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Tokede B, Brandon R, Lee CT, Lin GH, White J, Yansane A, Jiang X, Kalenderian E, Walji M. Development and validation of a rule-based algorithm to identify periodontal diagnosis using structured electronic health record data. J Clin Periodontol 2024; 51:547-557. [PMID: 38212876 DOI: 10.1111/jcpe.13938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 11/14/2023] [Accepted: 12/07/2023] [Indexed: 01/13/2024]
Abstract
AIM To develop and validate an automated electronic health record (EHR)-based algorithm to suggest a periodontal diagnosis based on the 2017 World Workshop on the Classification of Periodontal Diseases and Conditions. MATERIALS AND METHODS Using material published from the 2017 World Workshop, a tool was iteratively developed to suggest a periodontal diagnosis based on clinical data within the EHR. Pertinent clinical data included clinical attachment level (CAL), gingival margin to cemento-enamel junction distance, probing depth, furcation involvement (if present) and mobility. Chart reviews were conducted to confirm the algorithm's ability to accurately extract clinical data from the EHR, and then to test its ability to suggest an accurate diagnosis. Subsequently, refinements were made to address limitations of the data and specific clinical situations. Each refinement was evaluated through chart reviews by expert periodontists at the study sites. RESULTS Three-hundred and twenty-three charts were manually reviewed, and a periodontal diagnosis (healthy, gingivitis or periodontitis including stage and grade) was made by expert periodontists for each case. After developing the initial version of the algorithm using the unmodified 2017 World Workshop criteria, accuracy was 71.8% for stage alone and 64.7% for stage and grade. Subsequently, 16 modifications to the algorithm were proposed and 14 were accepted. This refined version of the algorithm had 79.6% accuracy for stage alone and 68.8% for stage and grade together. CONCLUSIONS Our findings suggest that a rule-based algorithm for suggesting a periodontal diagnosis using EHR data can be implemented with moderate accuracy in support of chairside clinical diagnostic decision making, especially for inexperienced clinicians. Grey-zone cases still exist, where clinical judgement will be required. Future applications of similar algorithms with improved performance will depend upon the quality (completeness/accuracy) of EHR data.
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Affiliation(s)
- Bunmi Tokede
- Department of Diagnostic and Biomedical Sciences, University of Texas at Houston, Health Science Center, Houston, Texas, USA
| | - Ryan Brandon
- Willamette Dental Group and Skourtes Institute, Hillsboro, Oregon, USA
| | - Chun-Teh Lee
- Department of Periodontics & Dental Hygiene, The University of Texas Health Science Center at Houston, School of Dentistry, Houston, Texas, USA
| | - Guo-Hao Lin
- Postgraduate Periodontics Program, School of Dentistry, University of California, San Francisco, California, USA
| | - Joel White
- Preventive and Restorative Dental Sciences, University of California, San Francisco/ UCSF School of Dentistry, San Francisco, California, USA
| | - Alfa Yansane
- Preventive and Restorative Dental Sciences, University of California, San Francisco/ UCSF School of Dentistry, San Francisco, California, USA
| | - Xiaoqian Jiang
- Department of Health Data Science and AI, UTHealth School of Biomedical Informatics, Houston, Texas, USA
| | - Elsbeth Kalenderian
- Preventive and Restorative Dental Sciences, University of California, San Francisco/ UCSF School of Dentistry, San Francisco, California, USA
| | - Muhammad Walji
- Department of Diagnostic and Biomedical Sciences, University of Texas at Houston, Health Science Center, Houston, Texas, USA
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Mullins J, Brandon R, Skourtes N, Kalenderian E, Walji M. Improvements in appropriate placement of dental sealants after implementation of a clinical decision support system. J Am Dent Assoc 2024:S0002-8177(24)00110-7. [PMID: 38583172 DOI: 10.1016/j.adaj.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/12/2024] [Accepted: 02/15/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Dental sealants are effective for the prevention of caries in children at elevated risk levels, and increasing the proportion of children and adolescents who have dental sealants on 1 or more molars is a Healthy People 2030 objective. Electronic health record (EHR)-based clinical decision support systems (CDSSs) have the ability to improve patient care. A dental quality measure related to dental sealant placement for children at elevated risk of caries was targeted for improvement using a CDSS. METHODS A validated dental quality measure was adapted to assess a patient's need for dental sealant placement. A CDSS was implemented to advise care team members whether a child was at elevated risk of developing caries and had sealant-eligible first or second molars. Data on dental sealant placement at examination visits during a 5-year period were analyzed, including 32 months before CDSS implementation and 28 months after CDSS implementation. RESULTS From January 1, 2018, through December 31, 2022, the authors assessed 59,047 examination visits for children at elevated risk of developing caries and with sealant-eligible teeth. With the implementation of a CDSS and training to support the clinical care team members in September 2020, the appropriate placement of dental sealants at examination visits increased from 27% through 60% (P < .00001). CONCLUSIONS Integration of a CDSS into the EHR as part of a quality improvement program was effective in increasing the delivery of sealants in eligible first and second molars of children aged 5 through 15 years and considered at high risk of developing caries. PRACTICAL IMPLICATIONS An EHR-based CDSS can be implemented to improve standardization and provide timely and appropriate patient care in dental practices.
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Ibarra-Noriega AM, Yansane A, Mullins J, Simmons K, Skourtes N, Holmes D, White J, Kalenderian E, Walji MF. Evaluating and improving the usability of a mHealth platform to assess postoperative dental pain. JAMIA Open 2024; 7:ooae018. [PMID: 38476372 PMCID: PMC10928307 DOI: 10.1093/jamiaopen/ooae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 01/26/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Objectives The use of interactive mobile health (mHealth) applications to monitor patient-reported postoperative pain outcomes is an emerging area in dentistry that requires further exploration. This study aimed to evaluate and improve the usability of an existing mHealth application. Materials and methods The usability of the application was assessed iteratively using a 3-phase approach, including a rapid cognitive walkthrough (Phase I), lab-based usability testing (Phase II), and in situ pilot testing (Phase III). The study team conducted Phase I, while providers and patients participated in Phase II and III. Results The rapid cognitive walkthrough identified 23 potential issues that could negatively impact user experience, with the majority classified as system issues. The lab-based usability testing yielded 141 usability issues.; 43% encountered by patients and 57% by dentists. Usability problems encountered during pilot testing included undelivered messages due to mobile phone carrier and service-related issues, errors in patients' phone number data entry, and problems in provider training. Discussion Through collaborative and iterative work with the vendor, usability issues were addressed before launching a trial to assess its efficacy. Conclusion The usability of the mHealth application for postoperative dental pain was remarkably improved by the iterative analysis and interdisciplinary collaboration.
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Affiliation(s)
- Ana M Ibarra-Noriega
- Diagnostic and Biomedical Sciences, School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX 77054, United States
| | - Alfa Yansane
- Preventive and Restorative Dental Sciences, School of Dentistry, University of California at San Francisco, San Francisco, CA 94143, United States
| | | | | | | | | | - Joel White
- Preventive and Restorative Dental Sciences, School of Dentistry, University of California at San Francisco, San Francisco, CA 94143, United States
| | - Elsbeth Kalenderian
- Marquette University School of Dentistry, Milwaukee, WI 53233, United States
- Department of Dental Management, School of Dentistry, University of Pretoria, Pretoria, 0002, South Africa
| | - Muhammad F Walji
- Diagnostic and Biomedical Sciences, School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX 77054, United States
- Department of Clinical and Health Informatics, UTHealth Houston McWilliams School of Biomedical Informatics, Houston, TX 77030, United States
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Kalenderian E, Zouaidi K, Yeager J, Urata J, Yansane A, Tokede B, Rindal DB, Spallek H, White J, Walji M. Learning from data in dentistry: Summary of the third annual OpenWide conference. Learn Health Syst 2024; 8:e10398. [PMID: 38633022 PMCID: PMC11019381 DOI: 10.1002/lrh2.10398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 04/19/2024] Open
Abstract
The overarching goal of the third scientific oral health symposium was to introduce the concept of a learning health system to the dental community and to identify and discuss cutting-edge research and strategies using data for improving the quality of dental care and patient safety. Conference participants included clinically active dentists, dental researchers, quality improvement experts, informaticians, insurers, EHR vendors/developers, and members of dental professional organizations and dental service organizations. This report summarizes the main outputs of the third annual OpenWide conference held in Houston, Texas, on October 12, 2022, as an affiliated meeting of the American Dental Association (ADA) 2022 annual conference.
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Affiliation(s)
- Elsbeth Kalenderian
- School of DentistryMarquette UniversityMilwaukeeWisconsinUSA
- School of DentistryUniversity of California at San Francisco (UCSF)San FranciscoCaliforniaUSA
- School of DentistryUniversity of PretoriaPretoriaSouth Africa
| | - Kawtar Zouaidi
- Department of Diagnostuc SciencesUTHealth School of DentistryHoustonTexasUSA
| | - Jan Yeager
- School of DentistryUniversity of California at San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Janelle Urata
- School of DentistryUniversity of California at San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Alfa Yansane
- School of DentistryUniversity of California at San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Bunmi Tokede
- Department of Diagnostuc SciencesUTHealth School of DentistryHoustonTexasUSA
| | - D. Brad Rindal
- Institute for Education and ResearchHealthPartners Research InstituteMinneapolisMinnesotaUSA
| | - Heiko Spallek
- School of DentistryUniversity of SydneyCamperdownNew South WalesAustralia
| | - Joel White
- School of DentistryUniversity of California at San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Muhammad Walji
- Department of Diagnostuc SciencesUTHealth School of DentistryHoustonTexasUSA
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Kalenderian E, Tungare S, Mehta U, Hamid S, Mungia R, Yansane AI, Holmes D, Funkhouser K, Ibarra-Noriega AM, Urata J, Rindal DB, Spallek H, White J, Walji MF. Patient and dentist perspectives on collecting patient reported outcomes after painful dental procedures in the National Dental PBRN. BMC Oral Health 2024; 24:201. [PMID: 38326805 PMCID: PMC10848340 DOI: 10.1186/s12903-024-03931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/24/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Dental Patient Reported Outcomes (PROs) relate to a dental patient's subjective experience of their oral health. How practitioners and patients value PROs influences their successful use in practice. METHODS Semi-structured interviews were conducted with 22 practitioners and 32 patients who provided feedback on using a mobile health (mHealth) platform to collect the pain experience after dental procedures. A themes analysis was conducted to identify implementation barriers and facilitators. RESULTS Five themes were uncovered: (1) Sense of Better Care. (2) Tailored Follow-up based on the dental procedure and patient's pain experience. (3) Effective Messaging and Alerts. (4) Usable Digital Platform. (5) Routine mHealth Integration. CONCLUSION Frequent automated and preferably tailored follow-up messages using an mHealth platform provided a positive care experience for patients, while providers felt it saved them time and effort. Patients thought that the mHealth questionnaires were well-developed and of appropriate length. The mHealth platform itself was perceived as user-friendly by users, and most would like to continue using it. PRACTICAL IMPLICATIONS Patients are prepared to use mobile phones to report their pain experience after dental procedures. Practitioners will be able to close the post-operative communication gap with their patients, with little interruption of their workflow.
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Affiliation(s)
- Elsbeth Kalenderian
- Marquette University, School of Dentistry, Milwaukee, WI, USA
- University of California San Francisco, School of Dentistry, 600 Parnassus Avenue, San Francisco, CA, USA
- University of Pretoria, School of Dentistry, Pretoria, South Africa
| | - Sayali Tungare
- UTHealth School of Dentistry, 7500 Cambridge St. room 4160, Houston, TX, TX 77054, USA
| | - Urvi Mehta
- UTHealth School of Dentistry, 7500 Cambridge St. room 4160, Houston, TX, TX 77054, USA
| | - Sharmeen Hamid
- UTHealth School of Dentistry, 7500 Cambridge St. room 4160, Houston, TX, TX 77054, USA
| | - Rahma Mungia
- UTHealth School of Dentistry, San Antonio, TX, USA
| | - Alfa-Ibrahim Yansane
- University of California San Francisco, School of Dentistry, 600 Parnassus Avenue, San Francisco, CA, USA
| | | | - Kim Funkhouser
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227-1098, USA
| | - Ana M Ibarra-Noriega
- UTHealth School of Dentistry, 7500 Cambridge St. room 4160, Houston, TX, TX 77054, USA
| | - Janelle Urata
- University of California San Francisco, School of Dentistry, 600 Parnassus Avenue, San Francisco, CA, USA
| | | | - Heiko Spallek
- University of Sydney, School of Dentistry, Sydney, Australia
| | - Joel White
- University of California San Francisco, School of Dentistry, 600 Parnassus Avenue, San Francisco, CA, USA
| | - Muhammad F Walji
- UTHealth School of Dentistry, 7500 Cambridge St. room 4160, Houston, TX, TX 77054, USA.
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Tokede B, Gandhi HA, Walji M, Kalenderian E, Olson G. Authors' Response. J Am Dent Assoc 2024; 155:6. [PMID: 38032591 DOI: 10.1016/j.adaj.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Bunmi Tokede
- Associate Professor, Diagnostic and Biomedical Sciences, Orthodontics, School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX
| | - Henal Alpesh Gandhi
- Graduate Research Assistant, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Muhammad Walji
- Professor and Chair, Department of Clinical and Health Informatics, School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX
| | - Elsbeth Kalenderian
- Professor and Dean, School of Dentistry, Marquette University, Milwaukee, WI
| | - Greg Olson
- Professor and Chair, Department of Pediatric Dentistry, School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX
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Gandhi HA, Olson G, Lee H, Zouaidi K, Yansane A, Walji M, Kalenderian E, Tokede B. Assessing the safety of deep sedation in outpatient pediatric oral health care. J Am Dent Assoc 2023; 154:975-983.e1. [PMID: 37676186 DOI: 10.1016/j.adaj.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/12/2023] [Accepted: 07/24/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Children are the patient subgroup with the lowest error tolerance regarding deep sedation (DS)-supported care. This study assessed the safety of DS-supported pediatric dental treatment carried out in an outpatient setting through retrospective review of patient charts. METHODS An automated script was developed to identify charts of pediatric patients who underwent DS-supported dental procedures from 2017 through 2019 at a dental clinic. Charts were assessed for the presence of sedation-related adverse events (AEs). A panel of experts performed a second review and confirmed or refuted the designation of AE (by the first reviewer). AEs were classified with the Tracking and Reporting Outcomes of Procedural Sedation system. RESULTS Of the 175 DS cases, 19 AEs were identified in 15 cases (8.60%). Using the Tracking and Reporting Outcomes of Procedural Sedation classification system, 7 (36.84%) events were related to the airway and breathing category, 9 (47.37%) were related to sedation quality (including a dizzy patient who fell at the checkout desk and sustained a head laceration), and 3 (15.79%) were classified as an allergy. CONCLUSION This study suggests an AE (whether relatively minor or of potentially major consequence) occurs in 1 of every 12 DS cases involving pediatric patients, performed at an outpatient dental clinic. Larger studies are needed, in addition to root cause analyses. PRACTICAL IMPLICATIONS As dentists increasingly pivot in the use of DS services from in-hospital to outpatient settings, patients expect comparable levels of safety. This work helps generate evidence to drive targeted efforts to improve the safety and reliability of pediatric outpatient sedation.
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Tokede B, Yansane A, Ibarra-Noriega A, Mullins J, Simmons K, Skourtes N, Mehta U, Tungare S, Holmes D, White J, Walji M, Kalenderian E. Evaluating the Impact of an mHealth Platform for Managing Acute Postoperative Dental Pain: Randomized Controlled Trial. JMIR Mhealth Uhealth 2023; 11:e49677. [PMID: 37933185 PMCID: PMC10644946 DOI: 10.2196/49677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 11/08/2023] Open
Abstract
Background Postoperative dental pain is pervasive and can affect a patient's quality of life. Adopting a patient-centric approach to pain management involves having contemporaneous information about the patient's experience of pain and using it to personalize care. Objective In this study, we evaluated the use of a mobile health (mHealth) platform to collect pain-related patient-reported outcomes over 7 days after the patients underwent pain-inducing dental procedures; we then relayed the information to the dentist and determined its impact on the patient's pain experience. Methods The study used a cluster-randomized experimental study design with an intervention arm where patients were prompted to complete a series of questions relating to their pain experience after receiving automated text notifications on their smartphone on days 1, 3, 5, and 7, with the resulting information fed back to dentists, and a control arm where patients received usual care. Providers were randomized, and patients subsequently assumed the enrollment status of their providers. Providers or their staff identified eligible patients and invited them to participate in the study. Provider interviews and surveys were conducted to evaluate acceptance of the mHealth platform. Results A total of 42 providers and 1525 patients participated. For the primary outcome (pain intensity on a 1 to 10 scale, with 10 being the most painful), intervention group patients reported an average pain intensity of 4.8 (SD 2.6), while those in the control group reported an average pain intensity of 4.7 (SD 2.8). These differences were not significant. There were also no significant differences in secondary outcomes, including pain interference with activity or sleep, patient satisfaction with pain management, or opioid prescribing. Patient surveys revealed reluctance to use the app was mostly due to technological challenges, data privacy concerns, and a preference for phone calls over texting. Providers had high satisfaction with the app and suggested integrating additional features, such as an in-system camera for patients to upload pictures and videos of the procedural site, and integration with the electronic health record system. Conclusions While the mHealth platform did not have a significant impact on acute postoperative pain experience, patients and providers indicated improvement in patient-provider communication, patient-provider relationship, postoperative complication management, and ability to manage pain medication prescribing. Expanded collaboration between mHealth developers and frontline health care providers can facilitate the applicability of these platforms, further help improve its integration with the normal clinic workflow, and assist in moving toward a more patient-centric approach to pain management.
