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Ackerhans S, Huynh T, Kaiser C, Schultz C. Exploring the role of professional identity in the implementation of clinical decision support systems-a narrative review. Implement Sci 2024; 19:11. [PMID: 38347525 PMCID: PMC10860285 DOI: 10.1186/s13012-024-01339-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/09/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Clinical decision support systems (CDSSs) have the potential to improve quality of care, patient safety, and efficiency because of their ability to perform medical tasks in a more data-driven, evidence-based, and semi-autonomous way. However, CDSSs may also affect the professional identity of health professionals. Some professionals might experience these systems as a threat to their professional identity, as CDSSs could partially substitute clinical competencies, autonomy, or control over the care process. Other professionals may experience an empowerment of the role in the medical system. The purpose of this study is to uncover the role of professional identity in CDSS implementation and to identify core human, technological, and organizational factors that may determine the effect of CDSSs on professional identity. METHODS We conducted a systematic literature review and included peer-reviewed empirical studies from two electronic databases (PubMed, Web of Science) that reported on key factors to CDSS implementation and were published between 2010 and 2023. Our explorative, inductive thematic analysis assessed the antecedents of professional identity-related mechanisms from the perspective of different health care professionals (i.e., physicians, residents, nurse practitioners, pharmacists). RESULTS One hundred thirty-one qualitative, quantitative, or mixed-method studies from over 60 journals were included in this review. The thematic analysis found three dimensions of professional identity-related mechanisms that influence CDSS implementation success: perceived threat or enhancement of professional control and autonomy, perceived threat or enhancement of professional skills and expertise, and perceived loss or gain of control over patient relationships. At the technological level, the most common issues were the system's ability to fit into existing clinical workflows and organizational structures, and its ability to meet user needs. At the organizational level, time pressure and tension, as well as internal communication and involvement of end users were most frequently reported. At the human level, individual attitudes and emotional responses, as well as familiarity with the system, most often influenced the CDSS implementation. Our results show that professional identity-related mechanisms are driven by these factors and influence CDSS implementation success. The perception of the change of professional identity is influenced by the user's professional status and expertise and is improved over the course of implementation. CONCLUSION This review highlights the need for health care managers to evaluate perceived professional identity threats to health care professionals across all implementation phases when introducing a CDSS and to consider their varying manifestations among different health care professionals. Moreover, it highlights the importance of innovation and change management approaches, such as involving health professionals in the design and implementation process to mitigate threat perceptions. We provide future areas of research for the evaluation of the professional identity construct within health care.
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Affiliation(s)
- Sophia Ackerhans
- Kiel Institute for Responsible Innovation, University of Kiel, Westring 425, 24118, Kiel, Germany.
| | - Thomas Huynh
- Kiel Institute for Responsible Innovation, University of Kiel, Westring 425, 24118, Kiel, Germany
| | - Carsten Kaiser
- Kiel Institute for Responsible Innovation, University of Kiel, Westring 425, 24118, Kiel, Germany
| | - Carsten Schultz
- Kiel Institute for Responsible Innovation, University of Kiel, Westring 425, 24118, Kiel, Germany
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Alsalemi N, Sadowski CA, Kilpatrick K, Elftouh N, Houle S, Lafrance JP. Exploring key components and factors that influence the use of clinical decision- support tools for prescribing to older patients with kidney disease: the perspective of healthcare providers. BMC Health Serv Res 2024; 24:126. [PMID: 38263025 PMCID: PMC10804714 DOI: 10.1186/s12913-024-10568-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Clinical decision-support (CDS) tools are systems that provide healthcare providers (HCPs) with recommendations based on knowledge and patient-specific factors to facilitate informed decisions. OBJECTIVES To identify the key components of a CDS tool that are most important to HCPs in caring for older adults with kidney disease, and to understand the facilitators and barriers toward using CDS tools in daily clinical practice. METHODS Design: A cross-sectional survey of Canadian HCPs was undertaken. DATA COLLECTION Participants affiliated with a provincial college, nephrology organization, or advocacy body were contacted. The survey was conducted between August and October 2021. INSTRUMENT A 59-item questionnaire was developed and divided into five main domains/themes. Analysis was done descriptively. RESULTS Sixty-three participants completed the questionnaire. Physicians (60%) and pharmacists (22%) comprised the majority of the participants. Most of the participants were specialized in nephrology (65%). The most important components in a CDS tool for prescribing to older patients with kidney disease were the safety and efficacy of the medication (89%), the goal of therapy (89%), and patient's quality of life (87%). 90% were willing to use CDS tools and 57% were already using some CDS tools for prescribing. The majority of the participants selected the validation of CDS tools (95%), accompanying the recommendations by the supporting evidence (84%), and the affiliation of the tools with known organizations (84%), as factors that facilitate the use of CDS tools. CONCLUSION CDS tools are being used and are accepted by HCPs and have value in their assistance in engaging patients in making well-informed decisions.
