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Shwetha V. Kumar Suhasini Bangar Ana Neumann Krishna Kumar Kookal Alfa Yansane Oluwabunmi Tokede Enihomo Obadan-Udoh Elizabeth Mertz Kristen Simmons Joshua Even Joanna Mullins Joel White Elsbeth Kalenderian Muhammad Walji 《Journal of the American Dental Association (1939)》2018,149(9):756-764.e1
Background
Although sealants are highly effective in preventing caries in children, placement rates continue to be low. The authors’ goals were to implement and assess the performance of 2 existing sealant quality measures against a manual audit of charts at 4 dental institutions and to identify measurement gaps that may be filled by using data from electronic health records.Methods
The authors evaluated the performance of 2 quality measures designed for claims-based data: the Dental Quality Alliance (DQA) sealant measure, which includes patients at risk of developing elevated caries, and the Oregon Health Authority (OHA) sealant measure (irrespective of caries risk). The authors adapted and validated these measures at 4 sites: 3 dental schools and 1 large dental accountable care organization.Results
The overall modified DQA and modified OHA measure scores in the 6- through 9-year-old age group were 37.0% and 31.6% and in the 10- through 14-year-old age group were 15.8% and 6.6%, respectively. Results from the manual review of charts showed that 67.6% of children who did not receive sealants did not have any teeth to seal because their molars had not yet erupted, had been extracted, had been sealed previously, or had existing caries or restorations.Conclusions
Both the DQA and OHA measures, which rely mainly on Current Dental Terminology procedure codes, led to underestimation of the care delivered from a practice perspective. Future sealant quality measures should exclude patients whose teeth cannot be sealed.Practical Implications
This study’s results support the suitability of using electronic health record data for assessing the quality of oral health care, particularly for measuring sealant placement in children. 相似文献2.
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Suhasini Bangar Ana Neumann Joel M. White Alfa Yansane Todd R. Johnson Gregory W. Olson Shwetha V. Kumar Krishna K. Kookal Aram Kim Enihomo Obadan-Udoh Elizabeth Mertz Kristen Simmons Joanna Mullins Ryan Brandon Muhammad F. Walji Elsbeth Kalenderian 《Applied clinical informatics》2022,13(1):80
Background Longitudinal patient level data available in the electronic health record (EHR) allows for the development, implementation, and validations of dental quality measures (eMeasures). Objective We report the feasibility and validity of implementing two eMeasures. The eMeasures determined the proportion of patients receiving a caries risk assessment (eCRA) and corresponding appropriate risk-based preventative treatments for patients at elevated risk of caries (appropriateness of care [eAoC]) in two academic institutions and one accountable care organization, in the 2019 reporting year. Methods Both eMeasures define the numerator and denominator beginning at the patient level, populations'' specifications, and validated the automated queries. For eCRA, patients who completed a comprehensive or periodic oral evaluation formed the denominator, and patients of any age who received a CRA formed the numerator. The eAoC evaluated the proportion of patients at elevated caries risk who received the corresponding appropriate risk-based preventative treatments. Results EHR automated queries identified in three sites 269,536 patients who met the inclusion criteria for receiving a CRA. The overall proportion of patients who received a CRA was 94.4% (eCRA). In eAoC, patients at elevated caries risk levels (moderate, high, or extreme) received fluoride preventive treatment ranging from 56 to 93.8%. For patients at high and extreme risk, antimicrobials were prescribed more frequently site 3 (80.6%) than sites 2 (16.7%) and 1 (2.9%). Conclusion Patient-level data available in the EHRs can be used to implement process-of-care dental eCRA and AoC, eAoC measures identify gaps in clinical practice. EHR-based measures can be useful in improving delivery of evidence-based preventative treatments to reduce risk, prevent tooth decay, and improve oral health. 相似文献
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