A whole systems approach to implementing standardized dental diagnostic terms

描述(申请人提供)：虽然医学长期以来一直使用标准化术语(即ICD 9)来记录诊断，但牙科还没有一套广泛使用的、可用的标准化牙科诊断术语。2009年，21所使用相同EHR软件系统的牙科学校开发了名为EZcode的标准化牙科诊断术语，该术语最近被确认为R01奖(1R01DE021051)的一部分。EZ代码目前在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100多万人次的就诊中使用这一术语。EZ代码的全部承诺只有在学术牙科诊所的“实验室”之外使用时才能实现。因此，在拟议的工作中，我们将在拥有54个办公室的威拉米特牙科集团(WDG)内实施EZ代码。目标：这项工作的目标是开发一种经过测试的、可推广的流程，以有效地实施EZ代码。我们将创建实施工具包(EZ-IT)，确定EZ-IT对牙科提供者态度的影响，以及以诊断为导向的牙医文化 组织，并确定计划对使用率和诊断术语的有效输入的影响。具体目标：(1)我们将开发用于实施牙科诊断术语的EZ-IT。(2)我们将确定程序对诊断术语周围的内部语境(“文化”)的影响。(3)我们将确定该程序对有效输入诊断术语的影响。设计和方法：由哈佛大学牙科医学院领导，在领域专家的协助下，这项工作将在WDG实施。我们将在实验室测试、WDG实施中的评估和工作组审查后，反复开发EZ-IT以其传播形式。接下来，我们将传播EZ-IT。在实施EZ-IT之前、期间和之后，我们将通过调查和访谈来评估EZ-IT代码对文化的影响。最后，将分析指定研究期间的所有患者就诊以及相关的诊断和治疗数据。将计算总体利用率的描述性统计数据，然后计算每个诊断类别内的数据。将通过评估EZ代码-治疗代码(CDT)对的有效性来执行诊断术语条目的验证。

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.