Implementing Dental Quality Measures in Practice

在实践中落实牙科质量措施 项目摘要 在美国，每年有超过19.5万名在职牙医为超过1.27亿名患者提供护理， 每年耗资超过1170亿美元。尽管国家在口腔健康方面进行了投资，但几乎没有 从质量的角度理解回报。尽管有强有力的证据表明有效的战略 在治疗和预防龋齿方面，口腔健康仍然是儿童和成年人的重大负担。我们是 目前面临着一个不均衡的口腔医疗保健提供系统，少数幸运的患者获得了证据- 以人为本、以人为本的关怀。我们目前的质量测量工作已经表明，我们可以使用数据 在电子健康记录中捕获，以准确衡量牙齿护理的质量。我们还有 表明牙科诊所的当前状态与预期之间存在很大差距 性能，特别是对于龋齿。在我们目前的奖项(R01DE024166)中，我们发现一个很大的 有44%-77%的患者没有因现有的龋齿而接受治疗。即使在接受治疗的时候， 13%到24%的现有患者在最后一次患病后的6个月内再次被诊断为新的龋齿 治疗。 我们的首要目标是在正确的时间为正确的患者提供正确的护理。为了做到这一点， 我们首先需要建立一个由有效的信息学支持的实践级学习健康系统(LHS) 基础设施、相关数据治理和推动循证牙科实践的学习文化。 因此，作为我们研究议程的下一步，该应用程序的目标是改善牙齿护理 与龋齿管理策略有关的质量，影响最大的口腔健康状况，由 发展多成分干预，包括LHS的关键组成部分。 我们将在四个不同的大型牙科机构进行这项研究：德克萨斯大学休斯顿分校，休斯顿大学 加州旧金山、HealthPartners和Willamette Dental Group/Skourtes Institute。在目标1中，我们确定 了解导致当前绩效水平的促成因素(进行问题分析) 通过图表审查、患者和提供者访谈以及有针对性的临床观察。在目标2中，我们设计了 并制定战略，以提高机构的龋齿管理质量，使用人类- 以设计为中心的有效和可操作的审计和反馈以及基于电子病历的临床 决策支持。在目标3中，我们实施和评估改进策略，并确定其影响 在质量方面，衡量绩效、可接受性和忠诚度，并确定使用它的障碍和促进者。早些时候 关键利益相关者在项目所有阶段的持续参与将增加以下可能性 制定、实施和采用可持续的解决方案。 我们的研究结果将为牙科提供者提供知识和诀窍 衡量和改善龋齿管理的质量，从而改善口腔健康，并随后 更好的整体健康，为我们的病人。

Implementing Dental Quality Measures in Practice Project Summary Each year in the US, over 195,000 active dental practitioners provide care to more than 127 million patients, costing more than $117 billion annually. Despite this national investment in oral health, there is little understanding of the return in terms of quality. Although there is strong evidence for effective strategies for treating and preventing caries, oral health remains a significant burden for both children and adults. We are currently faced with an uneven oral healthcare delivery system where a few lucky patients receive evidence- based and person-centered care. Our current quality measurement work has shown that we can use data captured in electronic health records to accurately measure the quality of dental care. We have also demonstrated that there is a large gap between the current state of how dental clinics perform and the desired performance, especially for dental caries. In our current award (R01DE024166), we discovered that a large proportion of patients (44%-77%) were not being treated for their existing dental caries. Even when treated, 13% to 24% of existing patients were being diagnosed again with new decay within 6 months of their last treatment. Our overarching goal is to provide the right care to the right patient at the right time. In order to do this, we first need to setup a practice-level learning health system (LHS) supported by an effective informatics infrastructure, relevant data governance and a culture of learning that drives evidence-based dental practice. Hence as the next step in our research agenda, the objective of this application is to improve dental care quality relating to caries management strategies, the oral health condition with the highest impact, by developing a multi-component intervention, that includes key components of an LHS. We will conduct the study at four large and diverse dental institutions: UT Houston, the University of California San Francisco, HealthPartners and Willamette Dental Group/Skourtes Institute. In Aim 1, we identify and understand the contributing factors (conduct problem analysis) leading to the current level of performance through chart reviews, patient and provider interviews, and targeted clinic observations. In Aim 2, we design and develop strategies to improve the quality of dental caries management at the institutions, using a human- centered design approach for developing effective and actionable Audit and Feedback and EHR-based Clinical Decision Support. In Aim 3, we implement and evaluate the improvement strategies and determine their impact on quality measure performance, acceptability, fidelity and identify the barriers and facilitators for its use. Early and continuous engagement of key stakeholders in all phases of the project will increase the likelihood of developing, implementing and adopting sustainable solutions. The outcomes of our research will arm dental providers with both the knowledge and know-how to measure and improve the quality of dental caries management resulting in better oral health, and subsequently better general health, for our patients.