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Affiliation(s)
- N Alsalemi
- Département de pharmacologie et physiologie, Université de Montréal, Montréal, Canada
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Montréal, Canada
- College of Pharmacy, Qatar University, Doha, Qatar
| | - C A Sadowski
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Canada
| | - K Kilpatrick
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Montréal, Canada
- Ingram School of Nursing, McGill University, Montreal, Canada
| | - N Elftouh
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Montréal, Canada
| | - Skd Houle
- School of Pharmacy, University of Waterloo, Waterloo, Canada
| | - J P Lafrance
- Département de pharmacologie et physiologie, Université de Montréal, Montréal, Canada.
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Montréal, Canada.
- Service de néphrologie, CIUSSS de l'Est-de-l'Île-de-Montréal, Montréal, Canada.
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DiLuigi M, Hagel N, Finkelman MD, Irusa K, White R, Zandona AF. Assessment of implementation of the caries management by risk assessment philosophy in a dental school. J Dent Educ 2023; 87:1410-1418. [PMID: 37402597 DOI: 10.1002/jdd.13297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/27/2023] [Accepted: 06/11/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE This cross-sectional study assessed the implementation of documenting a baseline caries risk assessment (CRA) of patients seen by predoctoral dental students and its association with the presence of caries risk management (CRM) treatment. METHODS A convenience sample of 10,000 electronic axiUm patient records at Tufts University School of Dental Medicine was retrospectively assessed for the presence or absence of a completed CRA and CRM after IRB approval following predetermined inclusion and exclusion criteria. The CRM variables (nutrition counseling, sealant, fluoride) were identified by procedure codes that were completed by the student. Associations were assessed via the chi-square test, Kruskal-Wallis test (with Dunn's test and the Bonferroni correction used in post-hoc tests) and Mann-Whitney U test. RESULTS Most patients (70.5%) had a CRA completed. However, only 24.9% (out of the 7045 patients with a completed CRA) received CRM, while 22.9% of the 2,955 patients without a CRA received CRM. The difference between the groups with and without a completed CRA in terms of the percentage receiving CRM was not clinically significant. Significant associations were found between a completed CRA and in-house fluoride treatment (p = .034) and between a completed CRA and sealant treatment (p = .001). Patients with higher baseline CRA levels (i.e., greater risk) were more likely to have CRM (16.9% of the 785 patients at low risk, 21.1% of the 1282 patients at moderate risk, 26.3% of the 4347 patients at high risk, and 32.6% of the 631 patients at extreme risk). The association between these two variables was significant (p < .001). CONCLUSION There is evidence that students were mostly compliant with completing a CRA for most patients; however, there is a deficiency in implementation of CRM approach to help support dental caries management, and there is still much room for improvement.
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Affiliation(s)
- Maria DiLuigi
- Essex North Shore Agricultural and Technical School, Danvers, Massachusetts, USA
| | - Natalie Hagel
- Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | | | - Karina Irusa
- Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Robyn White
- Tufts University School of Dental Medicine, Boston, Massachusetts, USA
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Huh AJH, Chen JW, Bakland L, Goodacre C. Comparison of Different Clinical Decision Support Tools in Aiding Dental and Medical Professionals in Managing Primary Dentition Traumatic Injuries. Pediatr Emerg Care 2022; 38:e534-e539. [PMID: 34009888 DOI: 10.1097/pec.0000000000002409] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
BACKGROUND Many patients are taken to the emergency room for dental trauma treatment, but studies reveal that medical professionals do not feel confident in diagnosing and treating children with traumatic dental injuries. The purpose of this study was to determine if a clinical decision support tool (CDST) would improve dental trauma knowledge of primary teeth in medical students and pediatric dentists. Another purpose was assessing effectiveness of print and mobile app CDSTs. METHODS Medical students (n = 100) and pediatric dentists (n = 49) were given a pretest to assess baseline dental trauma knowledge. All subjects were randomly assigned to 1 of 3 groups for the posttest: no CDST, print CDST, and mobile app CDST. Test scores and total time spent on each test were recorded and analyzed. RESULTS Compared with medical students, pediatric dentists scored significantly higher in both pretest (8.57 ± 0.96 vs 4.20 ± 1.58; P < 0.001) and posttest (8.37 ± 1.09 vs 4.96 ± 1.99; P < 0.001). There was no significant difference in time spent to complete the 2 tests between both groups. Medical students and pediatric dentists who utilized the mobile app CDST had scored highest (P = 0.028) but took the longest time (P < 0.001) on the posttest. CONCLUSIONS Both print and mobile app CDSTs improved diagnosing and managing traumatic dental injuries in primary dentition significantly compared with those without aid. Medical students with CDSTs showed significant improvement in managing primary dental trauma; therefore, it is recommended for better, more accurate diagnosis and treatment in patients.
