1
|
Fernandes JDL, Perazzo MF, Paiva SM, Martins-Júnior PA, Macari S. Orthodontic treatment during pregnancy, lactation, and postmenopausal period: a questionnaire development. Braz Oral Res 2024; 38:e013. [PMID: 38198311 DOI: 10.1590/1807-3107bor-2024.vol38.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 02/13/2023] [Indexed: 01/12/2024] Open
Abstract
This study aimed to develop and validate a self-administered questionnaire in Brazilian Portuguese to verify the level of knowledge of orthodontists in the care of pregnant, lactating, and postmenopausal women, named "Considerations on Orthodontic Treatment during Pregnancy, Lactation, and Postmenopausal Periods." The development and validation of the questionnaire consisted of the following steps: a) item generation; b) item reduction; c) questionnaire design; and d) validity and reliability tests in a cross-sectional study with 258 orthodontists working in the field from different Brazilian states. A total of 60 orthodontists participated in test-retest over a mean period of 45 days. The preliminary questionnaire consisted of a total of 60 questions. After item reduction, 40 questions were selected for the final version of the questionnaire, with eight questions about pregnant women; six about lactating women; 18 about postmenopausal women, and eight about general knowledge in dentistry. Each item had three response options in the Likert scale format. Face and content validity analysis, reliability assessment through internal consistency (Cronbach's alpha and McDonald's omega), and test-retest reliability through the intraclass correlation coefficient (ICC) and Spearman's correlation coefficient were performed. Face and content validity indicated that the questionnaire was considered valid, objective, and easily understandable. The questionnaire had good internal consistency (Cronbach's alpha = 0.77; McDonald's omega = 0.78) and good test-retest reliability (ICC = 0.71; Spearman's correlation coefficient = 0.51). The questionnaire was considered valid and reliable to assess the level of knowledge of orthodontists in the care of pregnant, lactating, and postmenopausal women.
Collapse
Affiliation(s)
- Juliana de Lourdes Fernandes
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Restorative Dentistry, Belo Horizonte, MG, Brazil
| | - Matheus França Perazzo
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Health of Children and Adolescents, Belo Horizonte, MG, Brazil
| | - Saul Martins Paiva
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Health of Children and Adolescents, Belo Horizonte, MG, Brazil
| | - Paulo Antônio Martins-Júnior
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Health of Children and Adolescents, Belo Horizonte, MG, Brazil
| | - Soraia Macari
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Restorative Dentistry, Belo Horizonte, MG, Brazil
| |
Collapse
|
2
|
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] [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.
Collapse
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
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
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] [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.
Collapse
|