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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] [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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Benoit B, Frédéric B, Jean-Charles D. Current state of dental informatics in the field of health information systems: a scoping review. BMC Oral Health 2022; 22:131. [PMID: 35439988 PMCID: PMC9020044 DOI: 10.1186/s12903-022-02163-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Over the past 50 years, dental informatics has developed significantly in the field of health information systems. Accordingly, several studies have been conducted on standardized clinical coding systems, data capture, and clinical data reuse in dentistry. Methods Based on the definition of health information systems, the literature search was divided into three specific sub-searches: “standardized clinical coding systems,” “data capture,” and “reuse of routine patient care data.” PubMed and Web of Science were searched for peer-reviewed articles. The review was conducted following the PRISMA-ScR protocol. Results A total of 44 articles were identified for inclusion in the review. Of these, 15 were related to “standardized clinical coding systems,” 15 to “data capture,” and 14 to “reuse of routine patient care data.” Articles related to standardized clinical coding systems focused on the design and/or development of proposed systems, on their evaluation and validation, on their adoption in academic settings, and on user perception. Articles related to data capture addressed the issue of data completeness, evaluated user interfaces and workflow integration, and proposed technical solutions. Finally, articles related to reuse of routine patient care data focused on clinical decision support systems centered on patient care, institutional or population-based health monitoring support systems, and clinical research. Conclusions While the development of health information systems, and especially standardized clinical coding systems, has led to significant progress in research and quality measures, most reviewed articles were published in the US. Clinical decision support systems that reuse EDR data have been little studied. Likewise, few studies have examined the working environment of dental practitioners or the pedagogical value of using health information systems in dentistry. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02163-9.
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Affiliation(s)
- Ballester Benoit
- Pôle d'Odontologie, Assistance Publique des Hôpitaux de Marseille, Marseille, France. .,Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
| | - Bukiet Frédéric
- Pôle d'Odontologie, Assistance Publique des Hôpitaux de Marseille, Marseille, France.,Aix Marseille Univ, CNRS, ISM, Inst Movement Sci, Marseille, France
| | - Dufour Jean-Charles
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.,APHM, Hôpital de la Timone, Service Biostatistique et Technologies de l'Information et de la Communication, Marseille, France
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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] [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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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] [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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Acharya A, Schroeder D, Schwei K, Chyou PH. Update on Electronic Dental Record and Clinical Computing Adoption Among Dental Practices in the United States. Clin Med Res 2017; 15:59-74. [PMID: 29229631 PMCID: PMC5849439 DOI: 10.3121/cmr.2017.1380] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/08/2017] [Accepted: 11/21/2017] [Indexed: 11/18/2022]
Abstract
This study sought to re-characterize trends and factors affecting electronic dental record (EDR) and technologies adoption by dental practices and the impact of the Health Information Technology for Economic and Clinical Health (HITECH) act on adoption rates through 2012. A 39-question survey was disseminated nationally over 3 months using a novel, statistically-modeled approach informed by early response rates to achieve a predetermined sample. EDR adoption rate for clinical support was 52%. Adoption rates were higher among: (1) younger dentists; (2) dentists ≤ 15 years in practice; (3) females; and (4) group practices. Top barriers to adoption were EDR cost/expense, cost-benefit ratio, electronic format conversion, and poor EDR usability. Awareness of the Federal HITECH incentive program was low. The rate of chairside computer implementation was 72%. Adoption of EDR in dental offices in the United States was higher in 2012 than electronic health record adoption rates in medical offices and was not driven by the HITECH program. Patient portal adoption among dental practices in the United States remained low.
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Affiliation(s)
- Amit Acharya
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Dixie Schroeder
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Kelsey Schwei
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Po-Huang Chyou
- Biomedical Informatics Research Center, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
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Dental Providers' Perspectives on Diagnosis-Driven Dentistry: Strategies to Enhance Adoption of Dental Diagnostic Terminology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070767. [PMID: 28703751 PMCID: PMC5551205 DOI: 10.3390/ijerph14070767] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 07/09/2017] [Accepted: 07/09/2017] [Indexed: 01/17/2023]
Abstract
The routine use of standardized diagnostic terminologies (DxTMs) in dentistry has long been the subject of academic debate. This paper discusses the strategies suggested by a group of dental stakeholders to enhance the uptake of DxTMs. Through unstructured interviewing at the 'Toward a Diagnosis-Driven Profession' National Conference held on 19 March 2016 in Los Angeles, CA, USA participants were asked how enthusiastic they were about implementing and consistently using DxTMs at their work. They also brainstormed on strategies to improve the widespread use of DxTMs. Their responses are summarized by recursive abstraction and presented in themes. Conference participants were very enthusiastic about using a DxTM in their place of work. Participants enumerated several strategies to make DxTMs more appealing including: the use of mandates, a value proposition for providers, communication and education, and integration with EHRs and existing systems. All groups across the dental healthcare delivery spectrum will need to work together for the success of the widespread and consistent use of DxTMs. Understanding the provider perspective is however the most critical step in achieving this goal, as they are the group who will ultimately be saddled with the critical task of ensuring DxTM use at the point of care.