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Affiliation(s)
| | | | | | - Charles Goodacre
- Restorative Dentistry, Loma Linda University School of Dentistry, Loma Linda, CA
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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] [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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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] [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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Kottek AM, Hoeft KS, White JM, Simmons K, Mertz EA. Implementing care coordination in a large dental care organization in the United States by upskilling front office personnel. HUMAN RESOURCES FOR HEALTH 2021; 19:48. [PMID: 33827583 PMCID: PMC8028788 DOI: 10.1186/s12960-021-00593-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/25/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Care coordination is a key strategy used to improve health outcomes and efficiency, yet there are limited examples in dentistry. A large dental accountable care organization piloted care coordination by retraining existing administrative staff to coordinate the care of high-risk patients. Following the pilot's success, a formal "dental care advocate" (DCA) role was integrated system-wide. The goal of this new role is to improve care, patient engagement, and health outcomes while integrating staff into the clinical care team. We aim to describe the process of DCA role implementation and assess staff and clinician perceptions about the role pre- and post-implementation. METHODS Guided by the Consolidated Framework for Implementation Research, semi-structured interviews with clinical and operational administrative staff and observation at the company-wide training session were combined with pre- and post-implementation electronic surveys. Descriptive statistics and mean scores were tested for significance between each survey sample (t-tests), and qualitative data were thematically analyzed. RESULTS With preliminary evidence from the pilot and strong executive support, a dedicated leadership team executed a stepwise rollout of the DCA role over 6 months. Success was facilitated by an organizational culture of frequent interventions deployed rapidly through a centralized system, along with supportive buy-in from managerial teams and high staff acceptance and enthusiasm for the DCA role before implementation. Following implementation, significant changes in attitudes and beliefs about the role were measured, though managers held stronger positive impressions than DCAs. DCAs reported high confidence in new skills and dental knowledge post-implementation, including motivational interviewing and the ability to confidently answer patients' questions about their oral health. Overall, the fast-paced implementation of this new role was well received, although consistent and significant differences in mean attitudes between managers and DCAs indicate more work to fine-tune the role is needed. CONCLUSIONS Successful implementation of the new DCA role was facilitated by a strong organizational commitment to team-based dentistry and positive impressions of care coordination among staff and managers. Upskilling existing administrative staff with the necessary training to manage some high-risk patient needs is one method that can be used to implement care coordination efforts in dentistry.
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Affiliation(s)
- Aubri M. Kottek
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, 490 Illinois Street, Floor 11, Box 1242, San Francisco, CA 94143 United States of America
- Healthforce Center at UCSF, School of Dentistry, University of California, San Francisco, 490 Illinois Street, Floor 11, Box 1242, San Francisco, CA 94143 United States of America
| | - Kristin S. Hoeft
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, 490 Illinois Street, Floor 11, Box 1242, San Francisco, CA 94143 United States of America
| | - Joel M. White
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, 490 Illinois Street, Floor 11, Box 1242, San Francisco, CA 94143 United States of America
| | - Kristen Simmons
- Willamette Dental Group, P.C., 6950 NE Campus Way, Hillsboro, OR 97124 United States of America
- Skourtes Institute, 6950 NE Campus Way, Hillsboro, OR 97124 United States of America
| | - Elizabeth A. Mertz
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, 490 Illinois Street, Floor 11, Box 1242, San Francisco, CA 94143 United States of America
- Healthforce Center at UCSF, School of Dentistry, University of California, San Francisco, 490 Illinois Street, Floor 11, Box 1242, San Francisco, CA 94143 United States of America
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White JM, Brandon RG, Mullins JM, Simmons KL, Kottek AM, Mertz EA. Tracking oral health in a standardized, evidence-based, prevention-focused dental care system. J Public Health Dent 2020; 80 Suppl 2:S35-S43. [PMID: 33104245 DOI: 10.1111/jphd.12413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Learning health-care systems are foundational for measuring and achieving value in oral health care. This article describes the components of a preventive dental care program and the quality of care in a large dental accountable care organization. METHODS A retrospective study design describes and evaluates the cross-sectional measures of process of care (PoC), appropriateness of care (AoC), and outcomes of care (OoC) extracted from the electronic health record (EHR), between 2014 and 2019. Annual and composite measures are derived from EHR-based clinical decision support for risk determination, diagnostic and treatment terminology, and decayed-missing-filled-teeth (DMFT) measures. RESULTS Annually, 253,515 ± 27,850 patients were cared for with 618,084 ± 80,559 visits, 209,366 ± 