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Affiliation(s)
- Bunmi Tokede
- The University of Texas Health Science Center, HoustonTX, United States
| | - Alfa Yansane
- School of Dentistry, University of California San Francisco, San FranciscoCA, United States
| | | | | | | | | | - Urvi Mehta
- The University of Texas Health Science Center, HoustonTX, United States
| | - Sayali Tungare
- The University of Texas Health Science Center, HoustonTX, United States
| | | | - Joel White
- School of Dentistry, University of California San Francisco, San FranciscoCA, United States
| | - Muhammad Walji
- The University of Texas Health Science Center, HoustonTX, United States
| | - Elsbeth Kalenderian
- School of Dentistry, University of California San Francisco, San FranciscoCA, United States
- Harvard School of Dental Medicine, BostonMA, United States
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Kalenderian E, Bangar S, Yansane A, Tran D, Sedlock E, Xiao Y, Urata J, Olson G, Franklin A, Kookal K, Ibarra-Noriega A, Tungare S, Tokede O, Spallek H, White JM, Walji MF. Identifying Contributing Factors Associated With Dental Adverse Events Through a Pragmatic Electronic Health Record-Based Root Cause Analysis. J Patient Saf 2023; 19:305-312. [PMID: 37015101 PMCID: PMC10363220 DOI: 10.1097/pts.0000000000001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVE This study assessed contributing factors associated with dental adverse events (AEs). METHODS Seven electronic health record-based triggers were deployed identifying potential AEs at 2 dental institutions. From 4106 flagged charts, 2 reviewers examined 439 charts selected randomly to identify and classify AEs using our dental AE type and severity classification systems. Based on information captured in the electronic health record, we analyzed harmful AEs to assess potential contributing factors; harmful AEs were defined as those that resulted in temporary moderate to severe harm, required hospitalization, or resulted in permanent moderate to severe harm. We classified potential contributing factors according to (1) who was involved (person), (2) what were they doing (tasks), (3) what tools/technologies were they using (tools/technologies), (4) where did the event take place (environment), (5) what organizational conditions contributed to the event? (organization), (6) patient (including parents), and (7) professional-professional collaboration. A blinded panel of dental experts conducted a second review to confirm the presence of an AE. RESULTS Fifty-nine cases had 1 or more harmful AEs. Pain occurred most frequently (27.1%), followed by nerve injury (16.9%), hard tissue injury (15.2%), and soft tissue injury (15.2%). Forty percent of the cases were classified as "temporary not moderate to severe harm." Person (training, supervision, and fatigue) was the most common contributing factor (31.5%), followed by patient (noncompliance, unsafe practices at home, low health literacy, 17.1%), and professional-professional collaboration (15.3%). CONCLUSIONS Pain was the most common harmful AE identified. Person, patient, and professional-professional collaboration were the most frequently assessed factors associated with harmful AEs.
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Affiliation(s)
| | - Suhasini Bangar
- University of Texas Health Science Center at Houston, School of Dentistry, Houston, Texas
| | - Alfa Yansane
- University of California at San Francisco School of Dentistry, San Francisco, California
| | - Duong Tran
- University of Texas Health Science Center at Houston, School of Dentistry, Houston, Texas
| | - Emily Sedlock
- University of Texas Health Science Center at Houston, School of Dentistry, Houston, Texas
| | - Yan Xiao
- University of Texas at Arlington, College of Nursing and Health Innovation, Arlington, Texas
| | - Janelle Urata
- University of California at San Francisco School of Dentistry, San Francisco, California
| | - Greg Olson
- University of Texas Health Science Center at Houston, School of Dentistry, Houston, Texas
| | - Amy Franklin
- University of Texas Health Science Center at Houston, School of Biomedical Informatics, Houston, Texas
| | - Krishna Kookal
- University of Texas Health Science Center at Houston, School of Dentistry, Houston, Texas
| | - Ana Ibarra-Noriega
- University of Texas Health Science Center at Houston, School of Dentistry, Houston, Texas
| | - Sayali Tungare
- University of Texas Health Science Center at Houston, School of Dentistry, Houston, Texas
| | - Oluwabunmi Tokede
- University of Texas Health Science Center at Houston, School of Dentistry, Houston, Texas
| | - Heiko Spallek
- University of Sydney School of Dentistry, Surry Hills, Australia
| | - Joel M White
- University of California at San Francisco School of Dentistry, San Francisco, California
| | - Muhammad F Walji
- University of Texas Health Science Center at Houston, School of Dentistry, Houston, Texas
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Brandon RG, Bangar S, Yansane A, Neumann A, Mullins JM, Kalenderian E, Walji MF, White JM. Development of quality measures to assess tooth decay outcomes from electronic health record data. J Public Health Dent 2023; 83:33-42. [PMID: 36224111 PMCID: PMC10006288 DOI: 10.1111/jphd.12545] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/10/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To develop outcomes of care quality measures derived from the dental electronic health record (EHR) to assess the occurrence and timely treatment of tooth decay. METHODS Quality measures were developed to assess whether decay was treated within 6 months and if new decay occurred in patients seen. Using EHR-derived data of the state of each tooth surface, algorithms compared the patient's teeth at different dates to determine if decay was treated or new decay had occurred. Manual chart reviews were conducted at three sites to validate the measures. The measures were implemented and scores were calculated for three sites over four calendar years, 2016 through 2019. RESULTS About 954 charts were manually reviewed for the timely treatment of tooth decay measure, with measure performance of sensitivity 97%, specificity 85%, positive predictive value (PPV) 91%, negative predictive value (NPV) 95%. About 739 charts were reviewed for new decay measure, with sensitivity 94%, specificity 99%, PPV 99%, and NPV 94%. Across all sites and years, 52.8% of patients with decay were fully treated within 6 months of diagnosis (n = 247,959). A total of 23.8% of patients experienced new decay, measured at an annual exam (n = 640,004). CONCLUSION Methods were developed and validated for assessing timely treatment of decay and occurrence of new decay derived from EHR data, creating effective outcome measures. These EHR-based quality measures produce accurate and reliable results that support efforts and advancement in quality assessment, quality improvement, patient care and research.
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Affiliation(s)
- Ryan G Brandon
- Willamette Dental Group and Skourtes Institute, Hillsboro, Oregon, USA
| | - Suhasini Bangar
- School of Dentistry, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Alfa Yansane
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Ana Neumann
- School of Dentistry, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Joanna M Mullins
- Willamette Dental Group and Skourtes Institute, Hillsboro, Oregon, USA
| | | | - Muhammad F Walji
- School of Dentistry, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Joel M White
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, California, USA
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Tokede B, Yansane A, White J, Bangar S, Mullins J, Brandon R, Gantela S, Kookal K, Rindal D, Lee CT, Lin GH, Spallek H, Kalenderian E, Walji M. Translating periodontal data to knowledge in a learning health system. J Am Dent Assoc 2022; 153:996-1004. [PMID: 35970673 PMCID: PMC9830777 DOI: 10.1016/j.adaj.2022.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND A learning health system (LHS) is a health system in which patients and clinicians work together to choose care on the basis of best evidence and to drive discovery as a natural outgrowth of every clinical encounter to ensure the right care at the right time. An LHS for dentistry is now feasible, as an increased number of oral health care encounters are captured in electronic health records (EHRs). METHODS The authors used EHRs data to track periodontal health outcomes at 3 large dental institutions. The 2 outcomes of interest were a new periodontitis case (for patients who had not received a diagnosis of periodontitis previously) and tooth loss due to progression of periodontal disease. RESULTS The authors assessed a total of 494,272 examinations (new periodontitis outcome: n = 168,442; new tooth loss outcome: n = 325,830), representing a total of 194,984 patients. Dynamic dashboards displaying performance on both measures over time allow users to compare demographic and risk factors for patients. The incidence of new periodontitis and tooth loss was 4.3% and 1.2%, respectively. CONCLUSIONS Periodontal disease, diagnosis, prevention, and treatment are particularly well suited for an LHS model. The results showed the feasibility of automated extraction and interpretation of critical data elements from the EHRs. The 2 outcome measures are being implemented as part of a dental LHS. The authors are using this knowledge to target the main drivers of poorer periodontal outcomes in a specific patient population, and they continue to use clinical health data for the purpose of learning and improvement. PRACTICAL IMPLICATIONS Dental institutions of any size can conduct contemporaneous self-evaluation and immediately implement targeted strategies to improve oral health outcomes.
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Affiliation(s)
- Bunmi Tokede
- Department of Diagnostic and Biomedical Sciences, The University of Texas Health Science Center at Houston, Houston, TX
| | - Alfa Yansane
- Preventative and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA
| | - Joel White
- Preventative and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA
| | - Suhasini Bangar
- School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX
| | | | - Ryan Brandon
- Willamette Dental Group and Skourtes Institute, Hillsboro, OR
| | - Swaroop Gantela
- School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX
| | - Krishna Kookal
- School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX
| | - Donald Rindal
- HealthPartners Institute, Minneapolis, MN, and an associate dental director for research, HealthPartners Dental Group, Minneapolis, MN
| | - Chun-Teh Lee
- Department of Periodontics and Dental Hygiene, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX
| | - Guo-Hao Lin
- School of Dentistry, University of California, San Francisco, CA
| | - Heiko Spallek
- The University of Sydney, Sydney, New South Wales, Australia
| | - Elsbeth Kalenderian
- professor, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA; a professor, Academic Centre for Dentistry, Amsterdam, The Netherlands; senior lecturer, Harvard School of Dental Medicine, Boston, MA; and an Extraordinary Professor, University of Pretoria School of Dentistry, Pretoria, South Africa
| | - Muhammad Walji
- Diagnostic and Biomedical Sciences Department, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX
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Kalenderian E, Lee JH, Obadan-Udoh EM, Yansane A, White JM, Walji MF. Development of an Inventory of Dental Harms: Methods and Rationale. J Patient Saf 2022; 18:559-564. [PMID: 35771964 PMCID: PMC9391256 DOI: 10.1097/pts.0000000000001033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES While adverse events (AEs) are all too prevalent, their underlying causes are difficult to assess because they are often multifactorial. Standardizing the language of dental AEs is an important first step toward increasing patient safety for the dental patient. METHODS We followed a multimodal approach building a dental AE inventory, which included a literature review; review of the MAUDE database; a cross-sectional, self-administered patient survey; focus groups; interviews with providers and domain experts; and chart reviews. RESULTS One hundred eight unique allergy/toxicity/foreign body response, 70 aspiration/ingestion of foreign body, 70 infection, 52 wrong site/wrong patient/wrong procedure, 23 bleeding, 48 pain, 149 hard tissue injury, 127 soft tissue injury, 91 nerve injury, 171 other systemic complication, and 177 other orofacial complication were identified. Subtype AEs within the categories revealed that allergic reaction, aspiration, pain, and wrong procedure were the most common AEs identified among known (i.e., chart reviews) and hypothetical (i.e., interviews) sources. CONCLUSIONS Using a multimodal approach, a broad list of dental AEs was developed, in which the AEs were classed into 12 categories. Hard tissue injury was noted frequently during interviews and in actuality. Pain was the unexpected AE that was consistently identified with every modality used. PRACTICAL IMPLICATIONS Most AEs result in temporary harm with hard tissue injury being a common AE identified through interviews and in actuality through chart reviews. Acknowledging that AEs happen is an important step toward mitigating them and assuring quality of care for our patients.
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Affiliation(s)
- Elsbeth Kalenderian
- University of California, San Francisco, School of Dentistry, CA, USA
- Harvard School of Dental Medicine, Boston, MA, USA
- University of Pretoria, School of Dentistry, South Africa
| | - Joo Hyun Lee
- University of California, San Francisco, School of Dentistry, CA, USA
| | | | - Alfa Yansane
- University of California, San Francisco, School of Dentistry, CA, USA
| | - Joel M. White
- University of California, San Francisco, School of Dentistry, CA, USA
| | - Muhammad F. Walji
- University of Texas Health Science Center, School of Dentistry at Houston, Houston, TX, USA
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Kalenderian E, Hebballi NB, Franklin A, Yansane A, Ibarra Noriega AM, White J, Walji MF. Development of a Quality Improvement Dental Chart Review Training Program. J Patient Saf 2022; 18:e883-e888. [PMID: 35067625 PMCID: PMC9300767 DOI: 10.1097/pts.0000000000000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Chart review is central to understanding adverse events (AEs) in medicine. In this article, we describe the process and results of educating chart reviewers assigned to evaluate dental AEs. METHODS We developed a Web-based training program, "Dental Patient Safety Training," which uses both independent and consensus-based curricula, for identifying AEs recorded in electronic health records in the dental setting. Training included (1) didactic education, (2) skills training using videos and guided walkthroughs, (3) quizzes with feedback, and (4) hands-on learning exercises. In addition, novice reviewers were coached weekly during consensus review discussions. TeamExpert was composed of 2 experienced reviewers, and TeamNovice included 2 chart reviewers in training. McNemar test, interrater reliability, sensitivity, specificity, positive predictive value, and negative predictive value were calculated to compare accuracy rates on the identification of charts containing AEs at the start of training and 7 months after consensus building discussions between the 2 teams. RESULTS TeamNovice completed independent and consensus development training. Initial chart reviews were conducted on a shared set of charts (n = 51) followed by additional training including consensus building discussions. There was a marked improvement in overall percent agreement, prevalence and bias-adjusted κ correlation, and diagnostic measures (sensitivity, specificity, positive predictive value, and negative predictive value) of reviewed charts between both teams from the phase I training program to phase II consensus building. CONCLUSIONS This study detailed the process of training new chart reviewers and evaluating their performance. Our results suggest that standardized training and continuous coaching improves calibration between experts and trained chart reviewers.
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Affiliation(s)
- Elsbeth Kalenderian
- University of California at San Francisco, School of Dentistry, Department of Preventive and Restorative Dental Sciences, CA, USA
- Harvard School of Dental Medicine, Boston, MA, USA
- University of Pretoria, School of Dentistry, South Africa
| | - Nutan B. Hebballi
- University of Texas Health Science Center, School of Dentistry at Houston, Houston, TX, USA
| | - Amy Franklin
- University of Texas Health Science Center, School of Dentistry at Houston, Houston, TX, USA
| | - Alfa Yansane
- University of California at San Francisco, School of Dentistry, Department of Preventive and Restorative Dental Sciences, CA, USA
| | - Ana M. Ibarra Noriega
- University of Texas Health Science Center, School of Dentistry at Houston, Houston, TX, USA
| | - Joel White
- University of California at San Francisco, School of Dentistry, Department of Preventive and Restorative Dental Sciences, CA, USA
| | - Muhammad F. Walji
- University of Texas Health Science Center, School of Dentistry at Houston, Houston, TX, USA
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Franklin A, Kalenderian E, Hebballi N, Delattre V, Etoule J, White J, Vaderhobli R, Stewart D, Kent K, Yansane A, Walji M. Building Consensus for a Shared Definition of Adverse Events: A Case Study in the Profession of Dentistry. J Patient Saf 2022; 18:470-474. [PMID: 35948296 PMCID: PMC9377700 DOI: 10.1097/pts.0000000000000959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To achieve high-quality health care, adverse events (AEs) must be proactively recognized and mitigated. However, there is often ambiguity in applying guidelines and definitions. We describe the iterative calibration process needed to achieve a shared definition of AEs in dentistry. Our alignment process includes both independent and consensus building approaches. OBJECTIVE We explore the process of defining dental AEs and the steps necessary to achieve alignment across different care providers. METHODS Teams from 4 dental institutions across the United States iteratively reviewed patient records after identification of charts using an automated trigger tool. Calibration across teams was supported through negotiated definition of AEs and standardization of evidence provided in review. Interrater reliability was assessed using descriptive and κ statistics. RESULTS After 5 iterative cycles of calibration, the teams (n = 8 raters) identified 118 cases. The average percent agreement for AE determination was 82.2%. Furthermore, the average, pairwise prevalence and bias-adjusted κ (PABAK) was 57.5% (κ = 0.575) for determining AE presence. The average percent agreement for categorization of the AE type was 78.5%, whereas the PABAK was 48.8%. Lastly, the average percent agreement for categorization of AE severity was 82.2% and the corresponding PABAK was 71.7%. CONCLUSIONS Successful calibration across reviewers is possible after consensus building procedures. Higher levels of agreement were found when categorizing severity (of identified events) rather than the events themselves. Our results demonstrate the need for collaborative procedures as well as training for the identification and severity rating of AEs.
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Affiliation(s)
- Amy Franklin
- From the School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Elsbeth Kalenderian
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, California
| | - Nutan Hebballi
- School of Dentistry, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Veronique Delattre
- School of Dentistry, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Jini Etoule
- Oral Health Policy and Epidemiology, School of Dental Medicine, Harvard University, Boston, Massachusetts
| | - Joel White
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, California
| | - Ram Vaderhobli
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, California
| | | | - Karla Kent
- Integrative Biosciences, School of Dentistry, Oregon Health and Science University, Portland, Oregon
| | - Alfa Yansane
- Oral Health Policy and Epidemiology, School of Dental Medicine, Harvard University, Boston, Massachusetts
| | - Muhammad Walji
- School of Dentistry, The University of Texas Health Science Center at Houston, Houston, Texas
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Zouaidi K, Olson G, Lee HH, Kalenderian E, Walji MF. An Observational Retrospective Study of Adverse Events and Behavioral Outcomes During Pediatric Dental Sedation. Pediatr Dent 2022; 44:174-180. [PMID: 35799341 PMCID: PMC9648664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Purpose: The purpose of this study was to examine a university-based dental electronic health records (EHR) database to identify sedation-related adverse events (AEs) and assess patients' behavioral outcomes during routine pediatric dental sedations (PDSs) in a dental school clinic. Methods: A database was screened for patients younger than 18 years old who had received dental sedation in 2019. The qualifying EHRs were then accessed and sedations were reviewed for AEs, which were categorized using a 12-point classification system and the Tracking and Reporting Outcomes of Procedural Sedation Tool. Patient behaviors were assessed using provider progress notes and categorized as presence/ absence of agitation. Results: A total of 690 sedations were reviewed, yielding 28 AEs. Emesis was the most common AE observed in 1.3 percent of sedations. Respiratory and cardiovascular AEs were observed in 0.7 percent and 0.6 percent of sedations, respectively. Agitation was identified in 47.5 percent of sedations, while 34.1 percent of agitations resulted in the documented suspension of dental treatment. Agitation was mainly observed for nitrous oxide and oral sedation resulting in one failed sedation out of five sedations for each method. Conclusions: Potentially serious adverse effects were identified during pediatric dental sedations, but their incidence was low. A significant proportion of the sedated children experienced agitation, resulting in some sedation failures. Such events need to be tracked and examined for risk assessment reduction and quality-of-care improvement.
