A whole systems approach to implementing standardized dental diagnostic terms

描述（由申请人提供）：虽然医学长期使用标准化术语（即ICD 9）来记录诊断，但牙科尚未享有广泛使用的标准化牙科诊断术语集的存在。2009年，21所使用相同EHR软件系统的牙科学校开发了一种标准化的牙科诊断术语，称为EZcodes，该术语最近被验证为R01奖（1R01DE021051）的一部分。EZcodes目前在14所牙科学校实施，因此，每年有超过3100名牙科学术提供者在超过100万名患者就诊时使用该术语。只有当EZcodes在学术牙科诊所的“实验室”之外使用时，它们的全部承诺才会实现。因此，在拟议的工作中，我们将在拥有54个办事处的威拉米特牙科集团（WDG）中实施EZcodes。目的：本工作的目的是开发一个可测试的，可推广的过程，有效地实施EZcodes。我们将创建一个实施工具包（EZ-IT），确定EZ-IT对牙科提供者态度的影响，以及美国文化的诊断导向

DESCRIPTION (provided by applicant): While medicine has long made use of standardized terminologies (i.e. ICD 9,), to record diagnoses, dentistry has not enjoyed the presence of a widely used, available set of standardized dental diagnostic terms. In 2009, 21 dental schools that all use the same EHR software system, developed a standardized dental diagnostic terminology called EZcodes, which was recently validated as part of an R01 award (1R01DE021051). The EZcodes are currently implemented in 14 dental schools and as such, more than 3,100 dental academic providers use this terminology during more than 1 million patient visits annually. The full promise of the EZcodes will only be realized if they are in use beyond the "laboratory" of the academic dental clinics. Thus, in the proposed work, we will implement the EZcodes within the 54-office Willamette Dental Group (WDG). OBJECTIVE: The objective of this work is to develop a tested, generalizable process for effectively implementing the EZcodes. We will create an Implementation Toolkit (EZ-IT), determine the impact of the EZ-IT on the attitudes of dental providers, as well as the diagnosis-orientation of the culture of the organization, and determine the impact of the program on utilization rates and valid entry of diagnostic terms. SPECIFIC AIMS: (1) We will develop the EZ-IT for implementing dental diagnostic terms. (2) We will determine the impact of the program on inner context ("culture") surrounding diagnostic terms. (3) We will determine the impact of the program on valid entry of diagnostic terms. DESIGN AND METHODS: Headed by the Harvard School of Dental Medicine, and aided by domain experts, the effort will be implemented at WDG. We will iteratively develop the EZ-IT to its dissemination form following laboratory testing, assessment within an implementation at WDG and workgroup review. Next, we will disseminate the EZ-IT. Before, during and after the implementation of the EZ-IT we will assess the impact of the EZcodes on the culture through the use of surveys and interviews. Lastly, all patient visits and associated diagnosis and treatment data for the specified study period will be analyzed. Descriptive statistics of the overall utilization and then within each category of diagnosis will be computed. The validation of the diagnostic term entry will be performed by assessing the validity of EZcodes-treatment code (CDT) pairs.