22,300 exams, and 2,072,844 ± 300,363 clinical procedures. PoC metrics included provider adherence (98.3 percent) in completing caries risk assessments and patient receipt (96.9 percent) of a proactive dental care plan. AoC metrics included patients receiving prevention according to the risk-based protocol. The percent of patients at risk for caries receiving fluoride varnish was 95.4 ± 0.4 percent. OoC metrics included untreated decay and new decay. The 6-year average prevalence of untreated decay was 11.3 ± 0.3 percent, and average incidence of new decay was 13.6 ± 0.5 percent, increasing with risk level: low = 7.5 percent, medium = 18.8 percent, high = 29.4 percent, and extreme = 28.1 percent. CONCLUSIONS The preventive dental care system demonstrates excellent provider adherence to the evidence-based prevention protocol, with measurably better dental outcomes by patient risk compared to national estimates. These achievements are enabled by a value-centric, accountable model of care and incentivized by a compensation model aligned with performance measures.
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Affiliation(s)
- Joel M White
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, CA, USA
| | - Ryan G Brandon
- Willamette Dental Group and Skourtes Institute, Hillsboro, OR, USA.,Independant Consultant, Maple Ridge, BC, Canada
| | - Joanna M Mullins
- Willamette Dental Group and Skourtes Institute, Hillsboro, OR, USA
| | | | - Aubri M Kottek
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, CA, USA
| | - Elizabeth A Mertz
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, CA, USA
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9
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Finkelstein J, Zhang F, Levitin SA, Cappelli D. Using big data to promote precision oral health in the context of a learning healthcare system. J Public Health Dent 2020; 80 Suppl 1:S43-S58. [PMID: 31905246 PMCID: PMC7078874 DOI: 10.1111/jphd.12354] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 10/08/2019] [Accepted: 12/02/2019] [Indexed: 12/31/2022]
Abstract
There has been a call for evidence-based oral healthcare guidelines, to improve precision dentistry and oral healthcare delivery. The main challenges to this goal are the current lack of up-to-date evidence, the limited integrative analytical data sets, and the slow translations to routine care delivery. Overcoming these issues requires knowledge discovery pipelines based on big data and health analytics, intelligent integrative informatics approaches, and learning health systems. This article examines how this can be accomplished by utilizing big data. These data can be gathered from four major streams: patients, clinical data, biological data, and normative data sets. All these must then be uniformly combined for analysis and modelling and the meaningful findings can be implemented clinically. By executing data capture cycles and integrating the subsequent findings, practitioners are able to improve public oral health and care delivery.
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Affiliation(s)
- Joseph Finkelstein
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Frederick Zhang
- Center for Bioinformatics and Data Analytics in Oral HealthCollege of Dental Medicine, Columbia UniversityNew YorkNYUSA
| | - Seth A. Levitin
- Center for Bioinformatics and Data Analytics in Oral HealthCollege of Dental Medicine, Columbia UniversityNew YorkNYUSA
| | - David Cappelli
- Department of Biomedical SciencesSchool of Dental Medicine, University of NevadaLas VegasNVUSA
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Kennedy G, Gallego B. Clinical prediction rules: A systematic review of healthcare provider opinions and preferences. Int J Med Inform 2018; 123:1-10. [PMID: 30654898 DOI: 10.1016/j.ijmedinf.2018.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 10/29/2018] [Accepted: 12/11/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The act of predicting clinical endpoints and patient trajectories based on past and current states is on the precipice of a technological revolution. This systematic review summarises the available evidence describing healthcare provider opinions and preferences with respect to the use of clinical prediction rules. The primary goal of this work is to inform the design and implementation of future systems, and secondarily to identify gaps for the development of clinician education programs. METHODS Five databases were systematically searched in May 2016 for studies collecting empirical opinions of healthcare providers regarding clinical prediction rule usage. Reference lists were scanned for additional eligible materials and an update search was made in August 2017. Data was extracted on high-level study features, before in-depth thematic analysis was performed. RESULTS 45 articles were identified from 9 countries. Most studies utilised surveys (28) or interviews (14). Fewer employed focus groups (9) or formal usability testing (4). Three high-level themes were identified, which form the basis of healthcare provider opinions of clinical prediction rules and their implementation - utility, credibility and usability. CONCLUSIONS Some of the objections and preferences stated by healthcare providers are inherent to the nature of the clinical problem addressed, which may or may not be within the designer's capacity to change; however, others (in particular - actionability, validation, integration and provision of high quality education materials) should be considered by prediction rule designers and implementation teams, in order to increase user acceptance and improve uptake of these tools. We summarise these findings across the clinical prediction rule lifecycle and pose questions for the rule developers, in order to produce tools that are more likely to successfully translate into clinical practice.
