disease prevalence using multiple data sources, including the Florida Medicaid Management Information System and the Florida County Health Department Clinic Management System. The data for these profiles is limits the scope to low income individuals and families only.
  • Florida Birth Defect Registry (FBDR): Created in 1999, the FBDR is a statewide, population-based surveillance system that identifies birth defects in children born in Florida. The FBDR is operated by the Florida Department of Health Bureau of Environmental Public Health Medicine and works in conjunction with the Children’s Medical Services and other state agencies. The FBDR collects information on the number of cleft lips and palates per live birth.
  • Water Fluoridation Reporting System (WFRS):Developed by the CDC, WFRSS provides state oral health program staff a tool for monitoring the quality of the water fluoridation program in their state. Data provided by water systems is used by state oral health program staff to recognize excellent work in water fluoridation and identify opportunities for continuous improvement in the water fluoridation program. The data are also used to develop estimates of the percentage of the population that receives fluoridated water.

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What is an example of a local oral health surveillance system?  

Hospital emergency room (ER) data collected on patient dental health conditions is a one useful source of data. The California Healthcare Foundation’s 2009 report on Emergency Department Visits for Preventable Dental Conditions in California analyzed emergency department data for ambulatory care sensitive dental conditions based on data from the California Office of Statewide Health Planning and Development (OSHPD) Emergency Department Data and OSHPD Patient Discharge Data. Using aggregate local data from across the state, the report was able to ascertain which populations rely most heavily on ERs for dental healthcare and provide suggestions for improving the oral health safety net.

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What impact does the federal Affordability and Coverage Act (ACA) have on oral health surveillance?   

Section 4102 of ACA requires the Secretary of HHS to update and improve national oral health surveillance as follows:

  • Require all states to participate in NOHSS;
  • Require the inclusion of oral health reporting on pregnant women through PRAMS (currently optional);
  • Retain the current NHANES “tooth-level” surveillance (plans were to drop this level of measure for “person-level” analysis); and
  • Require MEPS findings for dental expenditures be validated through a “look back” procedure to be in-line with current standards applied to medical expenditures.

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