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Affiliation(s)
- Kawtar Zouaidi
- Dr. Zouaidi is a graduate research assistant in the Diagnostic and Biomedical Sciences Department, at the School of Dentistry, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Gregory Olson
- Dr. Olson is a professor and chair of the Department of Pediatric Dentistry, at the School of Dentistry, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Helen H Lee
- Dr. Lee is an associate professor, Department of Anesthesiology, University of Illinois at Chicago, Chicago, Ill., USA
| | - Elsbeth Kalenderian
- Dr. Kalenderian is a professor, School of Dentistry, University of California at San Francisco, San Francisco, Calif., USA, and a senior lecturer, Harvard School of Dental Medicine, Boston, Mass., USA, and an adjunct professor, School of Dentistry, University of Pretoria, Pretoria, South Africa
| | - Muhammad F Walji
- Dr. Walji is a professor/associate dean for Technology Services and Informatics, Diagnostic and Biomedical Sciences Department, at the School of Dentistry, University of Texas Health Science Center at Houston, Houston, Texas, USA ;,
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D'Assunção FLC, Kalenderian E, Carneiro DC, Verçosa MVF, Dos Santos JP, Yansane AI, D'Assunção VCDSC, Felinto AR. Presence of management, entrepreneurship, leadership and marketing topics in the dental school curriculum in Brazil. Eur J Dent Educ 2022; 26:384-392. [PMID: 34490698 DOI: 10.1111/eje.12714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION To analyse the presence and characteristics of curricular components related to management, entrepreneurship, leadership and marketing as part of the structure and teaching methods of undergraduate courses in dentistry in Brazil. MATERIALS AND METHODS This is an observational study that used the Ministry of Education's Undergraduate Course Accreditation Platform, which included 424 undergraduate courses in Dentistry on the last date of collection (August 31 2019). The following items were analysed as follows: the existence of curricular components in relation to the proposed themes, the most recurring denominations of curricular components, minimum and maximum workload, mandatory/optional classification, theoretical/practical teaching condition and in which year the curricular components were inserted. RESULTS 367/424 (86.6%) of dentistry courses in Brazil included at least one of the topics: management, entrepreneurship, leadership and marketing curricular components in their curriculum, whilst 57/424 (13.4%) did not have these curricular components in their curricular structure. The most frequent names were "Management" 99 (45.21%) and "Entrepreneurship" 80 (36.5%). There was a predominance of the "theoretical method" and the number of hours varied considerably, with the most common course hours between 40 and 60 h. The majority of curricular components were inserted in the third to fifth year and offered on a compulsory basis. CONCLUSION Most curricular matrices of dentistry courses in Brazil had components related to the topics studied. However, due to the variety of curricular components' names, hours, periods of courses and different teaching methodologies, there is a need to redesign the teaching and learning process, defining educational and evaluation models with common curricular components.
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Affiliation(s)
| | - Elsbeth Kalenderian
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, School of Dentistry, San Francisco, California, USA
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Department of Dental Management Sciences, University of Pretoria, School of Dentistry, Pretoria, South Africa
| | | | | | | | - Alfa-Ibrahim Yansane
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, School of Dentistry, San Francisco, California, USA
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17
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Choi SE, Kalenderian E, Normand S. Measuring the quality of dental care among privately insured children in the United States. Health Serv Res 2022; 57:137-144. [PMID: 34327703 PMCID: PMC8763286 DOI: 10.1111/1475-6773.13713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To examine whether quality of dental care varies by age and over time and whether community-level characteristics explain these patterns. DATA SOURCE Deidentified medical and dental claims from a commercial insurer from January 2015 to December 2019. STUDY DESIGN A retrospective cohort study. The primary outcome was a composite quality score, derived from seven dental quality measures (DQMs), with higher values corresponding to better quality. Hierarchical regression models identified person- and zip code-level factors associated with the quality. DATA COLLECTION/EXTRACTION METHODS Continuously enrolled US dental insurance beneficiaries younger than 21 years of age. PRINCIPAL FINDINGS Quality was assessed for 4.88 million person-years covering 1.31 million persons. Overall quality slightly improved over time, mostly driven by substantial improvements among children aged 0-5 years by 0.153 points/year (95% confidence interval [CI]:0.151, 0.156). Quality was poorest and declined over time among adolescents with only 20.5% of DQMs met as compared to 42.6% among aged 0-5 years in 2019. Dental professional shortage, median household income, percentages of African Americans, unemployed, and less-educated populations at the zip code level were associated with the composite score. CONCLUSION Quality of dental care among adolescents remains low, and place of residence influenced the quality. Increasing the supply of dentists and oral health promotion strategies targeting adolescents and low-performing localities should be explored.
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Affiliation(s)
- Sung Eun Choi
- Department of Oral Health Policy and EpidemiologyHarvard School of Dental MedicineBostonMassachusettsUSA
| | - Elsbeth Kalenderian
- Department of Oral Health Policy and EpidemiologyHarvard School of Dental MedicineBostonMassachusettsUSA
- Department of Preventive and Restorative Dental SciencesUniversity of California at San Francisco, School of DentistrySan FranciscoCaliforniaUSA
- Department of Dental Management Sciences School of DentistryUniversity of PretoriaPretoriaSouth Africa
| | - Sharon‐Lise Normand
- Department of Health Care PolicyHarvard Medical SchoolBostonMassachusettsUSA
- Department of BiostatisticsHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
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Walji MF, Spallek H, Kookal KK, Barrow J, Magnuson B, Tiwari T, Oyoyo U, Brandt M, Howe BJ, Anderson GC, White JM, Kalenderian E. BigMouth: development and maintenance of a successful dental data repository. J Am Med Inform Assoc 2022; 29:701-706. [PMID: 35066586 PMCID: PMC8922177 DOI: 10.1093/jamia/ocac001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/10/2021] [Accepted: 01/20/2022] [Indexed: 12/27/2022] Open
Abstract
Few clinical datasets exist in dentistry to conduct secondary research. Hence, a novel dental data repository called BigMouth was developed, which has grown to include 11 academic institutions contributing Electronic Health Record data on over 4.5 million patients. The primary purpose for BigMouth is to serve as a high-quality resource for rapidly conducting oral health-related research. BigMouth allows for assessing the oral health status of a diverse US patient population; provides rationale and evidence for new oral health care delivery modes; and embraces the specific oral health research education mission. A data governance framework that encouraged data sharing while controlling contributed data was initially developed. This transformed over time into a mature framework, including a fee schedule for data requests and allowing access to researchers from noncontributing institutions. Adoption of BigMouth helps to foster new collaborations between clinical, epidemiological, statistical, and informatics experts and provides an additional venue for professional development.
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Affiliation(s)
- Muhammad F Walji
- Department of Diagnostics and Biomedical Sciences. School of Dentistry, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Heiko Spallek
- Faculty of Dentistry. The University of Sydney, Sydney, Australia
| | - Krishna Kumar Kookal
- Department of Diagnostics and Biomedical Sciences. School of Dentistry, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jane Barrow
- Office of Global and Community Health. Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Britta Magnuson
- Department of Diagnostic Sciences. Tufts School of Dental Medicine, Boston, Massachusetts, USA
| | - Tamanna Tiwari
- Department of Community Dentistry & Population Health. University of Colorado School of Dental Medicine, Aurora, Colorado, USA
| | - Udochukwu Oyoyo
- Office of Dental Education Services. Loma Linda University School of Dentistry, Loma Linda, California, USA
| | - Michael Brandt
- Office of Information Resources. University of Buffalo School of Dental Medicine, Buffalo, New York, USA
| | - Brian J Howe
- Department of Family Dentistry. University of Iowa College of Dentistry and Dental Clinics, Iowa City, Iowa, USA
| | - Gary C Anderson
- Department of Developmental and Surgical Sciences. University of Minnesota School of Dentistry, Minneapolis, Minnesota, USA
| | - Joel M White
- Department of Preventive and Restorative Dental Science. School of Dentistry, University of California at San Francisco, San Francisco, California, USA
| | - Elsbeth Kalenderian
- Office of Global and Community Health. Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Department of Preventive and Restorative Dental Science. School of Dentistry, University of California at San Francisco, San Francisco, California, USA
- Department of Dental Management Sciences. School of Dentistry, University of Pretoria, Pretoria, South Africa
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Bangar S, Neumann A, White JM, Yansane A, Johnson TR, Olson GW, Kumar SV, Kookal KK, Kim A, Obadan-Udoh E, Mertz E, Simmons K, Mullins J, Brandon R, Walji MF, Kalenderian E. Caries Risk Documentation And Prevention: eMeasures For Dental Electronic Health Records. Appl Clin Inform 2022; 13:80-90. [PMID: 35045582 PMCID: PMC8769809 DOI: 10.1055/s-0041-1740920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 10/30/2021] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Suhasini Bangar
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Ana Neumann
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Joel M. White
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco School of Dentistry, San Francisco, California, United States
| | - Alfa Yansane
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco School of Dentistry, San Francisco, California, United States
| | - Todd R. Johnson
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Gregory W. Olson
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Shwetha V. Kumar
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Krishna K. Kookal
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Aram Kim
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, United States
| | - Enihomo Obadan-Udoh
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco School of Dentistry, San Francisco, California, United States
| | - Elizabeth Mertz
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco School of Dentistry, San Francisco, California, United States
| | | | - Joanna Mullins
- Willamette Dental Group, Hillsboro, Oregon, United States
| | - Ryan Brandon
- Willamette Dental Group, Hillsboro, Oregon, United States
| | - Muhammad F. Walji
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Elsbeth Kalenderian
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco School of Dentistry, San Francisco, California, United States
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, United States
- Department of Dental Management, School of Dentistry, University of Pretoria, Pretoria, South Africa
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Abstract
BACKGROUND Errors can happen during patient care, and some result in harm to the patient. Work place stress has been well established in dentistry, but its relation with errors in the delivery of patient care is less understood. The authors evaluated the relationship between burnout, work engagement, and self-reported dental errors among American dentists. METHODS From May to August 2016, a national sample of American Dental Association member dentists were sent a validated, electronic survey assessing their levels of burnout, work engagement, and dental errors. RESULTS Of the 391 responding dentists, 46.1% reported concern that they had made a dental error in the last 6 months, 12.1% of the dentists were informed by dental staff that they may have committed an error in the last 6 months, 16% were concerned that a malpractice lawsuit would be filed against them, and 3.6% were actively involved in a malpractice lawsuit. In the adjusted analysis, multivariate logistic regression showed that dentists with either high burnout risk were more likely to report concern over a perceived error within the last 6 months. CONCLUSIONS The results suggest that dental provider burnout is potentially a key predictor of reporting perceived dental errors. It is imperative that the dental profession continue to study the effects of work-related stress, develop professional practices that decrease burnout, and reduce errors. PRACTICAL IMPLICATIONS Efforts that minimize the potential for burnout may help reduce the occurrence of errors and improve the quality of care provided to dental patients.
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Affiliation(s)
- Alfa Yansane
- From the Department of Preventive and Restorative Dental Sciences, University of California, San Francisco/UCSF School of Dentistry, San Francisco, California
| | - Oluwabunmi Tokede
- Oral Health Policy and Epidemiology Department, Harvard School of Dental Medicine, Boston, Massachusetts
| | - Muhammad Walji
- Diagnostic and Biomedical Sciences Department, University of Texas Health Science Center at Houston, School of Dentistry, Houston, Texas
| | - Enihomo Obadan-Udoh
- From the Department of Preventive and Restorative Dental Sciences, University of California, San Francisco/UCSF School of Dentistry, San Francisco, California
| | - Christine Riedy
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts
| | - Joel White
- From the Department of Preventive and Restorative Dental Sciences, University of California, San Francisco/UCSF School of Dentistry, San Francisco, California
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21
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Tokede O, Walji M, Ramoni R, Rindal DB, Worley D, Hebballi N, Kumar K, van Strien C, Chen M, Navat-Pelli S, Liu H, Etolue J, Yansane A, Obadan-Udoh E, Easterday C, Enstad C, Kane S, Rush W, Kalenderian E. Quantifying Dental Office-Originating Adverse Events: The Dental Practice Study Methods. J Patient Saf 2021; 17:e1080-e1087. [PMID: 29206706 PMCID: PMC10941983 DOI: 10.1097/pts.0000000000000444] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preventable medical errors in hospital settings are the third leading cause of deaths in the United States. However, less is known about harm that occurs in patients in outpatient settings, where the majority of care is delivered. We do not know the likelihood that a patient sitting in a dentist chair will experience harm. Additionally, we do not know if patients of certain race, age, sex, or socioeconomic status disproportionately experience iatrogenic harm. METHODS We initiated the Dental Practice Study (DPS) with the aim of determining the frequency and types of adverse events (AEs) that occur in dentistry on the basis of retrospective chart audit. This article discusses the 6-month pilot phase of the DPS during which we explored the feasibility and efficiency of our multistaged review process to detect AEs. RESULTS At sites 1, 2, and 3, respectively, 2 reviewers abstracted 21, 11, and 23 probable AEs, respectively, from the 100 patient charts audited per site. At site 2, a third reviewer audited the same 100 charts and found only 1 additional probable AE. Of the total 56 probable AEs (from 300 charts), the expert panel confirmed 9 AE cases. This equals 3 AEs per 100 patients per year. Patients who experienced an AE tended to be male and older and to have undergone more procedures within the study year. CONCLUSIONS This article presents an overview of the DPS. It describes the methods used and summarizes the results of its pilot phase. To minimize threats to dental patient safety, a starting point is to understand their basic epidemiology, both in terms of their frequency and the extent to which they affect different populations.
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Affiliation(s)
- Oluwabunmi Tokede
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston Massachusetts
| | - Muhammad Walji
- School of Dentistry, University of Texas at Houston, Health Science Center, Houston, Texas
| | - Rachel Ramoni
- Office of Research & Development, US Department of Veterans Affairs, Washington, District of Columbia
| | | | | | - Nutan Hebballi
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston Massachusetts
| | - Krishna Kumar
- School of Dentistry, University of Texas at Houston, Health Science Center, Houston, Texas
| | - Claire van Strien
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston Massachusetts
| | - Mengxia Chen
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston Massachusetts
| | - Shaked Navat-Pelli
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston Massachusetts
| | - Hongchun Liu
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston Massachusetts
| | - Jini Etolue
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston Massachusetts
| | - Alfa Yansane
- Department of Preventive & Restorative Dental Sciences, UCSF School of Dentistry, San Francisco, California
| | - Enihomo Obadan-Udoh
- Department of Preventive & Restorative Dental Sciences, UCSF School of Dentistry, San Francisco, California
| | - Casey Easterday
- Survey Research Center, Bloomington, Minnesota
- HealthPartners Institute for Education and Research, Bloomington, Minnesota
| | - Chris Enstad
- HealthPartners Institute for Education and Research, Bloomington, Minnesota
| | - Sheryl Kane
- HealthPartners Institute for Education and Research, Bloomington, Minnesota
| | - William Rush
- HealthPartners Institute for Education and Research, Bloomington, Minnesota
| | - Elsbeth Kalenderian
- Department of Preventive & Restorative Dental Sciences, UCSF School of Dentistry, San Francisco, California
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22
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Abstract
OBJECTIVES In recent years, there has been an increase in research studies highlighting patients' experiences of adverse events (AEs) as well as the role of patients in promoting safety. The primary goal of the study was to assess the prevalence of dental AEs (DAEs) among dental patients in South Africa and its associated factors. The integration of the patient perspective into dental patient safety research will enhance our collective understanding of DAEs. METHODS We conducted a cross-sectional study of adult patients at a large dental academic institution in South Africa from May to June 2015, evaluating their previous experiences of DAEs at any dental clinic in South Africa. Descriptive statistics and bivariate and multivariate analyses were performed to identify the factors associated with an increased likelihood of experiencing a DAE. RESULTS A total of 440 questionnaires were returned during the 6-week study period (response rate = 97.8%). Overall, 45.5% of participants reported experiencing one or more DAEs. Two hundred participants reported a total of 717 DAEs giving us a lifetime prevalence of 1.6 DAEs per respondent. Our results suggest that respondents who were younger (18-24 y), from high-income families (>R150,000 or US $9200), dissatisfied with their last dental visit and oral health had an increased likelihood of reporting a previous experience of a DAE. CONCLUSIONS This study provides an insight into the nature of information that can be gleaned from dental patients regarding safety and helps lay the foundation for patient involvement in patient safety reporting.
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Affiliation(s)
- Enihomo Obadan-Udoh
- From the Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, California
| | - Sophy Van der Berg-Cloete
- Department of Dental Management Sciences, School of Dentistry, University of Pretoria, Pretoria, South Africa
| | - Rachel Ramoni
- Center for Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Elsbeth Kalenderian
- From the Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, California
| | - John George White
- Department of Dental Management Sciences, School of Dentistry, University of Pretoria, Pretoria, South Africa
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23
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Kalenderian E, Obadan-Udoh E, Maramaldi P, Etolue J, Yansane A, Stewart D, White J, Vaderhobli R, Kent K, Hebballi NB, Delattre V, Kahn M, Tokede O, Ramoni RB, Walji MF. Classifying Adverse Events in the Dental Office. J Patient Saf 2021; 17:e540-e556. [PMID: 28671915 PMCID: PMC5748012 DOI: 10.1097/pts.0000000000000407] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dentists strive to provide safe and effective oral healthcare. However, some patients may encounter an adverse event (AE) defined as "unnecessary harm due to dental treatment." In this research, we propose and evaluate two systems for categorizing the type and severity of AEs encountered at the dental office. METHODS Several existing medical AE type and severity classification systems were reviewed and adapted for dentistry. Using data collected in previous work, two initial dental AE type and severity classification systems were developed. Eight independent reviewers performed focused chart reviews, and AEs identified were used to evaluate and modify these newly developed classifications. RESULTS A total of 958 charts were independently reviewed. Among the reviewed charts, 118 prospective AEs were found and 101 (85.6%) were verified as AEs through a consensus process. At the end of the study, a final AE type classification comprising 12 categories, and an AE severity classification comprising 7 categories emerged. Pain and infection were the most common AE types representing 73% of the cases reviewed (56% and 17%, respectively) and 88% were found to cause temporary, moderate to severe harm to the patient. CONCLUSIONS Adverse events found during the chart review process were successfully classified using the novel dental AE type and severity classifications. Understanding the type of AEs and their severity are important steps if we are to learn from and prevent patient harm in the dental office.