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Affiliation(s)
- Georgina Kennedy
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney 2113, Australia.
| | - Blanca Gallego
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney 2113, Australia
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11
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Scarbecz M, DeSchepper EJ. Trends in First-Year Dental Students' Information Technology Knowledge and Use: Results from a U.S. Dental School in 2009, 2012, and 2017. J Dent Educ 2018; 82:1287-1295. [PMID: 30504466 DOI: 10.21815/jde.018.135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/17/2018] [Indexed: 11/20/2022]
Abstract
Dental students must be skilled in the use and application of information technology (IT), but there are few studies of IT use and knowledge among U.S. dental students. The aim of this study was to retrospectively analyze survey data regarding IT use and knowledge collected from first-year dental students at one U.S. dental school in 2009, 2012, and 2017. Data were collected from an anonymous survey of these students as part of a D1 course called Informatics and Evaluation of Dental Literature. All students participated in the survey each year, for a response rate of 100%. Annual numbers of participants were 80 (2009), 90 (2012), and 97 (2017), for a total 267 respondents. The students reported that they frequently accessed Internet resources multiple times per day and that frequency of use had increased over time, principally from access via smartphones. These students reported feeling comfortable with higher education IT applications such as learning management systems and computerized testing. However, despite their frequent IT use, the students reported low levels of knowledge about IT security, and the three years of survey data showed that IT security knowledge had declined over time. These findings have implications for dental educators, including the need for methods for training students to protect their personal data and that of their patients.
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Affiliation(s)
- Mark Scarbecz
- Mark Scarbecz, MA, PhD, is Professor and Associate Dean for Institutional Affairs, College of Dentistry, University of Tennessee Health Science Center; Edward J. DeSchepper, MAEd, DDS, MS, is Professor and Associate Dean for Academic Affairs, College of Dentistry, University of Tennessee Health Science Center.
| | - Edward J DeSchepper
- Mark Scarbecz, MA, PhD, is Professor and Associate Dean for Institutional Affairs, College of Dentistry, University of Tennessee Health Science Center; Edward J. DeSchepper, MAEd, DDS, MS, is Professor and Associate Dean for Academic Affairs, College of Dentistry, University of Tennessee Health Science Center
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12
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Thyvalikakath T, Song M, Schleyer T. Perceptions and attitudes toward performing risk assessment for periodontal disease: a focus group exploration. BMC Oral Health 2018; 18:90. [PMID: 29783966 PMCID: PMC5963023 DOI: 10.1186/s12903-018-0550-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 05/10/2018] [Indexed: 11/21/2022] Open
Abstract
Background Currently, many risk assessment tools are available for clinicians to assess a patient’s periodontal disease risk. Numerous studies demonstrate the potential of these tools to promote preventive management and reduce morbidity due to periodontal disease. Despite these promising results, solo and small group dental practices, where most people receive care, have not adopted risk assessment tools widely, primarily due to lack of studies in these settings. The objective of this study was to explore the knowledge, attitudes, and beliefs of dental providers in these settings toward risk-based care through focus groups. Methods We conducted six focus group sessions with 52 dentists and dental hygienists practicing in solo and small group practices in Pittsburgh, PA and New York City (NYC), NY. An experienced moderator and a note-taker conducted the six sessions, each including 8–10 participants and lasting approximately 90 min. All sessions were audio-recorded and transcribed verbatim. Two researchers coded the focus group transcripts. Using a thematic analysis approach, they reviewed the coding results to identify important themes and selected representative excerpts that best described each theme. Results Providers strongly believed identifying risk factors could predict periodontal disease and use this information to change their patients’ behavior. A successful risk assessment tool could assist them in educating and changing their patient’s behaviors to adopt a healthy lifestyle, thus enabling them to play a major role in their patients’ overall health. However, to achieve this goal, it is essential to educate all dental providers and not just dentists on performing risk assessment and translating the results into actionable recommendations for patients. According to study participants, the research community has focused more on translating research findings into a risk assessment tool, and less on how clinicians would use these tools during patient encounters and if it affects a patients’ risk or outcome. Conclusions Dental practitioners were open to performing risk assessment as routine care and playing a bigger role in their patients’ overall health. Recommendations to overcome major barriers included educating dental providers at all levels, conducting more research about their adoption and use in real-world settings and developing appropriate reimbursement models. Electronic supplementary material The online version of this article (10.1186/s12903-018-0550-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thankam Thyvalikakath
- Dental Informatics Core, Department of Cariology, Operative Dentistry & Dental Public Health, Indiana University School of Dentistry, Research Scientist, Center for Biomedical Informatics, Regenstrief Institute, Inc, 1050 Wishard Boulevard, R2206, Indianapolis, IN, 46202, USA.
