Tracking oral health in a standardized, evidence-based, prevention-focused dental care system.
Tracking oral health in a standardized, evidence-based, prevention-focused dental care system.
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DOI：
10.1111/jphd.12413
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发表时间：
2020-09
影响因子：
2.3
通讯作者：
Mertz EA
中科院分区：
文献类型：
--
作者：
White JM;Brandon RG;Mullins JM;Simmons KL;Kottek AM;Mertz EA
学习医疗保健系统是衡量和实现口腔保健价值的基础。本文介绍了预防性牙科保健计划的组成部分和护理质量在一个大型牙科责任保健组织。一项回顾性研究设计描述并评估了2014-2019年间从电子健康记录（EHR）中提取的护理过程（EHR）、护理适当性（AoC）和护理结果（OoC）的横截面指标。年度和综合指标来自基于EHR的临床决策支持，用于风险确定、诊断和治疗术语以及DMFT指标。每年，253，515 ± 27，850例患者接受了618，084 ± 80，559次访视、209，366 ± 22，300次检查和2，072，844 ± 300，363次临床手术。评估指标包括提供者在完成龋齿风险评估方面的依从性（98.3%）和患者接受积极的牙科护理计划（96.9%）。AOC指标包括根据基于风险的方案接受预防的患者。接受氟保护漆的患者患龋风险的百分比为95.4 ± 0.4%。OoC指标包括未处理的衰变和新衰变。6年未治疗龋坏的平均患病率为11.3 ± 0.3%，新发龋坏的平均发病率为13.6 ± 0.5%，随风险水平的增加而增加：低= 7.5%，中= 18.8%，高=29.4%，极= 28.1%。预防性牙科保健系统表现出良好的提供者遵守循证预防协议，与国家估计相比，患者风险的牙科结果明显更好。这些成就是通过以价值为中心的负责任的护理模式实现的，并通过与绩效衡量标准相一致的薪酬模式进行激励。
Learning healthcare systems are foundational for measuring and achieving value in oral health care. This paper describes the components of a preventive dental care program and the quality of care in a large dental accountable care organization. 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 2014–2019. Annual and composite measures are derived from EHR-based clinical decision support for risk determination, diagnostic and treatment terminology, and DMFT measures. 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%) in completing caries risk assessments and patient receipt (96.9%) 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%. OoC metrics included untreated decay and new decay. The 6-year average prevalence of untreated decay was 11.3 ± 0.3%, and average incidence of new decay was 13.6 ± 0.5%, increasing with risk level: low=7.5%, medium=18.8%, high=29.4% and extreme=28.1%. 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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