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Affiliation(s)
| | | | | | - Jini Etolue
- Harvard School of Dental Medicine, Boston, MA, USA
| | - Alfa Yansane
- University of California, San Francisco, School of Dentistry, CA, USA
| | - Denice Stewart
- Oregon Health & Science University, School of Dentistry, Portland, OR, USA
| | - Joel White
- University of California, San Francisco, School of Dentistry, CA, USA
| | - Ram Vaderhobli
- University of California, San Francisco, School of Dentistry, CA, USA
| | - Karla Kent
- Oregon Health & Science University, School of Dentistry, Portland, OR, USA
| | - Nutan B. Hebballi
- University of Texas Health Science Center, School of Dentistry at Houston, Houston, TX, USA
| | - Veronique Delattre
- University of Texas Health Science Center, School of Dentistry at Houston, Houston, TX, USA
| | - Maria Kahn
- Harvard School of Dental Medicine, Boston, MA, USA
| | | | - Rachel B. Ramoni
- Center for Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Muhammad F. Walji
- University of Texas Health Science Center, School of Dentistry at Houston, Houston, TX, USA
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24
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Abstract
BACKGROUND Burnout is a threat to patient safety. It relates to emotional exhaustion, depersonalization, and lack of personal accomplishment. Work engagement conversely composed of levels of vigor, dedication, and absorption in one's profession. The aim of this study was to examine burnout and work engagement among US dentists. METHODS This study used the extensively validated Maslach Burnout Inventory-Human Services Survey and Utrecht Work Engagement Scale to measure burnout in a self-administered survey of 167 US dentists who attended continuing education courses held in Boston, Pittsburg, Iowa City, and Las Vegas. The mean scores on the 3 subscales of Maslach Burnout Inventory-Human Services Survey and Utrecht Work Engagement Scale were computed. The interscale correlations between the components of burnout and work engagement were assessed using Pearson correlations. We used 1-way analysis of variance and independent 2 sample t tests to examine the relationship between burnout and work engagement across sex and various age categories. Prevalence of burnout in our study population was also computed. RESULTS We observed that 13.2% of our study population experienced burnout and 16.2% of our study population was highly work engaged. There was a statistically significant, unadjusted association between burnout risk and work engagement (χ2 = 22.51, P < 0.0001). Furthermore, the scores in the subscales of burnout were significantly correlated with scores in the subscales of work engagement. CONCLUSIONS In this preliminary study, we observed some evidence of burnout among practicing US dentists. It is imperative that the dental profession understands this and works to promote professional practices that increase work engagement and decrease burnout.
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Affiliation(s)
| | - Japneet Kwatra
- Oral Health Policy and Epidemiology Department, Harvard School of Dental Medicine, Boston, Massachusetts
| | | | - Oluwabunmi Tokede
- Oral Health Policy and Epidemiology Department, Harvard School of Dental Medicine, Boston, Massachusetts
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25
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Mullins J, Yansane A, Kumar SV, Bangar S, Neumann A, Johnson TR, Olson GW, Kookal KK, Sedlock E, Kim A, Mertz E, Brandon R, Simmons K, White JM, Kalenderian E, Walji MF. Assessing the completeness of periodontal disease documentation in the EHR: a first step in measuring the quality of care. BMC Oral Health 2021; 21:282. [PMID: 34051781 PMCID: PMC8164293 DOI: 10.1186/s12903-021-01633-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/10/2021] [Indexed: 12/21/2022] Open
Abstract
Background Our objective was to measure the proportion of patients for which comprehensive periodontal charting, periodontal disease risk factors (diabetes status, tobacco use, and oral home care compliance), and periodontal diagnoses were documented in the electronic health record (EHR). We developed an EHR-based quality measure to assess how well four dental institutions documented periodontal disease-related information. An automated database script was developed and implemented in the EHR at each institution. The measure was validated by comparing the findings from the measure with a manual review of charts. Results The overall measure scores varied significantly across the four institutions (institution 1 = 20.47%, institution 2 = 0.97%, institution 3 = 22.27% institution 4 = 99.49%, p-value < 0.0001). The largest gaps in documentation were related to periodontal diagnoses and capturing oral homecare compliance. A random sample of 1224 charts were manually reviewed and showed excellent validity when compared with the data generated from the EHR-based measure (Sensitivity, Specificity, PPV, and NPV > 80%). Conclusion Our results demonstrate the feasibility of developing automated data extraction scripts using structured data from EHRs, and successfully implementing these to identify and measure the periodontal documentation completeness within and across different dental institutions.
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Affiliation(s)
| | - Alfa Yansane
- San Francisco - School of Dentistry, University of California, San Francisco, CA, USA
| | - Shwetha V Kumar
- School of Dentistry, University of Texas Health Science Center At Houston, 7500 Cambridge, SOD 4184, Houston, TX, 77054, USA
| | - Suhasini Bangar
- School of Dentistry, University of Texas Health Science Center At Houston, 7500 Cambridge, SOD 4184, Houston, TX, 77054, USA
| | - Ana Neumann
- School of Dentistry, University of Texas Health Science Center At Houston, 7500 Cambridge, SOD 4184, Houston, TX, 77054, USA
| | - Todd R Johnson
- School of Dentistry, University of Texas Health Science Center At Houston, 7500 Cambridge, SOD 4184, Houston, TX, 77054, USA
| | - Gregory W Olson
- School of Dentistry, University of Texas Health Science Center At Houston, 7500 Cambridge, SOD 4184, Houston, TX, 77054, USA
| | - Krishna Kumar Kookal
- School of Dentistry, University of Texas Health Science Center At Houston, 7500 Cambridge, SOD 4184, Houston, TX, 77054, USA
| | - Emily Sedlock
- School of Dentistry, University of Texas Health Science Center At Houston, 7500 Cambridge, SOD 4184, Houston, TX, 77054, USA
| | - Aram Kim
- Harvard School of Dental Medicine, Boston, MA, USA
| | - Elizabeth Mertz
- San Francisco - School of Dentistry, University of California, San Francisco, CA, USA
| | | | | | - Joel M White
- San Francisco - School of Dentistry, University of California, San Francisco, CA, USA
| | - Elsbeth Kalenderian
- San Francisco - School of Dentistry, University of California, San Francisco, CA, USA.,Harvard School of Dental Medicine, Boston, MA, USA.,School of Dentistry, University of Pretoria, Pretoria, South Africa
| | - Muhammad F Walji
- School of Dentistry, University of Texas Health Science Center At Houston, 7500 Cambridge, SOD 4184, Houston, TX, 77054, USA.
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26
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Riordain RN, Glick M, Mashhadani SSAA, Aravamudhan K, Barrow J, Cole D, Crall JJ, Gallagher JE, Gibson J, Hegde S, Kaberry R, Kalenderian E, Karki A, Celeste RK, Listl S, Myers SN, Niederman R, Severin T, Smith MW, Murray Thomson W, Tsakos G, Vujicic M, Watt RG, Whittaker S, Williams DM. Developing a Standard Set of Patient-centred Outcomes for Adult Oral Health - An International, Cross-disciplinary Consensus. Int Dent J 2021; 71:40-52. [PMID: 33616051 PMCID: PMC9275363 DOI: 10.1111/idj.12604] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To develop a minimum Adult Oral Health Standard Set (AOHSS) for use in clinical practice, research, advocacy and population health. Materials and methods An international oral health working group (OHWG) was established, of patient advocates, researchers, clinicians and public health experts to develop an AOHSS. PubMed was searched for oral health clinical and patient-reported measures and case-mix variables related to caries and periodontal disease. The selected patient-reported outcome measures focused on general oral health, and oral health-related quality of life tools. A consensus was reached via Delphi with parallel consultation of subject matter content experts. Finally, comments and input were elicited from oral health stakeholders globally, including patients/consumers. Results The literature search yielded 1,453 results. After inclusion/exclusion criteria, 959 abstracts generated potential outcomes and case-mix variables. Delphi rounds resulted in a consensus-based selection of 80 individual items capturing 31 outcome and case-mix concepts. Global reviews generated 347 responses from 87 countries, and the patient/consumer validation survey elicited 129 responses. This AOHSS includes 25 items directed towards patients (including demographics, the impact of their oral health on oral function, a record of pain and oral hygiene practices, and financial implications of care) and items for clinicians to complete, including medical history, a record of caries and periodontal disease activity, and types of dental treatment delivered. Conclusion In conclusion, utilising a robust methodology, a standardised core set of oral health outcome measures for adults, with a particular emphasis on caries and periodontal disease, was developed.
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Affiliation(s)
- Richeal Ni Riordain
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; University College London, London, UK; University College Cork, Cork, Ireland.
| | - Michael Glick
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; FDI Vision 2020 Think Tank, Geneva, Switzerland; School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
| | | | - Krishna Aravamudhan
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; American Dental Association, Chicago, IL, USA
| | - Jane Barrow
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; Harvard School of Dental Medicine, Boston, MA, USA
| | - Deborah Cole
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; Dental Health Services Victoria, Melbourne, Vic., Australia
| | - James J Crall
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; UCLA School of Dentistry, Los Angeles, CA, USA
| | - Jennifer E Gallagher
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; King's College London, London, UK
| | - Jacqui Gibson
- ICHOM Adult Oral Health Working Group, Boston, MA, USA
| | - Shalika Hegde
- Dental Health Services Victoria, Melbourne, Vic., Australia
| | | | - Elsbeth Kalenderian
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; UCSF School of Dentistry, San Francisco, CA, USA
| | - Anup Karki
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; Public Health Wales, Cardiff, UK
| | - Roger Keller Celeste
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; Federal University of Rio Grande do Sol, Porto Alegre, Grande do Sul, Brazil
| | - Stefan Listl
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; FDI Vision 2020 Think Tank, Geneva, Switzerland; Department of Conservative Dentistry, Heidelberg University Clinics, Heidelberg, Germany; Department of Dentistry - Quality and Safety of Oral Health Care, Radboud University - Radboudumc (RIHS), Nijmegen, The Netherlands
| | - Stacie N Myers
- International Consortium for Health Outcomes Measurement (ICHOM), Boston, MA, USA
| | - Richard Niederman
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; NYU College of Dentistry, New York, NY, USA
| | - Tania Severin
- FDI World Dental Federation (FDI), Geneva, Switzerland
| | - Mark W Smith
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; Hospitals Contribution Fund, Sydney, NSW, Australia
| | - W Murray Thomson
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; University of Otago, Dunedin, New Zealand
| | - Georgios Tsakos
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; University College London, London, UK; FDI Vision 2020 Think Tank, Geneva, Switzerland
| | - Marko Vujicic
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; American Dental Association, Chicago, IL, USA
| | - Richard G Watt
- University College London, London, UK; FDI Vision 2020 Think Tank, Geneva, Switzerland
| | - Sarah Whittaker
- International Consortium for Health Outcomes Measurement (ICHOM), Boston, MA, USA
| | - David M Williams
- ICHOM Adult Oral Health Working Group, Boston, MA, USA; FDI Vision 2020 Think Tank, Geneva, Switzerland; Bart's and The London, School of Medicine and Dentistry, Queen Mary, University of London, London, UK
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27
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Kumar SV, Yansane A, Neumann A, Johnson TR, Olson GW, Bangar S, Kookal KK, Kim A, Obadan-Udoh E, Mertz E, Simmons K, Mullins J, White JM, Kalenderian E, Walji MF. Measuring sealant placement in children at the dental practice level. J Am Dent Assoc 2020; 151:745-754. [PMID: 32979953 PMCID: PMC8259312 DOI: 10.1016/j.adaj.2020.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 02/04/2023]
Abstract
Background. Although sealants are an established and recommended caries-preventive treatment, many children still fail to receive them. In addition, research has shown that existing measures underestimate care by overlooking the sealable potential of teeth before evaluating care. To address this, the authors designed and evaluated 3 novel dental electronic health record–based clinical quality measures that evaluate sealant care only after assessing the sealable potential of teeth. Methods. Measure I recorded the proportion of patients with sealable teeth who received sealants. Measure II recorded the proportion of patients who had at least 1 of their sealable teeth sealed. Measure III recorded the proportion of patients who received sealant on all of their sealable teeth. Results. On average, 48.1% of 6- through 9-year-old children received 1 or more sealants compared with 32.4% of 10- through 14-year-olds (measure I). The average measure score decreased for patients who received sealants for at least 1 of their sealable teeth (measure II) (43.2% for 6- through 9-year-olds and 28.4% for 10- through 14-year-olds). Fewer children received sealants on all eligible teeth (measure III) (35.5% of 6- through 9-year-olds and 21% of 10- through 14-year-olds received sealant on all eligible teeth). Among the 48.5% who were at elevated caries risk, the sealant rates were higher across all 3 measures. Conclusions. A valid and actionable practice-based sealant electronic measure that evaluates sealant treatment among the eligible population, both at the patient level and the tooth level, has been developed. Practical Implications. The measure developed in this work provides practices with patient-centered and actionable sealant quality measures that aim to improve oral health outcomes.
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28
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Yansane A, Listl S, Dawda D, Brandon R, White J, Spallek H, Walji MF, Kalenderian E. Increasing value, reducing waste: tailoring the application of dental sealants according to individual caries risk. J Public Health Dent 2020; 80 Suppl 2:S8-S16. [PMID: 32901955 DOI: 10.1111/jphd.12396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Despite a significant national investment in oral health, there is little understanding of the return in terms of quality. Value-based payments aim to refocus provider reimbursement based on the value created to the patient. Our objectives were to apply a set of dental quality measures to help determine the value of preventive dental care provided to children at two academic dental school clinics. METHODS We queried the institutional electronic health records (EHRs) for patients between the ages of 6-14 years with sealable first or second permanent molars, determined caries risk status, identified if dental sealants were placed, and finally if the teeth showed evidence of new caries experience. In order to determine the cost-effectiveness of EHR-based triage of applying dental sealants, we calculated the incremental cost-effectiveness ratio (ICER) for the dental quality measures supported sealing program. RESULTS Between the two academic sites, there were 6,155 unique children for a total of 12,302 eligible teeth without a sealant and 32,811 eligible teeth with a sealant. Teeth without a sealant were more likely to have decay (4.8 percent) than those with a sealant (1.7 percent). At both sites, patients with high caries risk were more likely to benefit from sealants compared to those patients with low risk. CONCLUSION Implementation of caries risk stratified fissure sealant quality measures demonstrates the potential for extracting better value in oral health care.
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Affiliation(s)
- Alfa Yansane
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, CA, USA
| | - Stefan Listl
- Department of Dentistry - Quality and Safety of Oral Healthcare, Radboud University - Radboudumc (RIHS), Nijmegen, The Netherlands.,Medical Faculty, Department of Conservative Dentistry, Section for Translational Health Economics, Heidelberg University, Heidelberg, Germany
| | - Dyutee Dawda
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, CA, USA
| | | | - Joel White
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, CA, USA
| | - Heiko Spallek
- University of Sydney, School of Dentistry, Sydney, Australia
| | - Muhammad F Walji
- Department of Diagnostic and Biomedical Sciences, University of Texas Health Science Center School of Dentistry at Houston, Houston, TX, USA
| | - Elsbeth Kalenderian
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, CA, USA.,Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
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29
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Obadan-Udoh E, Panwar S, Yansane AI, Nayudu A, Pang J, White J, Kalenderian E. Are Dental Patients Concerned About Safety? An Exploratory Study. J Evid Based Dent Pract 2020; 20:101424. [PMID: 32921378 DOI: 10.1016/j.jebdp.2020.101424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 12/09/2019] [Accepted: 01/27/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study addresses a gap in the literature regarding dental patients' perceptions about safety at the dental office and their attitudes toward reporting safety concerns and experiences. METHODS We conducted a cross-sectional study with adult dental patients at an academic dental institution over a 6-week study period. A 16-item questionnaire was distributed to the patients to assess (1) past safety concerns and experiences during dental visits; (2) factors affecting the future reporting of safety concerns and experiences; (3) overall concern about safety at the dental office; (4) overall perceptions that patients should report of safety concerns or experiences to dental providers and staff. RESULTS A majority (63.5%) of dental patients were concerned about safety at the dental office, although only one-third of them shared their past safety concerns or experiences with their dental providers or clinic staff. Irrespective of their past experiences, most patients (96.9%) believed that patients should report any safety concerns or experiences to the clinic. Being female, highly educated, and having poor oral health were associated with a decreased overall perception that patients should report safety concerns and experiences to dental care providers and staff. CONCLUSIONS Our findings suggest that dental patients are concerned about safety and can be valuable sources of data, when adequately engaged. The current level of patient reporting of safety concerns and/or experiences to clinic staff or care providers is not optimal for learning and improvement. PRACTICAL IMPLICATIONS Better patient engagement in safety activities will potentially increase our collective understanding of threats to safety. Therefore, dental clinics need to encourage patients to speak up about their safety concerns or experiences.
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Affiliation(s)
- Enihomo Obadan-Udoh
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA.
| | - Sapna Panwar
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - Alfa-Ibrahim Yansane
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - Anuradha Nayudu
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - Jason Pang
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - Joel White
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - Elsbeth Kalenderian
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
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Yansane A, Lee JH, Hebballi N, Obadan-Udoh E, White J, Walji M, Easterday C, Rindal B, Worley D, Kalenderian E. Assessing the Patient Safety Culture in Dentistry. JDR Clin Trans Res 2020; 5:399-408. [PMID: 31923373 DOI: 10.1177/2380084419897614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Medical errors are among the leading causes of death within the United States. Studies have shown that patients can be harmed while receiving care, sometimes resulting in permanent injury or, in extreme cases, death. To reduce the risk of patient safety incidents, it is imperative that a robust culture of safety be established. The primary objective of this study was to evaluate the patient safety culture among providers at 4 US dental institutions, comparing the results with their medical counterparts in 2016. METHODS This cross-sectional study uses the Medical Office Survey on Patient Safety Culture that was modified for dentistry and administered at 4 US dental institutions during the 2016 calendar year. All dental team members were invited to complete electronic or paper-based versions of the questionnaire. RESULTS Among 1,615 invited participants, 656 providers responded (rate, 40.6%). Medical institutions outperformed the dental institutions on 9 of the 10 safety culture dimensions, 6 of the 6 overall quality items, and 8 of the 9 patient safety and quality issues. The surveyed dental institutions reported the strongest average percentage positive scores in organizational learning (85%) and teamwork (79%). CONCLUSION These findings suggest that the patient safety culture progressed over time. However, there is still heterogeneity within safety culture among academic dental, private (nonacademic), and medical clinics. KNOWLEDGE TRANSFER STATEMENT Patient safety is the first dimension of quality improvement. Administering the Medical Office Survey on Patient Safety Culture within dental clinics represents a key measure to understand where improvements can be made with respect to patient care safety.
