Implementing Dental Quality Measures in Practice

在实践中实施牙科质量措施

• 批准号: 10469566
• 负责人: Elsbeth Kalenderian
• 金额: $ 71.58万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-03-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10469566
• 关键词: Academic Medical Centers; Adopted; Adult; Award; California; Caring; Child; Clinic; Data; Data Scientist; Dental; Dental Care; Dental Clinics; Dental General Practice; Dental caries; Dentistry; Dentists; Diagnosis; Effectiveness; Electronic Health Record; Elements; Engineering; Epidemiologist; Feedback; Future; Goals; Group Practice; Health; Health Sciences; Health system; Healthcare; Human; Informatics; Institutes; Institution; Intervention; Interview; Investments; Knowledge; Learning; Measurement; Measures; Oral; Oral health; Outcome; Patient Rights; Patient-Focused Outcomes; Patients; Performance; Phase; Provider; Publications; Quality of Care; Research; San Francisco; Science; Site; Specialist; Support System; System; Texas; Time; Universities; Work; arm; base; clinical decision support; conduct problem; cost; dashboard; design; efficacy study; evidence base; health care delivery; human centered design; improved; informatics infrastructure; insight; multi-component intervention; multidisciplinary; patient safety; person centered; prevent; sealant

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.

在实践中实施牙科质量措施 项目概要 在美国，每年有超过 195,000 名活跃的牙科医生为超过 1.27 亿患者提供护理， 每年花费超过 1170 亿美元。尽管国家在口腔健康方面进行了如此多的投资，但仍然很少 对质量回报的理解。尽管有强有力的证据表明有效的策略 治疗和预防龋齿，口腔健康仍然是儿童和成人的重大负担。我们是 目前面临着不平衡的口腔医疗保健服务系统，一些幸运的患者收到了证据- 以人为本的护理。我们当前的质量测量工作表明我们可以使用数据 电子健康记录中捕获的数据可以准确衡量牙科护理的质量。我们还有 表明牙科诊所的现状与期望之间存在很大差距 性能，特别是对于龋齿。在我们当前的奖项（R01DE024166）中，我们发现一个大的 部分患者（44%-77%）没有因现有的龋齿而接受治疗。即使接受治疗， 13% 至 24% 的现有患者在上次治疗后 6 个月内再次被诊断出患有新的腐烂 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。为此， 我们首先需要建立一个由有效信息学支持的实践水平学习健康系统（LHS） 基础设施、相关数据治理以及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科护理 与龋齿管理策略相关的质量，影响最大的口腔健康状况， 制定多成分干预措施，其中包括 LHS 的关键组成部分。 我们将在四家大型且多元化的牙科机构进行这项研究： UT 休斯顿大学、 加利福尼亚州旧金山、HealthPartners 和 Willamette Dental Group/Skourtes Institute。在目标 1 中，我们确定 并了解导致当前绩效水平的影响因素（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 制定战略，利用人力 以开发有效且可操作的审计和反馈以及基于 EHR 的临床为中心的设计方法 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 质量衡量绩效、可接受性、保真度，并确定其使用的障碍和促进因素。早期的 关键利益相关者持续参与项目的各个阶段将增加实现目标的可能性 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服务提供者提供知识和技能 衡量和提高龋齿管理的质量，从而改善口腔健康，随后 为了我们的患者更好的整体健康。