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Gressler LE, Cowley T, Velezis M, Aryal S, Clare D, Kusiak JW, Cowley AW, Sedrakyan A, Marinac-Dabic D, Reardon M, Schmidt L, Feldman JG, DiFabio V, Bergman S, Simonyan V, Yesha Y, Vasiliu-Feltes I, Durham J, Steen AI, Woods P, Kapos FP, Loyo-Berrios N. Building the foundation for a modern patient-partnered infrastructure to study temporomandibular disorders. Front Digit Health 2023; 5:1132446. [PMID: 37255961 PMCID: PMC10226081 DOI: 10.3389/fdgth.2023.1132446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/25/2023] [Indexed: 06/01/2023] Open
Abstract
Background Conflicting reports from varying stakeholders related to prognosis and outcomes following placement of temporomandibular joint (TMJ) implants gave rise to the development of the TMJ Patient-Led RoundTable initiative. Following an assessment of the current availability of data, the RoundTable concluded that a strategically Coordinated Registry Network (CRN) is needed to collect and generate accessible data on temporomandibular disorder (TMD) and its care. The aim of this study was therefore to advance the clinical understanding, usage, and adoption of a core minimum dataset for TMD patients as the first foundational step toward building the CRN. Methods Candidate data elements were extracted from existing data sources and included in a Delphi survey administered to 92 participants. Data elements receiving less than 75% consensus were dropped. A purposive multi-stakeholder sub-group triangulated the items across patient and clinician-based experience to remove redundancies or duplicate items and reduce the response burden for both patients and clinicians. To reliably collect the identified data elements, the identified core minimum data elements were defined in the context of technical implementation within High-performance Integrated Virtual Environment (HIVE) web-application framework. HIVE was integrated with CHIOS™, an innovative permissioned blockchain platform, to strengthen the provenance of data captured in the registry and drive metadata to record all registry transaction and create a robust consent network. Results A total of 59 multi-stakeholder participants responded to the Delphi survey. The completion of the Delphi surveys followed by the application of the required group consensus threshold resulted in the selection of 397 data elements (254 for patient-generated data elements and 143 for clinician generated data elements). The infrastructure development and integration of HIVE and CHIOS™ was completed showing the maintenance of all data transaction information in blockchain, flexible recording of patient consent, data cataloging, and consent validation through smart contracts. Conclusion The identified data elements and development of the technological platform establishes a data infrastructure that facilitates the standardization and harmonization of data as well as perform high performance analytics needed to fully leverage the captured patient-generated data, clinical evidence, and other healthcare ecosystem data within the TMJ/TMD-CRN.
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Affiliation(s)
- Laura Elisabeth Gressler
- Center for Devices and Radiological Health (CDRH), Food and Drug Administration, Silver Spring, MD, United States
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | | | - Marti Velezis
- Center for Devices and Radiological Health (CDRH), Food and Drug Administration, Silver Spring, MD, United States
| | - Suvekshya Aryal
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | | | | | - Allen W. Cowley
- Department of Physiology, Medical College of Wisconsin, Madison, WI, United States
| | - Art Sedrakyan
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Danica Marinac-Dabic
- Center for Devices and Radiological Health (CDRH), Food and Drug Administration, Silver Spring, MD, United States
| | | | | | | | - Vincent DiFabio
- Oral and Maxillofacial Surgery, University of Maryland Medical System, Baltimore, MD, United States
| | - Suzie Bergman
- Dentistry on Officers Row, Vancouver, WA, United States
| | | | - Yelena Yesha
- Department of Computer Science, University of Miami, Miami, FL, United States
| | | | - Justin Durham
- School of Dental Sciences, NewcastleUnited Kingdom
- Newcastle-Upon Tyne Hospitals’ NHS Foundation Trust, Newcastle, United Kingdom
| | - Andrew I. Steen
- Center for Devices and Radiological Health (CDRH), Food and Drug Administration, Silver Spring, MD, United States
| | - Phillip Woods
- Center for Devices and Radiological Health (CDRH), Food and Drug Administration, Silver Spring, MD, United States
| | - Flavia P. Kapos
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Nilsa Loyo-Berrios
- Center for Devices and Radiological Health (CDRH), Food and Drug Administration, Silver Spring, MD, United States