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Affiliation(s)
- A Yansane
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco/UCSF School of Dentistry, San Francisco, CA, USA
| | - J H Lee
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco/UCSF School of Dentistry, San Francisco, CA, USA
| | - N Hebballi
- School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - E Obadan-Udoh
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco/UCSF School of Dentistry, San Francisco, CA, USA
| | - J White
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco/UCSF School of Dentistry, San Francisco, CA, USA
| | - M Walji
- School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - C Easterday
- HealthPartners Institute, Minneapolis, MN, USA
| | - B Rindal
- HealthPartners Institute, Minneapolis, MN, USA
| | - D Worley
- HealthPartners Institute, Minneapolis, MN, USA
| | - E Kalenderian
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco/UCSF School of Dentistry, San Francisco, CA, USA
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Walji MF, Yansane A, Hebballi NB, Ibarra-Noriega AM, Kookal KK, Tungare S, Kent K, McPharlin R, Delattre V, Obadan-Udoh E, Tokede O, White J, Kalenderian E. Finding Dental Harm to Patients through Electronic Health Record-Based Triggers. JDR Clin Trans Res 2019; 5:271-277. [PMID: 31821766 DOI: 10.1177/2380084419892550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Patients may be inadvertently harmed while undergoing dental treatments. To improve care, we must first determine the types and frequency of harms that patients experience, but identifying cases of harm is not always straightforward for dental practices. Mining data from electronic health records is a promising means of efficiently detecting possible adverse events (AEs). METHODS We developed 7 electronic triggers (electronic health record based) to flag patient charts that contain distinct events common to AEs. These electronic charts were then manually reviewed to identify AEs. RESULTS Of the 1,885 charts reviewed, 16.2% contained an AE. The positive predictive value of the triggers ranged from a high of 0.23 for the 2 best-performing triggers (failed implants and postsurgical complications) to 0.09 for the lowest-performing triggers. The most common types of AEs found were pain (27.5%), hard tissue (14.8%), soft tissue (14.8%), and nerve injuries (13.3%). Most AEs were classified as temporary harm (89.2%). Permanent harm was present in 9.6% of the AEs, and 1.2% required transfer to an emergency room. CONCLUSION By developing these triggers and a process to identify harm, we can now start measuring AEs, which is the first step to mitigating harm in the future. KNOWLEDGE TRANSFER STATEMENT A retrospective review of patients' health records is a useful approach for systematically identifying and measuring harm. Rather than random chart reviews, electronic health record-based dental trigger tools are an effective approach for practices to identify patient harm. Measurement is one of the first steps in improving the safety and quality of care delivered.
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Affiliation(s)
- M F Walji
- School of Dentistry at Houston, University of Texas Health Science Center, Houston, TX, USA
| | - A Yansane
- School of Dentistry, University of California, San Francisco, CA, USA
| | - N B Hebballi
- School of Dentistry at Houston, University of Texas Health Science Center, Houston, TX, USA
| | - A M Ibarra-Noriega
- School of Dentistry at Houston, University of Texas Health Science Center, Houston, TX, USA
| | - K K Kookal
- School of Dentistry at Houston, University of Texas Health Science Center, Houston, TX, USA
| | - S Tungare
- School of Dentistry at Houston, University of Texas Health Science Center, Houston, TX, USA
| | - K Kent
- School of Dentistry, Oregon Health and Science University, Portland, OR, USA
| | - R McPharlin
- School of Dentistry, Oregon Health and Science University, Portland, OR, USA
| | - V Delattre
- School of Dentistry at Houston, University of Texas Health Science Center, Houston, TX, USA
| | - E Obadan-Udoh
- School of Dentistry, University of California, San Francisco, CA, USA
| | - O Tokede
- Harvard School of Dental Medicine, Boston, MA, USA
| | - J White
- School of Dentistry, University of California, San Francisco, CA, USA
| | - E Kalenderian
- School of Dentistry, University of California, San Francisco, CA, USA
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Calvo JM, Obadan-Udoh E, Walji M, Kalenderian E. Adverse Events in Pediatric Dentistry: An Exploratory Study. Pediatr Dent 2019; 41:455-467. [PMID: 31882032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose: Existing studies on adverse events (AEs) in pediatric dentistry have been limited in scope. The purpose of this study was to develop a comprehensive list of pediatric dental adverse events and assess their occurrences among pediatric dentists. This study developed the first inventory of pediatric dental adverse events. Methods: Over a three-month period, semistructured interviews were conducted with domain expert pediatric dentists to develop a comprehensive list of AEs occurring in pediatric dentistry. American Academy of Pediatric Dentistry (AAPD) members were invited to complete a validated 15-item survey about their experience with pediatric dental AEs. Data analysis was performed to determine the percentage of pediatric dentists experiencing AEs. Results: A total of 193 pediatric dental AEs were identified through interviews and surveys; 1,042 AAPD members completed the survey (response rate equals 16.3 percent). The most common AEs experienced were post-treatment soft tissue trauma (86.1 percent), nicking/damaging of adjacent teeth (52.0 percent), and intraoperative soft tissue damage (47.1 percent). The least commonly experienced AEs were patients requiring CPR (0.5 percent) and patients aspirating materials (0.4 percent). Conclusions: A significant proportion of pediatric dentists experienced adverse events, and a small but poignant number indicated that their patients faced moderate to severe AEs.
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Affiliation(s)
- Jean Marie Calvo
- Dr. Calvo is a postgraduate resident, Division of Pediatric Dentistry, Department of Orofacial Sciences, UCSF School of Dentistry, San Francisco, Calif., USA; Calvo at,
| | - Enihomo Obadan-Udoh
- Dr. Obadan-Udoh is an assistant professor, Division of Oral Epidemiology and Dental Public Health, and an associate program director, Dental Public Health, Department of Preventive and Restorative Dental Sciences, UCSF School of Dentistry, San Francisco, Calif., USA
| | - Muhammad Walji
- Dr. Walji is an associate dean for Technology Services and Informatics and professor, Diagnostic and Biomedical Sciences, Technology Services and Informatics, School of Dentistry, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Elsbeth Kalenderian
- Dr. Kalenderian is chair, Department of Preventive and Restorative Dental Sciences, and Leland A. & Gladys K. Barber Distinguished Professor in Dentistry, UCSF School of Dentistry, San Francisco, Calif., USA
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Shadrav A, Kalenderian E, Roig P. "7/12" patient touch point strategy: a novel method to increase patient attendance and recommendation. BDJ Open 2019; 5:14. [PMID: 31632693 PMCID: PMC6795842 DOI: 10.1038/s41405-019-0023-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/15/2019] [Accepted: 08/21/2019] [Indexed: 11/23/2022] Open
Abstract
The US dental system is not likely to see major expansions in dental care use in the foreseeable future. The rise of dental care utilization among low-income children as well as wealthy seniors did not offset flat dental utilization among adults since the Great Recession. Similarly in Spain, the increase in the number of dental practitioners surpasses the rate of population growth. Hence, in order to remain economically viable in this competitive market, one important aspect for every dental office is to retain patients besides attracting new ones. Patients may be lost to follow-up due to a number of factors, including a lack of attention from the dental practice or a lack of trust in the provider. The “7/12" patient touch point strategy of marketing builds consumer loyalty as a result of a strong patient–provider relationship. Furthermore, this method aims to facilitate the patient’s decision to visit their dentist when it is time for preventative treatments. The purpose of this study was to measure the efficacy of a “7/12” patient touch point strategy when compared to the traditional annual recall with respect to number of active patients, percentage of word-of-mouth-recommended patients, and overall number of first-visit patients. We executed the relationship marketing concept through a novel “7/12” patient touch point approach, in which the patient was exposed to seven separate exposures in a period of 12 months. The efficacy of the “7/12” patient touch point was analyzed for 48 months across 10 clinics (24 months before and 24 months after the “7/12” strategy implementation). The “7/12” patient touch point strategy resources consisted of online and printed materials with a focus on oral health knowledge. fter analyzing the efficacy of the “7/12” patient touch point, we found an average increase of 86.91% in the number of active patients, 24.12% in the number of word-of-mouth-recommended patients, and 38.05% in the number of first visits across all clinics. This novel “7/12” patient touch point approach may be successful in increasing the retention of existing patients and generating new patients. Furthermore, this method promotes preventative care and oral health maintanance for patients and economic progress for the dental clinic.
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Affiliation(s)
- Aida Shadrav
- 1Harvard School of Dental Medicine, Boston, MA USA
| | - Elsbeth Kalenderian
- 2Department of Preventive and Restorative Dental Sciences, University of California at San Francisco, San Francisco, CA USA
| | - Primitivo Roig
- 1Harvard School of Dental Medicine, Boston, MA USA.,dentalDoctors Institute of Management, Valencia, Spain
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Abstract
To assess and improve the quality of oral healthcare, we must first agree on what constitutes good care. Currently there is no internationally accepted definition for quality of oral healthcare. Therefore, the purpose of the study was to establish a working definition for quality of oral healthcare that would help to advance further improvements in the field of quality improvement in oral healthcare. The development of the working definition included a 3-step approach: 1) literature screening; 2) expert-based compilation of an initial list of topics, leaning on the National Academy of Medicine framework for quality of care; and 3) a World Café with voting, which took place during the annual general meeting of the International Association for Dental Research in 2018. Following this approach, the collective intelligence of involved participants yielded a comprehensive list of items, prioritized by relevance. The resulting working definition comprises 7 domains—patient safety, effectiveness, efficiency, patient-centeredness, equitability, timeliness, access to care—and 30 items, which together characterize quality of oral healthcare. This aspirational working definition provides the potential to facilitate further conversations and activities aiming at quality improvement in oral healthcare.
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Affiliation(s)
- A J Righolt
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry - Quality and Safety of Oral Healthcare, Nijmegen, the Netherlands
| | - M F Walji
- Center for Oral Healthcare Quality and Safety, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - J S Feine
- Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - D M Williams
- Institute of Dentistry, Bart's and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - E Kalenderian
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA
| | - S Listl
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Dentistry - Quality and Safety of Oral Healthcare, Nijmegen, the Netherlands.,Section for Translational Health Economics, Medical Faculty, Heidelberg University, Heidelberg, Germany
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Neumann A, Obadan-Udoh E, Bangar S, Kumar SV, Tokede O, Kim A, Yansane A, Mertz E, Panwar S, Gharpure A, Kookal KK, Mullins J, Even JB, Simmons K, White JM, Walji MF, Kalenderian E. Number of Pregnant Women at Four Dental Clinics and the Care They Received: A Dental Quality eMeasure Evaluation. J Dent Educ 2019; 83:1158-1165. [PMID: 31235503 DOI: 10.21815/jde.019.123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/07/2019] [Indexed: 12/15/2022]
Abstract
Process-of-care quality measure research can be used to identify gaps in the delivery of dental services to pregnant patients. The aim of this study was to evaluate the types of dental services that pregnant patients received in four dental clinics over five years as documented in the electronic health record (EHR). To accomplish this objective, the authors modified and validated a previously published claims-based dental quality measure for EHR use. After the electronic dental quality measure specifications were defined, the number of pregnant patients was calculated at three academic dental institutions and one large accountable care organization, and the types of dental care services they received over a five-year period (2013-17) were determined. Calibrated reviewers at each institution independently reviewed a sub-sample of patient charts to validate the information obtained from EHR queries, and the concordance between manual chart reviews and EHR query reports was analyzed. Of the 335,078 women aged 15-44 years who received care at the four clinics for the five reporting years, 3.9% (n=13,026) were pregnant. Among these pregnant patients, 48.9% (n=6,366) received a periodic dental examination; 30.0% (n=3,909) received a comprehensive dental exam; and 21.5% (n=2,799) received additional dental services, irrespective of comprehensive or periodic oral evaluations. Overall, the mean proportion of pregnant patients seeking care in these academic dental and group practice clinics was low, but 78.9% of them received either a periodic or comprehensive oral evaluation. Given the importance of oral health care during pregnancy, these findings suggest a need for curriculum development to incorporate prenatal oral health education in the training of dental students.
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Affiliation(s)
- Ana Neumann
- Ana Neumann and Enihomo Obadan-Udoh contributed equally to this article. Ana Neumann is Associate Professor, The University of Texas School of Dentistry at Houston; Enihomo Obadan-Udoh is Assistant Professor, School of Dentistry, University of California, San Francisco; Suhasini Bangar is Research Associate, The University of Texas School of Dentistry at Houston; Shwetha V. Kumar is Graduate Research Assistant, The University of Texas School of Dentistry at Houston; Oluwabunmi Tokede is Assistant Professor, Harvard School of Dental Medicine; Aram Kim is Instructor, Harvard School of Dental Medicine; Alfa Yansane is Assistant Professor, School of Dentistry, University of California, San Francisco; Elizabeth Mertz is Professor, School of Dentistry, University of California, San Francisco; Sapna Panwar is Research Assistant, School of Dentistry, University of California, San Francisco; Arti Gharpure is Research Assistant, School of Dentistry, University of California, San Francisco; Krisha Kumar Kookal is Clinical Informatics Research Data Warehouse Lead Systems Analyst, The University of Texas School of Dentistry at Houston; Joanna Mullins is Manager of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Joshua B. Even is Director of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Kristen Simmons is Chief Operating Officer, Skourtes Institute, Hillsboro, OR; Joel M. White is Professor, School of Dentistry, University of California, San Francisco; Muhammad F. Walji is Associate Dean and Professor, The University of Texas School of Dentistry at Houston; and Elsbeth Kalenderian is Professor and Department Chair, School of Dentistry, University of California, San Francisco
| | - Enihomo Obadan-Udoh
- Ana Neumann and Enihomo Obadan-Udoh contributed equally to this article. Ana Neumann is Associate Professor, The University of Texas School of Dentistry at Houston; Enihomo Obadan-Udoh is Assistant Professor, School of Dentistry, University of California, San Francisco; Suhasini Bangar is Research Associate, The University of Texas School of Dentistry at Houston; Shwetha V. Kumar is Graduate Research Assistant, The University of Texas School of Dentistry at Houston; Oluwabunmi Tokede is Assistant Professor, Harvard School of Dental Medicine; Aram Kim is Instructor, Harvard School of Dental Medicine; Alfa Yansane is Assistant Professor, School of Dentistry, University of California, San Francisco; Elizabeth Mertz is Professor, School of Dentistry, University of California, San Francisco; Sapna Panwar is Research Assistant, School of Dentistry, University of California, San Francisco; Arti Gharpure is Research Assistant, School of Dentistry, University of California, San Francisco; Krisha Kumar Kookal is Clinical Informatics Research Data Warehouse Lead Systems Analyst, The University of Texas School of Dentistry at Houston; Joanna Mullins is Manager of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Joshua B. Even is Director of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Kristen Simmons is Chief Operating Officer, Skourtes Institute, Hillsboro, OR; Joel M. White is Professor, School of Dentistry, University of California, San Francisco; Muhammad F. Walji is Associate Dean and Professor, The University of Texas School of Dentistry at Houston; and Elsbeth Kalenderian is Professor and Department Chair, School of Dentistry, University of California, San Francisco
| | - Suhasini Bangar
- Ana Neumann and Enihomo Obadan-Udoh contributed equally to this article. Ana Neumann is Associate Professor, The University of Texas School of Dentistry at Houston; Enihomo Obadan-Udoh is Assistant Professor, School of Dentistry, University of California, San Francisco; Suhasini Bangar is Research Associate, The University of Texas School of Dentistry at Houston; Shwetha V. Kumar is Graduate Research Assistant, The University of Texas School of Dentistry at Houston; Oluwabunmi Tokede is Assistant Professor, Harvard School of Dental Medicine; Aram Kim is Instructor, Harvard School of Dental Medicine; Alfa Yansane is Assistant Professor, School of Dentistry, University of California, San Francisco; Elizabeth Mertz is Professor, School of Dentistry, University of California, San Francisco; Sapna Panwar is Research Assistant, School of Dentistry, University of California, San Francisco; Arti Gharpure is Research Assistant, School of Dentistry, University of California, San Francisco; Krisha Kumar Kookal is Clinical Informatics Research Data Warehouse Lead Systems Analyst, The University of Texas School of Dentistry at Houston; Joanna Mullins is Manager of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Joshua B. Even is Director of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Kristen Simmons is Chief Operating Officer, Skourtes Institute, Hillsboro, OR; Joel M. White is Professor, School of Dentistry, University of California, San Francisco; Muhammad F. Walji is Associate Dean and Professor, The University of Texas School of Dentistry at Houston; and Elsbeth Kalenderian is Professor and Department Chair, School of Dentistry, University of California, San Francisco
| | - Shwetha V Kumar
- Ana Neumann and Enihomo Obadan-Udoh contributed equally to this article. Ana Neumann is Associate Professor, The University of Texas School of Dentistry at Houston; Enihomo Obadan-Udoh is Assistant Professor, School of Dentistry, University of California, San Francisco; Suhasini Bangar is Research Associate, The University of Texas School of Dentistry at Houston; Shwetha V. Kumar is Graduate Research Assistant, The University of Texas School of Dentistry at Houston; Oluwabunmi Tokede is Assistant Professor, Harvard School of Dental Medicine; Aram Kim is Instructor, Harvard School of Dental Medicine; Alfa Yansane is Assistant Professor, School of Dentistry, University of California, San Francisco; Elizabeth Mertz is Professor, School of Dentistry, University of California, San Francisco; Sapna Panwar is Research Assistant, School of Dentistry, University of California, San Francisco; Arti Gharpure is Research Assistant, School of Dentistry, University of California, San Francisco; Krisha Kumar Kookal is Clinical Informatics Research Data Warehouse Lead Systems Analyst, The University of Texas School of Dentistry at Houston; Joanna Mullins is Manager of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Joshua B. Even is Director of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Kristen Simmons is Chief Operating Officer, Skourtes Institute, Hillsboro, OR; Joel M. White is Professor, School of Dentistry, University of California, San Francisco; Muhammad F. Walji is Associate Dean and Professor, The University of Texas School of Dentistry at Houston; and Elsbeth Kalenderian is Professor and Department Chair, School of Dentistry, University of California, San Francisco
| | - Oluwabunmi Tokede