| | - Mei Song
- Microbicide Trials Network, Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
| | - Titus Schleyer
- Center for Biomedical Informatics, Regenstrief Institute, Inc. Indiana University School of Medicine, 1101 West Tenth Street, Indianapolis, IN, 46202, USA
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13
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Machado JP, Lam XT, Chen JW. Use of a clinical decision support tool for the management of traumatic dental injuries in the primary dentition by novice and expert clinicians. Dent Traumatol 2018; 34:120-128. [DOI: 10.1111/edt.12390] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Jessica P. Machado
- Department of Pediatric Dentistry; Loma Linda University School of Dentistry; Loma Linda CA USA
| | - Xuan T. Lam
- Department of Pediatric Dentistry; Loma Linda University School of Dentistry; Loma Linda CA USA
| | - Jung-Wei Chen
- Program Director of Advanced Education in Pediatric Dentistry, Department of Pediatric Dentistry; Loma Linda University School of Dentistry; Loma Linda CA USA
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14
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van der Zande MM, Gorter RC, Bruers JJM, Aartman IHA, Wismeijer D. Dentists' opinions on using digital technologies in dental practice. Community Dent Oral Epidemiol 2017; 46:143-153. [PMID: 28983942 DOI: 10.1111/cdoe.12345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 07/24/2017] [Accepted: 09/05/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate which opinions among dentists are associated with level of technology use, when characteristics of the dentist and dental practice, as well as motivating work aspects are taken into account. METHODS A total of 1000 general dental practitioners in the Netherlands received a questionnaire on digital technologies they use, opinions on using technologies and related motivating work aspects. Questions were derived from expert interviews, the Dentists' Experienced Job Resources Scale and literature on technology implementation. Technology use was measured as the number of technologies used, and divided into three technology user groups: low (using 0-4 technologies, mostly administrative and radiographic technologies), intermediate (using 5-7, more varied technologies) and high technology users (using 8-12, including more innovative diagnostic technologies). Opinions on technology use and motivating work aspects were analysed using principal components analysis (PCA) and exploratory factor analysis. Scores on all components and factors were calculated for each respondent by computing the mean of all valid responses on the underlying items. Differences in these scale scores on opinions among the technology user groups were assessed using one-way analysis of variance and Kruskal-Wallis tests. A multiple linear regression analysis assessed the association of scale scores about opinions on technology use with the sum of technologies used, taking into account motivating work aspects and characteristics of the dentist and dental practice. RESULTS The response rate was 31%. Dentists who were high technology users perceived technologies as yielding more improvements in quality of care, adding more value to the dental practice and being easier to use, than low technology users. High technology users thought technologies added more value to their work and they reported higher skills and resources. They also focused more on technologies and thought these are more ready to use than low technology users. High technology users derived more motivation from "Immediate results" and "Craftsmanship" than low technology users. Personal and practice characteristics, motivating work aspects, and the opinion scales "Focus" and "Added value to dentist" explained 50% of the variance in the number of technologies a dentist uses. CONCLUSION Opinions on digital technologies among dentists and motivating work aspects vary with level of technology use. Being more focused on technologies and perceiving a higher added value from using them are associated with using more digital dental technologies, when taking into account motivating work aspects and characteristics of the dentist and dental practice.