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Neumann A, Kalenderian E, Ramoni R, Yansane A, Tokede B, Etolue J, Vaderhobli R, Simmons K, Even J, Mullins J, Kumar S, Bangar S, Kookal K, White J, Walji M. Evaluating quality of dental care among patients with diabetes: Adaptation and testing of a dental quality measure in electronic health records. J Am Dent Assoc 2017. [PMID: 28624074 DOI: 10.1016/j.adaj.2017.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with diabetes are at increased risk of developing oral complications, and annual dental examinations are an endorsed preventive strategy. The authors evaluated the feasibility and validity of implementing an automated electronic health record (EHR)-based dental quality measure to determine whether patients with diabetes received such evaluations. METHODS The authors selected a Dental Quality Alliance measure developed for claims data and adapted the specifications for EHRs. Automated queries identified patients with diabetes across 4 dental institutions, and the authors manually reviewed a subsample of charts to evaluate query performance. After assessing the initial EHR measure, the authors defined and tested a revised EHR measure to capture better the oral care received by patients with diabetes. RESULTS In the initial and revised measures, the authors used EHR automated queries to identify 12,960 and 13,221 patients with diabetes, respectively, in the reporting year. Variations in the measure scores across sites were greater with the initial measure (range, 36.4-71.3%) than with the revised measure (range, 78.8-88.1%). The automated query performed well (93% or higher) for sensitivity, specificity, and positive and negative predictive values for both measures. CONCLUSIONS The results suggest that an automated EHR-based query can be used successfully to measure the quality of oral health care delivered to patients with diabetes. The authors also found that using the rich data available in EHRs may help estimate the quality of care better than can relying on claims data. PRACTICAL IMPLICATIONS Detailed clinical patient-level data in dental EHRs may be useful to dentists in evaluating the quality of dental care provided to patients with diabetes.
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Ramoni RB, Etolue J, Tokede O, McClellan L, Simmons K, Yansane A, White JM, Walji MF, Kalenderian E. Adoption of dental innovations: The case of a standardized dental diagnostic terminology. J Am Dent Assoc 2017; 148:319-327. [PMID: 28364948 DOI: 10.1016/j.adaj.2017.01.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 01/21/2017] [Accepted: 01/24/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Standardized dental diagnostic terminologies (SDDxTs) were introduced decades ago. Their use has been on the rise, accompanying the adoption of electronic health records (EHRs). One of the most broadly used terminologies is the Dental Diagnostic System (DDS). Our aim was to assess the adoption of SDDxTs by US dental schools by using the Rogers diffusion of innovations framework, focusing on the DDS. METHODS The authors electronically surveyed clinic deans in all US dental schools (n = 61) to determine use of an EHR and SDDxT, perceived barriers to adoption of an SDDxT, and the effect of implementing an SDDxT on clinical productivity. RESULTS The response rate was 57%. Of the 35 responses, 91% reported using an EHR to document patient care, with 84% using axiUm; 41% used the DDS. Fifty-four percent of those who did not use an SDDxT had considered adopting the DDS, but 38% had not, citing barriers such as complexity and compatibility. CONCLUSIONS Adoption of an SDDxT, particularly the DDS, is on the rise. Nevertheless, a large number of institutions are in the Rogers late majority and laggards categories with respect to adoption. Several factors may discourage adoption, including the inability to try out the terminology on a small scale, poor usability within the EHR, the fact that it would be a cultural shift in practice, and a perception of unclear benefits. However, the consolidation of the DDS and American Dental Association terminology efforts stands to encourage adoption. PRACTICAL IMPLICATIONS The successful adoption of dental innovation depends not only on the intrinsic merit of the innovation, as some useful innovations do not achieve widespread traction. As such, it is important for health care providers to understand how to disseminate their ideas in order to ensure traction and widespread adoption.
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