- Ana Neumann and Enihomo Obadan-Udoh contributed equally to this article. Ana Neumann is Associate Professor, The University of Texas School of Dentistry at Houston; Enihomo Obadan-Udoh is Assistant Professor, School of Dentistry, University of California, San Francisco; Suhasini Bangar is Research Associate, The University of Texas School of Dentistry at Houston; Shwetha V. Kumar is Graduate Research Assistant, The University of Texas School of Dentistry at Houston; Oluwabunmi Tokede is Assistant Professor, Harvard School of Dental Medicine; Aram Kim is Instructor, Harvard School of Dental Medicine; Alfa Yansane is Assistant Professor, School of Dentistry, University of California, San Francisco; Elizabeth Mertz is Professor, School of Dentistry, University of California, San Francisco; Sapna Panwar is Research Assistant, School of Dentistry, University of California, San Francisco; Arti Gharpure is Research Assistant, School of Dentistry, University of California, San Francisco; Krisha Kumar Kookal is Clinical Informatics Research Data Warehouse Lead Systems Analyst, The University of Texas School of Dentistry at Houston; Joanna Mullins is Manager of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Joshua B. Even is Director of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Kristen Simmons is Chief Operating Officer, Skourtes Institute, Hillsboro, OR; Joel M. White is Professor, School of Dentistry, University of California, San Francisco; Muhammad F. Walji is Associate Dean and Professor, The University of Texas School of Dentistry at Houston; and Elsbeth Kalenderian is Professor and Department Chair, School of Dentistry, University of California, San Francisco
| | - Aram Kim
- Ana Neumann and Enihomo Obadan-Udoh contributed equally to this article. Ana Neumann is Associate Professor, The University of Texas School of Dentistry at Houston; Enihomo Obadan-Udoh is Assistant Professor, School of Dentistry, University of California, San Francisco; Suhasini Bangar is Research Associate, The University of Texas School of Dentistry at Houston; Shwetha V. Kumar is Graduate Research Assistant, The University of Texas School of Dentistry at Houston; Oluwabunmi Tokede is Assistant Professor, Harvard School of Dental Medicine; Aram Kim is Instructor, Harvard School of Dental Medicine; Alfa Yansane is Assistant Professor, School of Dentistry, University of California, San Francisco; Elizabeth Mertz is Professor, School of Dentistry, University of California, San Francisco; Sapna Panwar is Research Assistant, School of Dentistry, University of California, San Francisco; Arti Gharpure is Research Assistant, School of Dentistry, University of California, San Francisco; Krisha Kumar Kookal is Clinical Informatics Research Data Warehouse Lead Systems Analyst, The University of Texas School of Dentistry at Houston; Joanna Mullins is Manager of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Joshua B. Even is Director of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Kristen Simmons is Chief Operating Officer, Skourtes Institute, Hillsboro, OR; Joel M. White is Professor, School of Dentistry, University of California, San Francisco; Muhammad F. Walji is Associate Dean and Professor, The University of Texas School of Dentistry at Houston; and Elsbeth Kalenderian is Professor and Department Chair, School of Dentistry, University of California, San Francisco
| | - Alfa Yansane
- Ana Neumann and Enihomo Obadan-Udoh contributed equally to this article. Ana Neumann is Associate Professor, The University of Texas School of Dentistry at Houston; Enihomo Obadan-Udoh is Assistant Professor, School of Dentistry, University of California, San Francisco; Suhasini Bangar is Research Associate, The University of Texas School of Dentistry at Houston; Shwetha V. Kumar is Graduate Research Assistant, The University of Texas School of Dentistry at Houston; Oluwabunmi Tokede is Assistant Professor, Harvard School of Dental Medicine; Aram Kim is Instructor, Harvard School of Dental Medicine; Alfa Yansane is Assistant Professor, School of Dentistry, University of California, San Francisco; Elizabeth Mertz is Professor, School of Dentistry, University of California, San Francisco; Sapna Panwar is Research Assistant, School of Dentistry, University of California, San Francisco; Arti Gharpure is Research Assistant, School of Dentistry, University of California, San Francisco; Krisha Kumar Kookal is Clinical Informatics Research Data Warehouse Lead Systems Analyst, The University of Texas School of Dentistry at Houston; Joanna Mullins is Manager of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Joshua B. Even is Director of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Kristen Simmons is Chief Operating Officer, Skourtes Institute, Hillsboro, OR; Joel M. White is Professor, School of Dentistry, University of California, San Francisco; Muhammad F. Walji is Associate Dean and Professor, The University of Texas School of Dentistry at Houston; and Elsbeth Kalenderian is Professor and Department Chair, School of Dentistry, University of California, San Francisco
| | - Elizabeth Mertz
- Ana Neumann and Enihomo Obadan-Udoh contributed equally to this article. Ana Neumann is Associate Professor, The University of Texas School of Dentistry at Houston; Enihomo Obadan-Udoh is Assistant Professor, School of Dentistry, University of California, San Francisco; Suhasini Bangar is Research Associate, The University of Texas School of Dentistry at Houston; Shwetha V. Kumar is Graduate Research Assistant, The University of Texas School of Dentistry at Houston; Oluwabunmi Tokede is Assistant Professor, Harvard School of Dental Medicine; Aram Kim is Instructor, Harvard School of Dental Medicine; Alfa Yansane is Assistant Professor, School of Dentistry, University of California, San Francisco; Elizabeth Mertz is Professor, School of Dentistry, University of California, San Francisco; Sapna Panwar is Research Assistant, School of Dentistry, University of California, San Francisco; Arti Gharpure is Research Assistant, School of Dentistry, University of California, San Francisco; Krisha Kumar Kookal is Clinical Informatics Research Data Warehouse Lead Systems Analyst, The University of Texas School of Dentistry at Houston; Joanna Mullins is Manager of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Joshua B. Even is Director of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Kristen Simmons is Chief Operating Officer, Skourtes Institute, Hillsboro, OR; Joel M. White is Professor, School of Dentistry, University of California, San Francisco; Muhammad F. Walji is Associate Dean and Professor, The University of Texas School of Dentistry at Houston; and Elsbeth Kalenderian is Professor and Department Chair, School of Dentistry, University of California, San Francisco
| | - Sapna Panwar
- Ana Neumann and Enihomo Obadan-Udoh contributed equally to this article. Ana Neumann is Associate Professor, The University of Texas School of Dentistry at Houston; Enihomo Obadan-Udoh is Assistant Professor, School of Dentistry, University of California, San Francisco; Suhasini Bangar is Research Associate, The University of Texas School of Dentistry at Houston; Shwetha V. Kumar is Graduate Research Assistant, The University of Texas School of Dentistry at Houston; Oluwabunmi Tokede is Assistant Professor, Harvard School of Dental Medicine; Aram Kim is Instructor, Harvard School of Dental Medicine; Alfa Yansane is Assistant Professor, School of Dentistry, University of California, San Francisco; Elizabeth Mertz is Professor, School of Dentistry, University of California, San Francisco; Sapna Panwar is Research Assistant, School of Dentistry, University of California, San Francisco; Arti Gharpure is Research Assistant, School of Dentistry, University of California, San Francisco; Krisha Kumar Kookal is Clinical Informatics Research Data Warehouse Lead Systems Analyst, The University of Texas School of Dentistry at Houston; Joanna Mullins is Manager of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Joshua B. Even is Director of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Kristen Simmons is Chief Operating Officer, Skourtes Institute, Hillsboro, OR; Joel M. White is Professor, School of Dentistry, University of California, San Francisco; Muhammad F. Walji is Associate Dean and Professor, The University of Texas School of Dentistry at Houston; and Elsbeth Kalenderian is Professor and Department Chair, School of Dentistry, University of California, San Francisco
| | - Arti Gharpure
- Ana Neumann and Enihomo Obadan-Udoh contributed equally to this article. Ana Neumann is Associate Professor, The University of Texas School of Dentistry at Houston; Enihomo Obadan-Udoh is Assistant Professor, School of Dentistry, University of California, San Francisco; Suhasini Bangar is Research Associate, The University of Texas School of Dentistry at Houston; Shwetha V. Kumar is Graduate Research Assistant, The University of Texas School of Dentistry at Houston; Oluwabunmi Tokede is Assistant Professor, Harvard School of Dental Medicine; Aram Kim is Instructor, Harvard School of Dental Medicine; Alfa Yansane is Assistant Professor, School of Dentistry, University of California, San Francisco; Elizabeth Mertz is Professor, School of Dentistry, University of California, San Francisco; Sapna Panwar is Research Assistant, School of Dentistry, University of California, San Francisco; Arti Gharpure is Research Assistant, School of Dentistry, University of California, San Francisco; Krisha Kumar Kookal is Clinical Informatics Research Data Warehouse Lead Systems Analyst, The University of Texas School of Dentistry at Houston; Joanna Mullins is Manager of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Joshua B. Even is Director of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Kristen Simmons is Chief Operating Officer, Skourtes Institute, Hillsboro, OR; Joel M. White is Professor, School of Dentistry, University of California, San Francisco; Muhammad F. Walji is Associate Dean and Professor, The University of Texas School of Dentistry at Houston; and Elsbeth Kalenderian is Professor and Department Chair, School of Dentistry, University of California, San Francisco
| | - Krisha Kumar Kookal
- Ana Neumann and Enihomo Obadan-Udoh contributed equally to this article. Ana Neumann is Associate Professor, The University of Texas School of Dentistry at Houston; Enihomo Obadan-Udoh is Assistant Professor, School of Dentistry, University of California, San Francisco; Suhasini Bangar is Research Associate, The University of Texas School of Dentistry at Houston; Shwetha V. Kumar is Graduate Research Assistant, The University of Texas School of Dentistry at Houston; Oluwabunmi Tokede is Assistant Professor, Harvard School of Dental Medicine; Aram Kim is Instructor, Harvard School of Dental Medicine; Alfa Yansane is Assistant Professor, School of Dentistry, University of California, San Francisco; Elizabeth Mertz is Professor, School of Dentistry, University of California, San Francisco; Sapna Panwar is Research Assistant, School of Dentistry, University of California, San Francisco; Arti Gharpure is Research Assistant, School of Dentistry, University of California, San Francisco; Krisha Kumar Kookal is Clinical Informatics Research Data Warehouse Lead Systems Analyst, The University of Texas School of Dentistry at Houston; Joanna Mullins is Manager of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Joshua B. Even is Director of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Kristen Simmons is Chief Operating Officer, Skourtes Institute, Hillsboro, OR; Joel M. White is Professor, School of Dentistry, University of California, San Francisco; Muhammad F. Walji is Associate Dean and Professor, The University of Texas School of Dentistry at Houston; and Elsbeth Kalenderian is Professor and Department Chair, School of Dentistry, University of California, San Francisco
| | - Joanna Mullins
- Ana Neumann and Enihomo Obadan-Udoh contributed equally to this article. Ana Neumann is Associate Professor, The University of Texas School of Dentistry at Houston; Enihomo Obadan-Udoh is Assistant Professor, School of Dentistry, University of California, San Francisco; Suhasini Bangar is Research Associate, The University of Texas School of Dentistry at Houston; Shwetha V. Kumar is Graduate Research Assistant, The University of Texas School of Dentistry at Houston; Oluwabunmi Tokede is Assistant Professor, Harvard School of Dental Medicine; Aram Kim is Instructor, Harvard School of Dental Medicine; Alfa Yansane is Assistant Professor, School of Dentistry, University of California, San Francisco; Elizabeth Mertz is Professor, School of Dentistry, University of California, San Francisco; Sapna Panwar is Research Assistant, School of Dentistry, University of California, San Francisco; Arti Gharpure is Research Assistant, School of Dentistry, University of California, San Francisco; Krisha Kumar Kookal is Clinical Informatics Research Data Warehouse Lead Systems Analyst, The University of Texas School of Dentistry at Houston; Joanna Mullins is Manager of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Joshua B. Even is Director of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Kristen Simmons is Chief Operating Officer, Skourtes Institute, Hillsboro, OR; Joel M. White is Professor, School of Dentistry, University of California, San Francisco; Muhammad F. Walji is Associate Dean and Professor, The University of Texas School of Dentistry at Houston; and Elsbeth Kalenderian is Professor and Department Chair, School of Dentistry, University of California, San Francisco
| | - Joshua B Even
- Ana Neumann and Enihomo Obadan-Udoh contributed equally to this article. Ana Neumann is Associate Professor, The University of Texas School of Dentistry at Houston; Enihomo Obadan-Udoh is Assistant Professor, School of Dentistry, University of California, San Francisco; Suhasini Bangar is Research Associate, The University of Texas School of Dentistry at Houston; Shwetha V. Kumar is Graduate Research Assistant, The University of Texas School of Dentistry at Houston; Oluwabunmi Tokede is Assistant Professor, Harvard School of Dental Medicine; Aram Kim is Instructor, Harvard School of Dental Medicine; Alfa Yansane is Assistant Professor, School of Dentistry, University of California, San Francisco; Elizabeth Mertz is Professor, School of Dentistry, University of California, San Francisco; Sapna Panwar is Research Assistant, School of Dentistry, University of California, San Francisco; Arti Gharpure is Research Assistant, School of Dentistry, University of California, San Francisco; Krisha Kumar Kookal is Clinical Informatics Research Data Warehouse Lead Systems Analyst, The University of Texas School of Dentistry at Houston; Joanna Mullins is Manager of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Joshua B. Even is Director of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Kristen Simmons is Chief Operating Officer, Skourtes Institute, Hillsboro, OR; Joel M. White is Professor, School of Dentistry, University of California, San Francisco; Muhammad F. Walji is Associate Dean and Professor, The University of Texas School of Dentistry at Houston; and Elsbeth Kalenderian is Professor and Department Chair, School of Dentistry, University of California, San Francisco
| | - Kristen Simmons
- Ana Neumann and Enihomo Obadan-Udoh contributed equally to this article. Ana Neumann is Associate Professor, The University of Texas School of Dentistry at Houston; Enihomo Obadan-Udoh is Assistant Professor, School of Dentistry, University of California, San Francisco; Suhasini Bangar is Research Associate, The University of Texas School of Dentistry at Houston; Shwetha V. Kumar is Graduate Research Assistant, The University of Texas School of Dentistry at Houston; Oluwabunmi Tokede is Assistant Professor, Harvard School of Dental Medicine; Aram Kim is Instructor, Harvard School of Dental Medicine; Alfa Yansane is Assistant Professor, School of Dentistry, University of California, San Francisco; Elizabeth Mertz is Professor, School of Dentistry, University of California, San Francisco; Sapna Panwar is Research Assistant, School of Dentistry, University of California, San Francisco; Arti Gharpure is Research Assistant, School of Dentistry, University of California, San Francisco; Krisha Kumar Kookal is Clinical Informatics Research Data Warehouse Lead Systems Analyst, The University of Texas School of Dentistry at Houston; Joanna Mullins is Manager of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Joshua B. Even is Director of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Kristen Simmons is Chief Operating Officer, Skourtes Institute, Hillsboro, OR; Joel M. White is Professor, School of Dentistry, University of California, San Francisco; Muhammad F. Walji is Associate Dean and Professor, The University of Texas School of Dentistry at Houston; and Elsbeth Kalenderian is Professor and Department Chair, School of Dentistry, University of California, San Francisco
| | - Joel M White
- Ana Neumann and Enihomo Obadan-Udoh contributed equally to this article. Ana Neumann is Associate Professor, The University of Texas School of Dentistry at Houston; Enihomo Obadan-Udoh is Assistant Professor, School of Dentistry, University of California, San Francisco; Suhasini Bangar is Research Associate, The University of Texas School of Dentistry at Houston; Shwetha V. Kumar is Graduate Research Assistant, The University of Texas School of Dentistry at Houston; Oluwabunmi Tokede is Assistant Professor, Harvard School of Dental Medicine; Aram Kim is Instructor, Harvard School of Dental Medicine; Alfa Yansane is Assistant Professor, School of Dentistry, University of California, San Francisco; Elizabeth Mertz is Professor, School of Dentistry, University of California, San Francisco; Sapna Panwar is Research Assistant, School of Dentistry, University of California, San Francisco; Arti Gharpure is Research Assistant, School of Dentistry, University of California, San Francisco; Krisha Kumar Kookal is Clinical Informatics Research Data Warehouse Lead Systems Analyst, The University of Texas School of Dentistry at Houston; Joanna Mullins is Manager of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Joshua B. Even is Director of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Kristen Simmons is Chief Operating Officer, Skourtes Institute, Hillsboro, OR; Joel M. White is Professor, School of Dentistry, University of California, San Francisco; Muhammad F. Walji is Associate Dean and Professor, The University of Texas School of Dentistry at Houston; and Elsbeth Kalenderian is Professor and Department Chair, School of Dentistry, University of California, San Francisco
| | - Muhammad F Walji
- Ana Neumann and Enihomo Obadan-Udoh contributed equally to this article. Ana Neumann is Associate Professor, The University of Texas School of Dentistry at Houston; Enihomo Obadan-Udoh is Assistant Professor, School of Dentistry, University of California, San Francisco; Suhasini Bangar is Research Associate, The University of Texas School of Dentistry at Houston; Shwetha V. Kumar is Graduate Research Assistant, The University of Texas School of Dentistry at Houston; Oluwabunmi Tokede is Assistant Professor, Harvard School of Dental Medicine; Aram Kim is Instructor, Harvard School of Dental Medicine; Alfa Yansane is Assistant Professor, School of Dentistry, University of California, San Francisco; Elizabeth Mertz is Professor, School of Dentistry, University of California, San Francisco; Sapna Panwar is Research Assistant, School of Dentistry, University of California, San Francisco; Arti Gharpure is Research Assistant, School of Dentistry, University of California, San Francisco; Krisha Kumar Kookal is Clinical Informatics Research Data Warehouse Lead Systems Analyst, The University of Texas School of Dentistry at Houston; Joanna Mullins is Manager of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Joshua B. Even is Director of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Kristen Simmons is Chief Operating Officer, Skourtes Institute, Hillsboro, OR; Joel M. White is Professor, School of Dentistry, University of California, San Francisco; Muhammad F. Walji is Associate Dean and Professor, The University of Texas School of Dentistry at Houston; and Elsbeth Kalenderian is Professor and Department Chair, School of Dentistry, University of California, San Francisco
| | - Elsbeth Kalenderian
- Ana Neumann and Enihomo Obadan-Udoh contributed equally to this article. Ana Neumann is Associate Professor, The University of Texas School of Dentistry at Houston; Enihomo Obadan-Udoh is Assistant Professor, School of Dentistry, University of California, San Francisco; Suhasini Bangar is Research Associate, The University of Texas School of Dentistry at Houston; Shwetha V. Kumar is Graduate Research Assistant, The University of Texas School of Dentistry at Houston; Oluwabunmi Tokede is Assistant Professor, Harvard School of Dental Medicine; Aram Kim is Instructor, Harvard School of Dental Medicine; Alfa Yansane is Assistant Professor, School of Dentistry, University of California, San Francisco; Elizabeth Mertz is Professor, School of Dentistry, University of California, San Francisco; Sapna Panwar is Research Assistant, School of Dentistry, University of California, San Francisco; Arti Gharpure is Research Assistant, School of Dentistry, University of California, San Francisco; Krisha Kumar Kookal is Clinical Informatics Research Data Warehouse Lead Systems Analyst, The University of Texas School of Dentistry at Houston; Joanna Mullins is Manager of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Joshua B. Even is Director of Clinical Strategy and Support, Skourtes Institute, Hillsboro, OR; Kristen Simmons is Chief Operating Officer, Skourtes Institute, Hillsboro, OR; Joel M. White is Professor, School of Dentistry, University of California, San Francisco; Muhammad F. Walji is Associate Dean and Professor, The University of Texas School of Dentistry at Houston; and Elsbeth Kalenderian is Professor and Department Chair, School of Dentistry, University of California, San Francisco.