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Currie C, Palmer J, Stone S, Brocklehurst P, Aggarwal V, Dorman P, Pearce M, Durham J. Persistent Orofacial Pain Attendances at General Medical Practitioners. J Dent Res 2023; 102:164-169. [PMID: 36314491 PMCID: PMC9896262 DOI: 10.1177/00220345221128226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Patients with persistent orofacial pain (POFP) can go through complex care pathways to receive a diagnosis and management, which can negatively affect their pain. This study aimed to describe 44-y trends in attendances at Welsh medical practices for POFP and establish the number of attendances per patient and referrals associated with orofacial pain and factors that may predict whether a patient is referred. A retrospective observational study was completed using the nationwide Secure Anonymised Information Linkage Databank of visits to general medical practices in Wales (UK). Data were extracted using diagnostic codes ("Read codes"). Orofacial and migraine Read codes were extracted between 1974 and 2017. Data were analyzed using descriptive statistics and univariate and multivariable logistic regression. Over the 44-y period, there were 468,827 POFP and migraine diagnostic codes, accounting for 468,137 patient attendances, or 301,832 patients. The overall attendance rate was 4.22 attendances per 1,000 patient-years (95% confidence interval [CI], 4.21-4.23). The attendance rate increased over the study period. Almost one-third of patients (n = 92,192, 30.54%) attended more than once over the study period, and 15.83% attended more than once within a 12-mo period. There were 20,103 referral codes that were associated with 8,183 patients, with over half these patients being referred more than once. Odds of receiving a referral were highest in females (odds ratio [OR], 1.23; 95% CI, 1.17-1.29), in those living in rural locations (OR, 1.17; 95% CI, 1.12-1.22), and in the least deprived quintile (OR, 1.39; 95% CI, 1.29-1.48). Odds also increased with increasing age (OR, 1.03; 95% CI, 1.03-1.03). The increasing attendance may be explained by the increasing incidence of POFP within the population. These patients can attend on a repeated basis, and very few are referred, but when they are, this may occur multiple times; therefore, current care pathways could be improved.
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Affiliation(s)
- C.C. Currie
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK,Newcastle Upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK,C.C. Currie, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4BW, UK.
| | - J. Palmer
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK,Newcastle Upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - S.J. Stone
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK,Newcastle Upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | - P.J. Dorman
- Newcastle Upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - M.S. Pearce
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - J. Durham
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK,Newcastle Upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
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Feine J. Considering the Vulnerable Populations of Young and Old. JDR Clin Trans Res 2023; 8:4-5. [PMID: 36534061 PMCID: PMC9772887 DOI: 10.1177/23800844221141630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- J.S. Feine
- Oral Health and Society Division, Faculty of Dentistry, McGill University, Montreal, Quebec, Canada,J.S. Feine, Oral Health and Society Division, Faculty of Dentistry, McGill University, 2001 McGill College Ave, Montreal, Quebec H3A 1G1, Canada.
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Grunberg VA, Reichman M, Lovette BC, Vranceanu AM, Greenberg J. "No One Truly Understands What We Go through and How to Treat It": Lived Experiences with Medical Providers among Patients with Orofacial Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10396. [PMID: 36012029 PMCID: PMC9408497 DOI: 10.3390/ijerph191610396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
UNLABELLED Orofacial pain affects 10-15% of adults, yet treatments are limited. The gaps in care are frustrating for both patients and providers and can negatively impact patient-provider interactions. These interactions are key because they impact patient-reported outcomes and satisfaction with care. PURPOSE Our study aims to understand the nuanced experiences with medical providers among patients with orofacial pain. METHODS In a cross-sectional survey, 260 patients provided written responses describing their experiences with medical providers. Using an inductive-deductive approach to thematic analysis, we identified themes and subthemes and organized them into four domains based on the Patient-Centered Model of Communication. RESULTS Patients reported feeling hopeless about treatment options, frustrated with lack of provider knowledge, disappointed in ineffective care, and stigmatized and dismissed by providers. Patients also said they learned to advocate for their health, were grateful for effective care, and felt lucky when providers listened and showed compassion. Patients identified key barriers that interfere with care (e.g., insurance, transportation, limited providers, lack of team coordination). CONCLUSIONS Findings can help inform training programs and psychoeducation that target patient-provider communication to improve patient-reported outcomes, the quality of care delivered, and health care utilization and costs.