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Affiliation(s)
- Marieke M van der Zande
- Department of Oral Implantology and Prosthetic Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands.,Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Ronald C Gorter
- Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Josef J M Bruers
- Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands.,Royal Dutch Dental Association (KNMT), Nieuwegein, The Netherlands
| | - Irene H A Aartman
- Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Daniel Wismeijer
- Department of Oral Implantology and Prosthetic Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
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15
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Tan EM, Nagpal A, DeSimone DC, Anderson B, Linderbaum J, De Ziel T, Li Z, Sohail MR, Cha YM, Loomis E, Espinosa R, Friedman PA, Greason K, Schiller H, Virk A, Wilson WR, Steckelberg JM, Baddour LM. Impacts of a care process model and inpatient electrophysiology service on cardiovascular implantable electronic device infections: a preliminary evaluation. J Interv Card Electrophysiol 2017; 50:117-124. [PMID: 28844107 DOI: 10.1007/s10840-017-0282-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/10/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Cardiovascular implantable electronic device infection (CIEDI) rates are rising. To improve outcomes, our institution developed an online care process model (CPM) and a specialized inpatient heart rhythm service (HRS). METHODS This retrospective review compared hospital length of stay (LOS), mortality, and times to subspecialty consultation and procedures before and after CPM and HRS availability. RESULTS CPM use was associated with shortened time to surgical consultation (median 2 days post-CPM vs. 3 days pre-CPM, p = 0.0152), pocket closure (median 4 vs. 5 days, p < 0.0001), and days to new CIED implant (median 7 vs. 8 days, p = 0.0126). Post-HRS patients were more likely to have a surgical consultation (OR 7.01, 95% CI 1.56-31.5, p = 0.011) and shortened time to pocket closure (coefficient - 2.21 days, 95% CI - 3.33 to - 1.09, p < 0.001), compared to pre-HRS. CONCLUSIONS The CPM and HRS were associated with favorable outcomes, but further integration of CPM features into hospital workflow is needed.
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Affiliation(s)
- Eugene M Tan
- Division of Infectious Diseases, Mayo Clinic, 200 First St S.W., Rochester, MN, 55905, USA.
| | - Avish Nagpal
- Infectious Diseases, Sanford Health, Fargo, ND, USA
| | - Daniel C DeSimone
- Division of Infectious Diseases, Mayo Clinic, 200 First St S.W., Rochester, MN, 55905, USA
| | - Brenda Anderson
- Anesthesia Clinical Research Unit, Mayo Clinic, Rochester, MN, USA
| | | | - Thomas De Ziel
- Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Zhuo Li
- Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Muhammad R Sohail
- Division of Infectious Diseases, Mayo Clinic, 200 First St S.W., Rochester, MN, 55905, USA
| | - Yong-Mei Cha
- Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Erica Loomis
- Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, MN, USA
| | - Raul Espinosa
- Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | | | - Kevin Greason
- Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Henry Schiller
- Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, MN, USA
| | - Abinash Virk
- Division of Infectious Diseases, Mayo Clinic, 200 First St S.W., Rochester, MN, 55905, USA
| | - Walter R Wilson
- Division of Infectious Diseases, Mayo Clinic, 200 First St S.W., Rochester, MN, 55905, USA
| | - James M Steckelberg
- Division of Infectious Diseases, Mayo Clinic, 200 First St S.W., Rochester, MN, 55905, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic, 200 First St S.W., Rochester, MN, 55905, USA
- Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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16
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Clinician attitudes, skills, motivations and experience following the implementation of clinical decision support tools in a large dental practice. J Evid Based Dent Pract 2016; 17:1-12. [PMID: 28259309 DOI: 10.1016/j.jebdp.2016.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study assesses dental clinicians' pre- and post-implementation attitudes, skills, and experiences with three clinical decision support (CDS) tools built into the electronic health record (EHR) of a multi-specialty group dental practice. METHODS Electronic surveys designed to examine factors for acceptance of EHR-based CDS tools including caries management by risk assessment (CAMBRA), periodontal disease management by risk assessment (PEMBRA) and a risk assessment-based Proactive Dental Care Plan (PDCP) were distributed to all Willamette Dental Group employees at 2 time points; 3 months pre-implementation (Fall 2013) and 15 months after implementation (winter 2015). The surveys collected demographics, measures of job experience and satisfaction, and attitudes toward each CDS tool. The baseline survey response rate among clinicians was 83.1% (n = 567) and follow-up survey response rate was 63.2% (n = 508). Among the 344 clinicians who responded to both before and after surveys, 27% were general and specialist dentists, 32% were dental hygienists, and 41% were dental assistants. RESULTS Adherence to the CDS tools has been sustained at 98%+ since roll-out. Between baseline and follow-up, the change in mean attitude scores regarding CAMBRA reflect statistically significant improvement in formal training, knowing how to use the tools, belief in the science supporting the tools, and the usefulness of the tool to motivate patients. For PEMBRA, statistically significant improvement was found in formal training, knowing how to use the tools, belief in the science supporting the tools, with improvement also found in belief that the format and process worked well. Finally, for the PDCP, significant and positive changes were seen for every attitude and skill item scored. A strong and positive correlation with post-implementation attitudes was found with positive experiences in the work environment, whereas a negative correlation was found with workload and stress. Clinicians highly ranked a commitment to evidence-based care and sense that the tools were helping to improve patient care, health, and experience as motivations to use the tools. Peer pressure, fears about malpractice, and incentive pay were rated the lowest among the motivation factors. CONCLUSION This study shows that CDS tools built into the EHR can be successfully implemented in a dental practice and widely accepted by the entire clinical team. Achieving a high level of adherence to use of CDS can be done through adequate training, alignment with the mission and purpose of the organization, and is compatible with an improved work environment and clinician satisfaction.