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Simon L, Obadan-Udoh E, Yansane AI, Gharpure A, Licht S, Calvo J, Deschner J, Damanaki A, Hackenberg B, Walji M, Spallek H, Kalenderian E. Improving Oral-Systemic Healthcare through the Interoperability of Electronic Medical and Dental Records: An Exploratory Study. Appl Clin Inform 2019; 10:367-376. [PMID: 31141831 DOI: 10.1055/s-0039-1688832] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Electronic health records (EHRs) are rarely shared among medical and dental providers. The purpose of this study was to assess current information sharing and the value of improved electronic information sharing among physicians and dentists in Germany and the United States. MATERIALS AND METHODS A survey was validated and distributed electronically to physicians and dentists at four academic medical centers. Respondents were asked anonymously about EHR use and the medical and dental information most valuable to their practice. RESULTS There were 118 responses, a response rate of 23.2%. The majority (63.9%) of respondents were dentists and the remainder were physicians. Most respondents (66.3%) rated the importance of sharing information an 8 or above on a 1-to-10 Likert scale. Dentists rated the importance of sharing clinical information significantly higher than physicians (p = 0.0033). Most (68.5%) providers could recall an instance when access to medical or dental information would have improved patient care. Dentists were significantly more likely to report this than physicians (p = 0.008). CONCLUSION Physicians would value a standardized measure of "oral health" in their EHR. Dentists were less likely to find specific medical diagnostic test results of value. Both dentists and physicians agreed that oral-systemic health was important; interoperable EHRs could facilitate information transfer between providers and enhance research on oral-systemic health connections. Both dentists and physicians believed that an interoperable EHR would be useful to practice, but desired information was different between these groups. Refinement of the information needed for shared practice is required.
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Affiliation(s)
- Lisa Simon
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, United States
| | - Enihomo Obadan-Udoh
- Department of Preventive and Restorative Dental Sciences, Division of Oral Epidemiology and Dental Public Health, UCSF School of Dentistry, San Francisco, California, United States
| | - Alfa-Ibrahim Yansane
- Department of Preventive and Restorative Dental Sciences, UCSF School of Dentistry, San Francisco, California, United States
| | - Arti Gharpure
- Department of Preventive and Restorative Dental Sciences, UCSF School of Dentistry, San Francisco, California, United States
| | - Steven Licht
- University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania, United States
| | - Jean Calvo
- Department of Pediatric Dentistry, UCSF School of Dentistry, San Francisco, California, United States
| | - James Deschner
- University Medical Center, University of Mainz, Mainz, Germany
| | - Anna Damanaki
- Department of Periodontology and Operative Dentistry, University Medical Center, University of Mainz, Mainz, Germany
| | - Berit Hackenberg
- Department of Otolaryngology, Head and Neck Surgery, University Medical Center, University of Mainz, Mainz, Germany
| | - Muhammad Walji
- Department of Diagnostic and Biomedical Sciences, Technology Services and Informatics, University of Texas Health Science Center at Houston (UTHealth) School of Dentistry, Houston, Texas, United States
| | - Heiko Spallek
- The University of Sydney School of Dentistry, Westmead, New South Wales, Australia
| | - Elsbeth Kalenderian
- Department of Preventive and Restorative Dental Sciences, UCSF School of Dentistry, San Francisco, California, United States
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Chen M, Wright CD, Tokede O, Yansane A, Montasem A, Kalenderian E, Beaty TH, Feingold E, Shaffer JR, Crout RJ, Neiswanger K, Weyant RJ, Marazita ML, McNeil DW. Predictors of dental care utilization in north-central Appalachia in the USA. Community Dent Oral Epidemiol 2019; 47:283-290. [PMID: 30993747 DOI: 10.1111/cdoe.12453] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/15/2019] [Accepted: 02/18/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Dental utilization is an important determinant of oral health and well-being. The aim of this study was to evaluate potential associations between a variety of biopsychosocial factors and dental utilization in north-central Appalachia, USA, a region where oral health disparities are profound. METHODS This study used household-based data from the Center for Oral Health Research in Appalachia (COHRA1) study in north-central Appalachia, including 449 families with 868 adults. The generalized estimating equation (GEE) approach was used to determine the best-fitting predictor model for dental utilization among adult family members. RESULTS On average across West Virginia and Pennsylvania, having dental insurance was associated with greater dental utilization over a 3-year time period (OR = 2.20, 95% CI = 1.54, 3.14). When stratified by state, the association held for only West Virginia (OR = 2.41, 95% CI = 1.54, 3.79) and was nonsignificant for Pennsylvania residents (OR = 1.50, 95% CI = 0.80, 2.79). Individuals from Pennsylvania were more likely to utilize dental care and participants from West Virginia less so (2.31, 95% CI = 1.57, 3.40). Females from Pennsylvania were more likely than males to regularly seek dental care (OR = 1.44, 95% CI = 1.00, 2.05), and a higher income was associated with greater frequency of regular dental visits (OR = 1.21, 95% CI = 1.09, 1.34) in West Virginia. Individuals from Pennsylvania who scored higher on the Physiological Arousal subscale of the Dental Fear Survey were more likely to attend routine care visits (OR = 1.18, 95% CI = 1.03, 1.35). Across both states, more fatalistic beliefs related to oral health care also predicted less routine care (OR = 0.87, 95% CI = 0.81, 0.94), and more investment in or more positive attitudes towards one's oral health also was associated with higher utilization (OR = 1.18, 95% CI = 1.13, 1.23). CONCLUSIONS Overall, the findings of this study suggest state residency, sex, insurance, income, fatalistic beliefs, health values, and aspects of dental care-related anxiety and fear predicted dental care utilization in north-central Appalachia. These findings reinforce the need to address insurance and other economic factors affecting utilization and to consider how individual-level fatalistic beliefs and oral health values may affect utilization of routine oral health care.
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Affiliation(s)
- Mengxia Chen
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts
| | - Casey D Wright
- Center for Oral Health Research in Appalachia, University of Pittsburgh, Pittsburgh, Pennsylvania.,Center for Oral Health Research in Appalachia, West Virginia University, Morgantown, West Virginia.,Department of Psychology, Eberly College of Arts and Sciences, West Virginia University, Morgantown, West Virginia
| | - Oluwabunmi Tokede
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts
| | - Alfa Yansane
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts
| | | | - Elsbeth Kalenderian
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts
| | - Terri H Beaty
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eleanor Feingold
- Center for Oral Health Research in Appalachia, University of Pittsburgh, Pittsburgh, Pennsylvania.,Center for Oral Health Research in Appalachia, West Virginia University, Morgantown, West Virginia.,Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John R Shaffer
- Center for Oral Health Research in Appalachia, University of Pittsburgh, Pittsburgh, Pennsylvania.,Center for Oral Health Research in Appalachia, West Virginia University, Morgantown, West Virginia.,Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Richard J Crout
- Center for Oral Health Research in Appalachia, University of Pittsburgh, Pittsburgh, Pennsylvania.,Center for Oral Health Research in Appalachia, West Virginia University, Morgantown, West Virginia.,Department of Periodontics, School of Dentistry, West Virginia University, Morgantown, West Virginia
| | - Katherine Neiswanger
- Center for Oral Health Research in Appalachia, University of Pittsburgh, Pittsburgh, Pennsylvania.,Center for Oral Health Research in Appalachia, West Virginia University, Morgantown, West Virginia.,Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert J Weyant
- Center for Oral Health Research in Appalachia, University of Pittsburgh, Pittsburgh, Pennsylvania.,Center for Oral Health Research in Appalachia, West Virginia University, Morgantown, West Virginia.,Department of Dental Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mary L Marazita
- Center for Oral Health Research in Appalachia, University of Pittsburgh, Pittsburgh, Pennsylvania.,Center for Oral Health Research in Appalachia, West Virginia University, Morgantown, West Virginia.,Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Daniel W McNeil
- Center for Oral Health Research in Appalachia, University of Pittsburgh, Pittsburgh, Pennsylvania.,Center for Oral Health Research in Appalachia, West Virginia University, Morgantown, West Virginia.,Department of Psychology, Eberly College of Arts and Sciences, West Virginia University, Morgantown, West Virginia.,Department of Dental Practice & Rural Health, West Virginia University, Morgantown, West Virginia
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Neumann AS, Kumar SV, Bangar S, Kookal KK, Spallek H, Tokede B, Simmons K, Even J, Mullins J, Mertz E, Yansane A, Obadan-Udoh E, White JM, Walji MF, Kalenderian E. Tobacco screening and cessation efforts by dental providers: A quality measure evaluation. J Public Health Dent 2019; 79:93-101. [PMID: 30566752 PMCID: PMC6570416 DOI: 10.1111/jphd.12298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 09/12/2018] [Accepted: 10/22/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The purpose of this study was to adapt, test, and evaluate the implementation of a primary care "Preventive care and Screening" meaningful use quality measure for tobacco use, in dental institutions. We determined the percentage of dental patients screened for tobacco use, and the percentage of tobacco users who received cessation counseling. METHODS We implemented the dental quality measure (DQM), in three dental schools and a large dental accountable care organization. An automated electronic health record (EHR) query identified patients 18 years and older who were screened for tobacco use one or more times within 24 months, and who received cessation counseling intervention if identified as a tobacco user. We evaluated EHR query performance with a manual review of a subsample of charts. RESULTS Across all four sites, in the reporting calendar year of 2015, a total of 143,675 patients met the inclusion criteria for the study. Within 24 months, including 2014 and 2015 calendar years, percentages of tobacco screening ranged from 79.7 to 99.9 percent, while cessation intervention percentages varied from 1 to 81 percent among sites. By employing DQM research methodology, we identified intervention gaps in clinical practice. CONCLUSIONS We demonstrated the successful implementation of a DQM to evaluate screening rates for tobacco use and cessation intervention. There is substantial variation in the cessation intervention rates across sites, and these results are a call for action for the dental profession to employ tobacco evidence-based cessation strategies to improve oral health and general health outcomes.
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Affiliation(s)
- Ana S Neumann
- Department of General Dentistry and Dental Public Health. University of Texas Health Science Center, School of Dentistry at Houston, 7500 Cambridge, Houston, TX, 77054
| | - Shwetha V Kumar
- Department of Diagnostic and Biomedical Sciences, Technology Services and Informatics. University of Texas Health Science Center, School of Dentistry at Houston, 7500 Cambridge, Houston, TX, 77054
| | - Suhasini Bangar
- Department of Diagnostic and Biomedical Sciences, Technology Services and Informatics. University of Texas Health Science Center, School of Dentistry at Houston, 7500 Cambridge, Houston, TX, 77054
| | - Krishna K Kookal
- Technology Services and Informatics. University of Texas Health Science Center, School of Dentistry at Houston, 7500 Cambridge, Houston, TX, 77054
| | - Heiko Spallek
- The University of Sydney. Faculty of Dentistry. 1 Mons Road, Westmead, NSW, 2145 Australia
| | - Bunmi Tokede
- Department of Oral Health Policy and Epidemiology. Harvard School of Dental Medicine. 188 Longwood Avenue, Boston, MA 02115
| | - Kristen Simmons
- Willamette Dental Group. 6950 NE Campus Way. Hillsboro, OR 97124
| | - Joshua Even
- Willamette Dental Group. 6950 NE Campus Way. Hillsboro, OR 97124
| | - Joanna Mullins
- Willamette Dental Group. 6950 NE Campus Way. Hillsboro, OR 97124
| | - Elizabeth Mertz
- Department of Preventive & Restorative Dental Sciences University of California San Francisco School of Dentistry. 707 Parnassus Ave., San Francisco, CA 94143
| | - Alfa Yansane
- Department of Preventive & Restorative Dental Sciences University of California San Francisco School of Dentistry. 707 Parnassus Ave., San Francisco, CA 94143
| | - Enihomo Obadan-Udoh
- Department of Preventive & Restorative Dental Sciences University of California San Francisco School of Dentistry. 707 Parnassus Ave., San Francisco, CA 94143
| | - Joel M White
- Department of Preventive & Restorative Dental Sciences University of California San Francisco School of Dentistry. 707 Parnassus Ave., San Francisco, CA 94143
| | - Muhammad F Walji
- Department of Diagnostic and Biomedical Sciences, Technology Services and Informatics. University of Texas Health Science Center, School of Dentistry at Houston, 7500 Cambridge, Houston, TX, 77054
| | - Elsbeth Kalenderian
- Department of Preventive & Restorative Dental Sciences University of California San Francisco School of Dentistry. 707 Parnassus Ave., San Francisco, CA 94143
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Obadan-Udoh EM, Calvo JM, Panwar S, Simmons K, White JM, Walji MF, Kalenderian E. Unintended consequences and challenges of quality measurements in dentistry. BMC Oral Health 2019; 19:38. [PMID: 30823894 PMCID: PMC6397478 DOI: 10.1186/s12903-019-0726-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 02/11/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In recent years, several state dental programs, researchers and the Dental Quality Alliance (DQA) have sought to develop baseline quality measures for dentistry as a way to improve health outcomes, reduce costs and enhance patient experiences. Some of these measures have been tested and validated for various population groups. However, there are some unintended consequences and challenges with quality measurement in dentistry as observed from our previous work on refining and transforming dental quality measures into e-measures. MAIN BODY Some examples of the unintended consequences and challenges associated with implementing dental quality measures include: a de-emphasis on patient-centeredness with process-based quality measures, an incentivization of unethical behavior due to fee-for-service reimbursement systems, the risk of compromising patient and provider autonomy with plan-level measures, a disproportionate benefits of dental quality measurement going toward payers, and the risk of alienating smaller dental offices due to the resource-intensive nature of quality measurement. CONCLUSION As our medical counterparts have embraced quality measurement for improved health outcomes, so too must the dental profession. Our ultimate goal is to ensure the delivery of high quality, patient-centered dental care and effective quality measurement is the first step. By continuously monitoring the performance of dental quality measures and their continued refinement when unintended consequences are observed, we can improve patient and population health outcomes.
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Affiliation(s)
- Enihomo M. Obadan-Udoh
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, 707 Parnassus Avenue, San Francisco, CA 94143 USA
| | - Jean M. Calvo
- Pediatric Dentistry Post-Graduate Program, School of Dentistry, University of California San Francisco, 707 Parnassus Ave, San Francisco, CA 94143 USA
| | - Sapna Panwar
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, 707 Parnassus Avenue, San Francisco, CA 94143 USA
| | - Kristen Simmons
- Skourtes Institute, 6950 NE Campus Way, Hillsboro, OR 97124 USA
| | - Joel M. White
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, 707 Parnassus Avenue, San Francisco, CA 94143 USA
| | - Muhammad F. Walji
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, University of Texas Health Science Center, 7500 Cambridge St., Houston, 77054 TX USA
| | - Elsbeth Kalenderian
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, 707 Parnassus Avenue, San Francisco, CA 94143 USA
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Walji MF, Kumar SV, Bangar S, Neumann A, Kookal KK, Yansane A, Tokede O, Obadan-Udoh E, Mertz E, Simmons K, Even J, Mullins J, White J, Kalenderian E. Authors' response. J Am Dent Assoc 2019; 150:5-6. [PMID: 30611326 DOI: 10.1016/j.adaj.2018.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Muhammad F Walji
- Associate Dean, Technology Services and Informatics, Professor, Department of Diagnostic and Biomedical Sciences, School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX
| | - Shwetha V Kumar
- Graduate Research Assistant, Department of Diagnostic and Biomedical Sciences, School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX
| | - Suhasini Bangar
- Research Associate, Department of Diagnostic and Biomedical Sciences, School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX
| | - Ana Neumann
- Associate Professor, Department of General Practice and Dental Public Health, School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX
| | - Krishna Kumar Kookal
- Clinical Informatics Research Data Warehouse Systems Analyst, Technology Services and Informatics, School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX
| | - Alfa Yansane
- Assistant Professor, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA
| | - Oluwabunmi Tokede
- Assistant Professor, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Cambridge, MA
| | - Enihomo Obadan-Udoh
- Assistant Professor, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA
| | - Elizabeth Mertz
- Assistant Professor, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA
| | - Kristen Simmons
- Chief Operating Officer, Willamette Dental Group, Portland, OR
| | - Joshua Even
- Director, Clinical Strategy and Support, Willamette Dental Group, Portland, OR
| | - Joanna Mullins
- Manager, Clinical Strategy and Support, Willamette Dental Group, Portland, OR
| | - Joel White
- Professor, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA
| | - Elsbeth Kalenderian
- Professor, Chair, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA
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Yansane A, Tokede O, White J, Etolue J, McClellan L, Walji M, Obadan-Udoh E, Kalenderian E. Utilization and Validity of the Dental Diagnostic System over Time in Academic and Private Practice. JDR Clin Trans Res 2018; 4:143-150. [PMID: 30931711 DOI: 10.1177/2380084418815150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION To fill the void created by insufficient dental terminologies, a multi-institutional workgroup was formed among members of the Consortium for Oral Health Research and Informatics to develop the Dental Diagnostic System (DDS) in 2009. The adoption of dental diagnosis terminologies by providers must be accompanied by rigorous usability and validity assessments to ensure their effectiveness in practice. OBJECTIVES The primary objective of this study was to describe the utilization and correct use of the DDS over a 4-y period. METHODS Electronic health record data were amassed from 2013 to 2016 where diagnostic terms and Current Dental Terminology procedure code pairs were adjudicated by calibrated dentists. With the resultant data, we report on the 4-y utilization and validity of the DDS at 5 dental institutions. Utilization refers to the proportion of instances that diagnoses are documented in a structured format, and validity is defined as the frequency of valid pairs divided by the number of all treatment codes entered. RESULTS Nearly 10 million procedures ( n = 9,946,975) were documented at the 5 participating institutions between 2013 and 2016. There was a 1.5-fold increase in the number of unique diagnoses documented during the 4-y period. The utilization and validity proportions of the DDS had statistically significant increases from 2013 to 2016 ( P < 0.0001). Academic dental sites were more likely to document diagnoses associated with orthodontic and restorative procedures, while the private dental site was equally likely to document diagnoses associated with all procedures. Overall, the private dental site had significantly higher utilization and validity proportions than the academic dental sites. CONCLUSION The results demonstrate an improvement in utilization and validity of the DDS terminology over time. These findings also yield insight into the factors that influence the usability, adoption, and validity of dental terminologies, raising the need for more focused training of dental students. KNOWLEDGE TRANSFER STATEMENT Ensuring that providers use standardized methods for documentation of diagnoses represents a challenge within dentistry. The results of this study can be used by clinicians when evaluating the utility of diagnostic terminologies embedded within the electronic health record.
