VA Office of Dentistry Leverages GIS for Market Optimization and Equity

In 2018, Congress passed the Geospatial Data Act (GDA), which formalizes governance processes related to geospatial data, provides policy and guidance to empower the use of geospatial data and technology, while also facilitating broad cooperation between the public and private sectors. The GDA is meant to reduce duplicative efforts among federal, state, local, and tribal governments, as well as the private sector and institutions of higher education with respect to data. Before the GDA, organizations were extremely siloed and rarely shared data openly with other departments. For the US Department of Veteran Affairs (VA) Office of Dentistry, the GDA marked a turning point, enabling more effective market assessments and equitable resource allocation.

The VA Dentistry provides quality and compassionate dental care to over 700,000 eligible veterans at over 200 locations nationwide. Before the GDA, the VA Office of Dentistry had not conducted an extensive market area assessment, leaving them unaware of where new offices were needed to meet their community’s needs. The GDA introduced geographic information system (GIS) technology to improve this process. Leveraging GIS technology, the VA Office of Dentistry has been able to

• Conduct an accurate market area assessment through enhanced data visualization.
• Develop optimization plans to improve quality and equitably distribute resources.
• Work with the health equity team to ensure equitable access to care.

The Mission Act of 2018 established drive-time accessibility requirements for VA services. Veterans within 60 minutes of a VA dental clinic were required to seek care at that facility, while those further away could access care from community providers. Recognizing this as an issue with geospatial operations, the VA Office of Dentistry leveraged GIS technology to align resources strategically, optimize workload distribution, and plan for staffing needs based on treatment models.

“We wanted to see where we could strategically align our resources so we could distribute the workload based on our population’s needs,” said Dr. Scott Trapp, deputy director for Dentistry, Veterans Administration. “We were also looking at treatment plans and integrating those into our model to see how many doctors, dental assistants, hygienists, etc. were needed in an area.”

Leveraging ArcGIS Pro, the VA Office of Dentistry can provide their market analysis in a compelling way that effectively communicates the gaps in service.
 

Conducting a market assessment identifies the areas in need of improvement, however, a deeper analysis is required to see how the services can be improved. This is when the organization leveraged the four VA dental quality indicators in a geospatial context.

1. Fluoride application
2. Periodic oral evaluation
3. Periodontal/Preventive care
4. Primary dentist assignment

When the VA Office of Dentistry staff began examining quality indicators, they discovered significant regional disparities in how effectively VA Dentistry performed against these benchmarks. As a result, staff began to question why the quality of care was not more uniform across the country. They realized that the dental chiefs did not have enough dental treatment rooms, dentists, hygienists, and dental assistants to provide quality care to certain communities.

However, like many organizations, getting approvals to hire additional personnel can be a challenging process. Employees for the VA National Program Office recognized that to get more resources, they needed to market themselves better, elevating their dental infrastructure and personnel needs to a priority level.

“We needed to create a compelling argument that dental is more important than some of the other systems when it comes to resource assignment, and you can only show senior executives so much data before they become numb to it. You must give them something to visually see, this is when we started leveraging ArcGIS,” said Trapp.

The VA has one of the richest data sources available for analysis since their electronic dental records are fully integrated with the health-care records stored within an Azure database. Leveraging this data, the VA Office of Dentistry started doing comparative analyses across regions and facilities all the way down to the provider and patient level.

What staff found was that some regions were doing much better on certain quality indicators compared to others. This led them to analyze the differences they were seeing, which proved valuable in two ways. First, VA staff could see that their resources were not being equitably distributed. Second, sharing the quality maps with their local dental leaders inspired various efforts and innovations to match higher-performing regions. By applying spatial analysis to its data, the VA Office of Dentistry has been able to further develop and enhance its optimization plans further.

“When we map it out, we get to show areas that aren’t doing as well compared to other areas that are doing well. Directors will see these bright red areas and immediately want to do something,” said Trapp.
 

A market assessment can help an organization determine where it is currently providing high-quality, accessible health care, and where there are gaps in service. Including ArcGIS Pro in the process allowed overlay and analysis that supported important decisions across a national organization with localized impact.

Moving forward, the VA Office of Dentistry employees plan to overlay demographic data to ensure they analyze access to care with an equity lens, specifically around specialty dental procedures, such as dental implants. These kinds of procedures can be expensive, and it is important to ensure that all veterans are receiving the care they need despite their location. The power of spatial analysis allows the VA Office of Dentistry to present its data in a compelling way, conduct an extensive market assessment, and begin to apply an equity lens to resource allocation.

The VA Office of Dentistry has demonstrated the transformative power of GIS technology in health care. By integrating spatial analysis into their planning processes, VA staff have not only optimized resource distribution but also set a precedent for equity and quality in care.