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Mullins JM, Even JB, White JM. Periodontal Management by Risk Assessment: A Pragmatic Approach. J Evid Based Dent Pract 2016; 16 Suppl:91-8. [PMID: 27237001 DOI: 10.1016/j.jebdp.2016.01.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED An evidence-based periodontal disease risk assessment and diagnosis system has been developed and combined with a clinical decision support and management program to improve treatment and measure patient outcomes. BACKGROUND There is little agreement on a universally accepted periodontal risk assessment, periodontal diagnosis, and treatment management tool and their incorporation into dental practice to improve patient care. This article highlights the development and use of a practical periodontal management and risk assessment program that can be implemented in dental settings. METHODS The approach taken by Willamette Dental Group to develop a periodontal disease risk assessment, periodontal diagnosis, and treatment management tool is described using evidence-based best practices. With goals of standardized treatment interventions while maintaining personalized care and improved communication, this process is described to facilitate its incorporation into other dental settings. CONCLUSIONS Current electronic health records can be leveraged to enhance patient-centered care through the use of risk assessments and standardized guidelines to more effectively assess, diagnose, and treat patients to improve outcomes. Dental hygienists, and other committed providers, with their emphasis on prevention of periodontal disease can be principal drivers in creation and implementation of periodontal risk assessments and personalized treatment planning. Willamette Dental Group believes that such evidence-based tools can advance dentistry to new diagnostic and treatment standards.
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Affiliation(s)
- Joanna M Mullins
- RDH, BSDH, MHI(c), Willamette Dental Group, P.C., Hillsboro, OR, USA.
| | - Joshua B Even
- DMD, Willamette Dental Group, P.C., Hillsboro, OR, USA
| | - Joel M White
- DDS, MS, School of Dentistry, University of California, San Francisco, CA, USA
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18
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Simmons K, Gibson S, White JM. Drivers Advancing Oral Health in a Large Group Dental Practice Organization. J Evid Based Dent Pract 2016; 16 Suppl:104-12. [PMID: 27237003 DOI: 10.1016/j.jebdp.2016.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
UNLABELLED Three change drivers are being implemented to high standards of patient centric and evidence-based oral health care within the context of a large multispecialty dental group practice organization based on the commitment of the dental hygienist chief operating officer and her team. BACKGROUND AND PURPOSE A recent environmental scan elucidated 6 change drivers that can impact the provision of oral health care. Practitioners who can embrace and maximize aspects of these change drivers will move dentistry forward and create future opportunities. This article explains how 3 of these change drivers are being applied in a privately held, accountable risk-bearing entity that provides individualized treatment programs for more than 417,000 members. To facilitate integration of the conceptual changes related to the drivers, a multi-institutional, multidisciplinary, highly functioning collaborative work group was formed. METHODS AND APPROACH The document Dental Hygiene at a Crossroads for Change(1) inspired the first author, a dental hygienist in a unique position as chief operating officer of a large group practice, to pursue evidence-based organizational change and to impact the quality of patient care. This was accomplished by implementing technological advances including dental diagnosis terminology in the electronic health record, clinical decision support, standardized treatment guidelines, quality metrics, and patient engagement to improve oral health outcomes at the patient and population levels. The systems and processes used to implement 3 change drivers into a large multi-practice dental setting is presented to inform and inspire others to implement change drivers with the potential for advancing oral health. CONCLUSIONS Technology implementing best practices and improving patient engagement are excellent drivers to advance oral health and are an effective use of oral health care dollars. Improved oral health can be leveraged through technological advances to improve clinical practice.
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Affiliation(s)
| | | | - Joel M White
- DDS, MS, School of Dentistry, University of California, San Francisco, San Francisco, CA, USA
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