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Affiliation(s)
- A Yansane
- 1 Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA
| | - O Tokede
- 2 Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - J White
- 1 Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA
| | - J Etolue
- 2 Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - L McClellan
- 3 Willamette Dental Group, Portland, OR, USA
| | - M Walji
- 4 Diagnostic and Biomedical Sciences Department, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - E Obadan-Udoh
- 1 Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA
| | - E Kalenderian
- 1 Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California-San Francisco, San Francisco, CA, USA
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Nelson LP, Maramaldi P, Kinnunen TH, Kalenderian E. Early Performance in a Humanistic Medicine Course as a Predictor of Dental Students’ Later Clinical Performance. J Dent Educ 2018. [DOI: 10.1002/j.0022-0337.2013.77.8.tb05569.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Linda Pollak Nelson
- Developmental Biology (Pediatric Dentistry); Harvard School of Dental Medicine and Director of Postdoctoral Pediatric Dentistry Residency Program Children's Hospital Boston
| | - Peter Maramaldi
- Simmons School of Social Work Research Associate Professor at Simmons School of Health Sciences and Clinical Instructor, Department of Oral Health Policy and Epidemiology; Harvard School of Dental Medicine
| | - Taru H. Kinnunen
- Department of Oral Health Policy and Epidemiology; Harvard School of Dental Medicine
| | - Elsbeth Kalenderian
- Oral Health Policy and Epidemiology; Harvard Dental Center; Harvard School of Dental Medicine
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Kalenderian E, Obadan-Udoh E, Yansane A, Kent K, Hebballi NB, Delattre V, Kookal KK, Tokede O, White J, Walji MF. Feasibility of Electronic Health Record-Based Triggers in Detecting Dental Adverse Events. Appl Clin Inform 2018; 9:646-653. [PMID: 30134473 DOI: 10.1055/s-0038-1668088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND We can now quantify and characterize the harm patients suffer in the dental chair by mining data from electronic health records (EHRs). Most dental institutions currently deploy a random audit of charts using locally developed definitions to identify such patient safety incidents. Instead, selection of patient charts using triggers and assessment through calibrated reviewers may more efficiently identify dental adverse events (AEs). OBJECTIVE Our goal was to develop and test EHR-based triggers at four academic institutions and find dental AEs, defined as moderate or severe physical harm due to dental treatment. METHODS We used an iterative and consensus-based process to develop 11 EHR-based triggers to identify dental AEs. Two dental experts at each institution independently reviewed a sample of triggered charts using a common AE definition and classification system. An expert panel provided a second level of review to confirm AEs identified by sites reviewers. We calculated the performance of each trigger and identified strategies for improvement. RESULTS A total of 100 AEs were identified by 10 of the 11 triggers. In 57% of the cases, pain was the most common AE identified, followed by infection and hard tissue damage. Positive predictive value (PPV) for the triggers ranged from 0 to 0.29. The best performing triggers were those developed to identify infections (PPV = 0.29), allergies (PPV = 0.23), failed implants (PPV = 0.21), and nerve injuries (PPV = 0.19). Most AEs (90%) were categorized as temporary moderate-to-severe harm (E2) and the remainder as permanent moderate-to-severe harm (G2). CONCLUSION EHR-based triggers are a promising approach to unearth AEs among dental patients compared with a manual audit of random charts. Data in dental EHRs appear to be sufficiently structured to allow the use of triggers. Pain was the most common AE type followed by infection and hard tissue damage.
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Affiliation(s)
- Elsbeth Kalenderian
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, California, United States
| | - Enihomo Obadan-Udoh
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, California, United States
| | - Alfa Yansane
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, California, United States
| | - Karla Kent
- Department of Quality Improvement, School of Dentistry, Oregon Health and Science University, Portland, Oregon, United States
| | - Nutan B Hebballi
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, University of Texas Health Science Center, Houston, Texas, United States
| | - Veronique Delattre
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, University of Texas Health Science Center, Houston, Texas, United States
| | - Krisna Kumar Kookal
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, University of Texas Health Science Center, Houston, Texas, United States
| | - Oluwabunmi Tokede
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, United States
| | - Joel White
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, California, United States
| | - Muhammad F Walji
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, University of Texas Health Science Center, Houston, Texas, United States
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Maramaldi P, Cadet T, Burke SL, LeCloux M, White E, Kalenderian E, Kinnunen T. Oral health and cancer screening in long‐term care nursing facilities: Motivation and opportunity as intervention targets. Gerodontology 2018; 35:407-416. [DOI: 10.1111/ger.12365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 06/21/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Peter Maramaldi
- Simmons College School of Social Work Boston Massachusetts
- HSDM‐Oral Health Policy and EpidemiologyHarvard School of Dental Medicine Boston Massachusetts
- Department of Social and Behavioral SciencesT.H. Chan School of Public HealthHarvard University Boston Massachusetts
| | - Tamara Cadet
- Simmons College School of Social Work Boston Massachusetts
- HSDM‐Oral Health Policy and EpidemiologyHarvard School of Dental Medicine Boston Massachusetts
| | - Shanna L. Burke
- School of Social WorkRobert Stempel College of Public Health and Social WorkFlorida International University Miami Florida
| | - Mary LeCloux
- School of Social WorkWest Virginia University Morgantown West Virginia
| | - Erina White
- Department of PsychiatryBoston Children's Hospital Boston Massachusetts
| | - Elsbeth Kalenderian
- Department of Preventive and Restorative Dental SciencesUniversity of California San Francisco School of Dentistry San Francisco California
| | - Taru Kinnunen
- Behavioral Science and Public HealthInstitute for Molecular Medicine Finland (FIMM)University of Helsinki Helsinki Finland
- Behavioral Science ConsultingNorth AndoverMA 01845 USA
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Kumar SV, Bangar S, Neumann A, Kookal KK, Yansane A, Tokede O, Obadan-Udoh E, Mertz E, Simmons K, Even J, Mullins J, White J, Kalenderian E, Walji M. Assessing the validity of existing dental sealant quality measures. J Am Dent Assoc 2018; 149:756-764.e1. [PMID: 29980245 DOI: 10.1016/j.adaj.2018.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/13/2018] [Accepted: 05/02/2018] [Indexed: 02/07/2023]
Abstract
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.
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Hastings NB, Centore LS, Gansky SA, Finzen FC, White JM, Wong E, Marshall GW, Chung L, Kalenderian E. A novel approach for effective integration of new faculty leadership. J Healthc Leadersh 2018; 10:1-9. [PMID: 29720883 PMCID: PMC5919165 DOI: 10.2147/jhl.s150493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose We report on an accelerated and effective way of assimilating a new leader into a team at a large academic dental school department. Methods At University of California, San Francisco (UCSF), a new Chair was recruited through a national search to lead its largest department in the School of Dentistry. Two months after arrival, the new Chair embarked on a process of leadership assimilation among her executive team, facilitated by a professional consultant. Within four weeks, team members participated in one-on-one interviews with the professional facilitator consultant and then completed the leadership assimilation questionnaire and returned it electronically to the facilitator. The facilitator then summarized all answers into themes and met with the team members without the Chair to debrief. Thereafter, the facilitator met with the Chair to discuss the major themes. Next, the Chair met with the team members in a facilitated session to discuss the results and negotiate a path forward. Results Approximately half of the feedback described the “how” of leadership: comments on communication, building relationships, building trust, and understanding UCSF history. The remaining half described the “what”: comments on vision, strategy, and operations. Team members indicated that the first debriefing session was helpful to alleviate initial anxiety and to start building team spirit. The session with the Chair was perceived as open and fruitful in which team members were able to express their concerns and hopes for the Department, while the Chair showed commitment to the team and the communication process. Conclusion Leader assimilation allows teams to share their expectations and anxieties with the new leader early in the relationship in an open way, before new habits and beliefs are formed. Conversely, for the leader, it effectively and efficiently allows a window into the team members’ thinking at a critical time period when otherwise first impressions occur. With a safe space created for open communication, the process allowed siloed individual division leaders to move toward a cohesive group while at the same time solidifying a commitment to the success of the new leader.
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Affiliation(s)
- Natalie B Hastings
- Division of Clinical General Dentistry, Department of Preventive and Restorative Dental Sciences, University of California, San Francisco (UCSF) School of Dentistry, San Francisco, CA, USA
| | - Linda S Centore
- Division of Behavioral Sciences … Community Dental Education, Department of Preventive and Restorative Dental Sciences, University of California, San Francisco (UCSF) School of Dentistry, San Francisco, CA, USA
| | - Stuart A Gansky
- Division of Oral Epidemiology … Dental Public Health, Department of Preventive and Restorative Dental Sciences, University of California, San Francisco (UCSF) School of Dentistry, San Francisco, CA, USA
| | - Frederick C Finzen
- Division of Prosthodontics, Department of Preventive and Restorative Dental Sciences, University of California, San Francisco (UCSF) School of Dentistry, San Francisco, CA, USA
| | - Joel M White
- Division of Preclinical Simulation, Department of Preventive and Restorative Dental Sciences, University of California, San Francisco (UCSF) School of Dentistry, San Francisco, CA, USA
| | - Eric Wong
- Division of Endodontics, Department of Preventive and Restorative Dental Sciences, University of California, San Francisco (UCSF) School of Dentistry, San Francisco, CA, USA
| | - Grayson W Marshall
- Division of Biomaterials and Bioengineering, Department of Preventive and Restorative Dental Sciences, University of California, San Francisco (UCSF) School of Dentistry, San Francisco, CA, USA
| | - Lisa Chung
- Division of Oral Epidemiology … Dental Public Health, Department of Preventive and Restorative Dental Sciences, University of California, San Francisco (UCSF) School of Dentistry, San Francisco, CA, USA
| | - Elsbeth Kalenderian
- Division of Oral Epidemiology … Dental Public Health, Department of Preventive and Restorative Dental Sciences, University of California, San Francisco (UCSF) School of Dentistry, San Francisco, CA, USA
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Roig Jornet P, Kalenderian E. The effectiveness of an initial continuing education course in leadership for dentists. Eur J Dent Educ 2018; 22:128-141. [PMID: 28727271 DOI: 10.1111/eje.12281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/13/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE/OBJECTIVES The purpose of this study was to measure the effectiveness of a continuing education course in leadership presented to postdoctoral dentist-leaders. METHODS The authors developed a 3-day course on leadership and management with topics including self-awareness, leadership qualities, emotional intelligence, communication skills, social skills, conflict management, personal branding, quality improvement and team motivation. Twenty-two course participants with a median age of 37.5 years and an average of 13.7 years of professional experience were assessed using three different metrics: satisfaction with the course and presenters immediately following the course; pre-course and post-course tests on knowledge of leadership topics; and self-assessments of leadership competency skills prior to the course, immediately following the course and then 6 months after the course. RESULTS Participant satisfaction with both instructors' effectiveness and the overall course design was very high. A survey 6 months following the course showed that participants were very positive regarding the practical use of the leadership skills they acquired in the course. The average of all participants' scores on the objectively assessed leadership knowledge test showed a statistically significant (P<.001) difference between pre-course and post-course scores. At 6-month follow-up, participant self-assessment of leadership competency significantly improved following the course. CONCLUSION A well-designed course in leadership skills can have a positive impact on the leadership knowledge and competency of dentist-leaders. This unique leadership course was effective in increasing leadership knowledge and self-perceived leadership competency. The course and the skilled instructors were rated very highly by participants.
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Affiliation(s)
| | - E Kalenderian
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco (UCSF), San Francisco, CA, USA
- Harvard School of Dental Medicine, Oral Health Policy and Epidemiology Department, Boston, MA, USA
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Nikdel C, Nikdel K, Ibarra-Noriega A, Kalenderian E, Walji MF. Clinical Dental Faculty Members' Perceptions of Diagnostic Errors and How to Avoid Them. J Dent Educ 2018; 82:340-348. [PMID: 29606650 DOI: 10.21815/jde.018.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/09/2017] [Indexed: 11/20/2022]
Abstract
Diagnostic errors are increasingly recognized as a source of preventable harm in medicine, yet little is known about their occurrence in dentistry. The aim of this study was to gain a deeper understanding of clinical dental faculty members' perceptions of diagnostic errors, types of errors that may occur, and possible contributing factors. The authors conducted semi-structured interviews with ten domain experts at one U.S. dental school in May-August 2016 about their perceptions of diagnostic errors and their causes. The interviews were analyzed using an inductive process to identify themes and key findings. The results showed that the participants varied in their definitions of diagnostic errors. While all identified missed diagnosis and wrong diagnosis, only four participants perceived that a delay in diagnosis was a diagnostic error. Some participants perceived that an error occurs only when the choice of treatment leads to harm. Contributing factors associated with diagnostic errors included the knowledge and skills of the dentist, not taking adequate time, lack of communication among colleagues, and cognitive biases such as premature closure based on previous experience. Strategies suggested by the participants to prevent these errors were taking adequate time when investigating a case, forming study groups, increasing communication, and putting more emphasis on differential diagnosis. These interviews revealed differing perceptions of dental diagnostic errors among clinical dental faculty members. To address the variations, the authors recommend adopting shared language developed by the medical profession to increase understanding.
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Affiliation(s)
- Cathy Nikdel
- Dr. Cathy Nikdel is Clinical Assistant Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Kian Nikdel is Clinical Assistant Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Ibarra-Noriega is Graduate Research Assistant, Department of Diagnostic and Biomedical Sciences, The University of Texas School of Dentistry at Houston; Dr. Kalenderian is Chair, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco; and Dr. Walji is Associate Dean for Technology Services and Informatics, and Professor, Department of Diagnostics and Biomedical Sciences, The University of Texas School of Dentistry at Houston
| | - Kian Nikdel
- Dr. Cathy Nikdel is Clinical Assistant Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Kian Nikdel is Clinical Assistant Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Ibarra-Noriega is Graduate Research Assistant, Department of Diagnostic and Biomedical Sciences, The University of Texas School of Dentistry at Houston; Dr. Kalenderian is Chair, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco; and Dr. Walji is Associate Dean for Technology Services and Informatics, and Professor, Department of Diagnostics and Biomedical Sciences, The University of Texas School of Dentistry at Houston
| | - Ana Ibarra-Noriega
- Dr. Cathy Nikdel is Clinical Assistant Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Kian Nikdel is Clinical Assistant Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Ibarra-Noriega is Graduate Research Assistant, Department of Diagnostic and Biomedical Sciences, The University of Texas School of Dentistry at Houston; Dr. Kalenderian is Chair, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco; and Dr. Walji is Associate Dean for Technology Services and Informatics, and Professor, Department of Diagnostics and Biomedical Sciences, The University of Texas School of Dentistry at Houston
| | - Elsbeth Kalenderian
- Dr. Cathy Nikdel is Clinical Assistant Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Kian Nikdel is Clinical Assistant Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Ibarra-Noriega is Graduate Research Assistant, Department of Diagnostic and Biomedical Sciences, The University of Texas School of Dentistry at Houston; Dr. Kalenderian is Chair, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco; and Dr. Walji is Associate Dean for Technology Services and Informatics, and Professor, Department of Diagnostics and Biomedical Sciences, The University of Texas School of Dentistry at Houston
| | - Muhammad F Walji
- Dr. Cathy Nikdel is Clinical Assistant Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Kian Nikdel is Clinical Assistant Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Ibarra-Noriega is Graduate Research Assistant, Department of Diagnostic and Biomedical Sciences, The University of Texas School of Dentistry at Houston; Dr. Kalenderian is Chair, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco; and Dr. Walji is Associate Dean for Technology Services and Informatics, and Professor, Department of Diagnostics and Biomedical Sciences, The University of Texas School of Dentistry at Houston.
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Kalenderian E, Ramoni R, Spallek H, White J, Walji M. Quality measures everywhere: The case for parsimony. J Am Dent Assoc 2018; 149:322-326. [PMID: 29599021 PMCID: PMC8259309 DOI: 10.1016/j.adaj.2018.01.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 11/21/2022]
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Abstract
This study aims to investigate burnout and study engagement among medical students at Sun Yat-sen University, China.A cross-sectional survey was conducted among undergraduate medical students of Sun Yat-sen University, China. A total of 453 undergraduate students completed a self-administered, structured questionnaire between January and February, 2016. Burnout and study engagement were measured using the Maslach Burnout Inventory-Student Survey (MBI-SS) and the UTRECHT Work Engagement Scale-Students (UWES-S), respectively. Subjects who scored high in emotional exhaustion subscale, high in cynicism subscale, and low in professional efficacy subscale simultaneously were graded as having high risk of burnout. Independent sample t tests and chi-square tests were used to compare the differences in burnout and work engagement between genders, majors, and grade levels.The means (standard deviations) of the MBI-SS subscales were 3.42 (1.45) for emotional exhaustion, 2.34 (1.64) for cynicism, and 3.04 (1.30) for professional efficacy. The means (standard deviations) of the UWES-S subscales were 3.13 (1.49) for vigor, 3.44 (1.47) for dedication and 3.00 (1.51) for absorption. Approximately 1 in 11 students experienced a high risk of burnout. There were no statistically significant gender differences in burnout and study engagement. There were also no statistically significant differences in burnout and study engagement subscales according to student major. Students in higher grades displayed increased burnout risk, higher mean burnout subscale score of cynicism, lower mean burnout subscale score of professional efficacy, and decreased mean study engagement subscale scores of dedication and absorption. There were strong correlations within study engagement subscales.Chinese medical students in this university experience a high level of burnout. Students at higher-grade level experience more burnout and decreased study engagement compared with students in lower level.
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Affiliation(s)
- Hongchun Liu
- Department of Preventive Dentistry, Guanghua School of Stomatology, Hospital of Stomatology
- Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Alfa Ibrahim Yansane
- Department of Preventive & Restorative Dental Sciences, The University of California, San Francisco School of Dentistry, San Francisco, CA
| | | | | | - Nanrui Hong
- Department of Prosthodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Elsbeth Kalenderian
- Department of Preventive & Restorative Dental Sciences, The University of California, San Francisco School of Dentistry, San Francisco, CA
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