Performance of a quality assurance program for assessing dental health in methamphetamine users
Performance of a quality assurance program for assessing dental health in methamphetamine users
复制标题
DOI：
10.1186/s12903-015-0057-z
复制
发表时间：
2015-07-05
期刊：
影响因子：
2.9
通讯作者：
Shetty, Vivek
中科院分区：
文献类型：
--
作者：
Dye, Bruce A.;Harrell, Lauren;Shetty, Vivek
背景：对甲基苯丙胺（MA）滥用的牙齿后果进行系统的表征，以严格的质量保证（QA）计划为前提，以确保所收集数据的可信度以及临床研究的科学完整性和有效性。在本报告中，我们描述并评估了质量保证计划的性能，该计划是在使用MA的牙科后果的大型横断面研究中实施的。方法：在2011- 2013年的30个月期间，招募了大量MA使用者的社区样本，并由洛杉矶两家大型社区卫生中心的现场检查员进行了全面的口腔检查和心理社会评估。使用国家健康和营养检查调查（NHANES）的口腔健康评估方案来描述牙病。使用NHANES口腔健康质量保证指南，计算审查员信度统计（如Cohen’s Kappa系数和类间相关系数），以评估现场审查员和参考审查员之间的一致性程度，以确保与NHANES实践的一致性和可比性。结果：574名MA使用者中约9% （n = 49）接受了参考审查员进行的重复龋齿和牙周检查。参考检举人与现场检举人对未治疗牙病的识别有较高的一致性（Kappa统计值：0.57 ~ 0.75，一致性83% ~ 88%）。对于前牙至少5个表面未经治疗的龋病的鉴定，Kappas在0.77 ~ 0.87之间，一致性在94% ~ 97%之间。在所有评估的牙周部位，附着丧失的分类内系数（ICCs）范围为0.87至89，袋深的ICCs范围为0.79至0.81。对于整体牙龈衰退，ICCs范围为0.88至0.91。当根据CDC/AAP对严重牙周炎的病例定义计算Kappa时，现场检验员的检查者之间的可靠性很低（Kappa 0.27-0.67）。结论：总体而言，质量保证计划确认了ma使用者中龋病和牙周病分布数据的质量符合程序要求。检查人员对龋齿的一致性较高，但对特定牙周评估的一致性较低。
Background: Systematic characterization of the dental consequences of methamphetamine (MA) abuse presupposes a rigorous quality assurance (QA) program to ensure the credibility of the data collected and the scientific integrity and validity of the clinical study. In this report we describe and evaluate the performance of a quality assurance program implemented in a large cross-sectional study of the dental consequences of MA use.Methods: A large community sample of MA users was recruited over a 30 month period during 2011-13 and received comprehensive oral examinations and psychosocial assessments by site examiners based at two large community health centers in Los Angeles. National Health and Nutrition Examination Survey (NHANES) protocols for oral health assessments were utilized to characterize dental disease. Using NHANES oral health quality assurance guidelines, examiner reliability statistics such as Cohen's Kappa coefficients and inter-class correlation coefficients were calculated to assess the magnitude of agreement between the site examiners and a reference examiner to ensure conformance and comparability with NHANES practices.Results: Approximately 9 % (n = 49) of the enrolled 574 MA users received a repeat dental caries and periodontal examination conducted by the reference examiner. There was high concordance between the reference examiner and the site examiners for identification of untreated dental disease (Kappa statistic values: 0.57-0.75, percent agreement 83-88 %). For identification of untreated caries on at least 5 surfaces of anterior teeth, the Kappas ranged from 0.77 to 0.87, and percent agreement from 94 to 97 %. The intra-class coefficients (ICCs) ranged from 0.87 to 89 for attachment loss across all periodontal sites assessed and the ICCs ranged from 0.79 to 0.81 for pocket depth. For overall gingival recession, the ICCs ranged from 0.88 to 0.91. When Kappa was calculated based on the CDC/AAP case definitions for severe periodontitis, inter-examiner reliability for site examiners was low (Kappa 0.27-0.67).Conclusion: Overall, the quality assurance program confirmed the procedural adherence of the quality of the data collected on the distribution of dental caries and periodontal disease in MA-users. Examiner concordance was higher for dental caries but lower for specific periodontal assessments.