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Affiliation(s)
- Victoria A. Grunberg
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA
- Division of Newborn Medicine, MassGeneral for Children, Boston, MA 02114, USA
| | - Mira Reichman
- Department of Psychology, University of Washington, Seattle, WA 98195, USA
| | - Brenda C. Lovette
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA 02129, USA
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA
| | - Jonathan Greenberg
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA
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Salinas Fredricson A, Krüger Weiner C, Adami J, Rosén A, Lund B, Hedenberg-Magnusson B, Fredriksson L, Svedberg P, Naimi-Akbar A. Sick leave and disability pension in a cohort of TMD-patients - The Swedish National Registry Studies for Surgically Treated TMD (SWEREG-TMD). BMC Public Health 2022; 22:916. [PMID: 35534826 PMCID: PMC9082829 DOI: 10.1186/s12889-022-13329-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 04/29/2022] [Indexed: 01/01/2023] Open
Abstract
Background Temporomandibular disorders (TMD) are common and affect approximately 10% of the adult population. TMD is usually associated with headache, pain in the masticatory muscles and/or the temporomandibular joint, clicking or crepitations during mandibular movement as well as painful and/or reduced mouth opening. This study aimed to investigate the level TMD-patients use social insurance benefits before and after their first time of diagnosis or first surgical event, compared to the general population. Furthermore, the aim was to investigate the differences in the use of social insurance benefits between surgically and non-surgically treated TMD-patients that were diagnosed in a hospital setting. Methods All Swedish citizens aged 23–59 diagnosed with TMD in a hospital setting and/or surgically treated for the condition during 1998–2016 were identified via the Swedish National Board of Health and Welfare. A non-exposed comparison cohort was collected via the Total Population Registry. Outcome and sociodemographic data were collected via Statistics Sweden. Main outcome was annual net days on sick leave and disability pension five years before (-T5) and five years after (T5) diagnosis and/or surgical treatment (T0). Regression analysis was conducted with generalized estimated equations. Results The study included 219 255 individuals (73% female) – 19 934 in the exposed cohort and 199 321 in the comparison cohort. The exposed group was classified into three subgroups: non-surgical, surgically treated once, and surgically treated twice or more. The mean annual net days of sick leave and disability pension combined during the ten-year follow-up was 61 days in the non-surgical group, 76 days in the surgically treated once group, and 104 days in the surgically treated twice or more subgroup. The corresponding number for the non-exposed comparison cohort was 32 days. Conclusion Patients diagnosed with TMD in a hospital setting are 2–3 times more dependent on the use of social benefits than the general population. The reliance on sick leave and disability pension is seen as early as five years before diagnosis, and the reliance remains after surgical treatment. The reliance is stronger in patients with several surgical interventions. These findings indicate that patients diagnosed with TMD constitute a patient group with a high burden of health issues causing long-term dependence on social security benefits.
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Affiliation(s)
- Adrian Salinas Fredricson
- Eastmaninstitutet Department of Oral and Maxillofacial Surgery, Public Dental Services, Folktandvården Stockholm, Stockholm, Sweden. .,Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Stockholm, Sweden.
| | - Carina Krüger Weiner
- Eastmaninstitutet Department of Oral and Maxillofacial Surgery, Public Dental Services, Folktandvården Stockholm, Stockholm, Sweden.,Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Stockholm, Sweden
| | | | - Annika Rosén
- Department of Clinical Dentistry, Division of Oral and Maxillofacial Surgery, University of Bergen, Bergen, Norway.,Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
| | - Bodil Lund
- Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Stockholm, Sweden.,Medical Unit for Reconstructive Plastic- and Craniofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Britt Hedenberg-Magnusson
- Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Stockholm, Sweden.,Eastmaninstitutet Department of Orofacial Pain and Jaw Function, Public Dental Services, Folktandvården Stockholm, Stockholm, Sweden
| | - Lars Fredriksson
- Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Stockholm, Sweden.,Eastmaninstitutet Department of Orofacial Pain and Jaw Function, Public Dental Services, Folktandvården Stockholm, Stockholm, Sweden
| | - Pia Svedberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Aron Naimi-Akbar
- Eastmaninstitutet Department of Oral and Maxillofacial Surgery, Public Dental Services, Folktandvården Stockholm, Stockholm, Sweden.,Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Stockholm, Sweden.,Health Technology Assessment-Odontology (HTA-O), Malmö University, Malmö, Sweden
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