Herndon Jill Boylston, Tomar Scott L, Catalanotto Frank A, Rudner Nancy, Huang I-Chan, Aravamudhan Krishna, Shenkman Elizabeth A, Crall James J
J Am Dent Assoc. 2015 Aug;146(8):581-591. doi: 10.1016/j.adaj.2015.03.017.
The authors conducted a study to validate the following 3 evidence-based, process-of-care quality measures focused on dental caries prevention for children with an elevated risk of experiencing caries: sealants for 6- to 9-year-olds, sealants for 10- to 14-year-olds, and topical fluoride.
Using evidence-based guidelines, the Dental Quality Alliance developed measures for implementation with administrative data at the plan and program levels. To validate the measures, the authors used data from the Florida and Texas Medicaid programs and Children's Health Insurance Programs and from national commercial dental benefit plans. Data were extracted from 414 randomly selected dental office records to validate the use of administrative data to accurately calculate the measures. The authors also assessed statistically significant variations in overall measure performance.
Agreement between administrative data and dental records was 95% for sealants (κ = 0.82) and 90% for topical fluoride (κ = 0.78). Sensitivity and specificity were 90.7% and 88.5% for topical fluoride and 77.8% and 98.8% for sealants, respectively. Variation in overall measure performance was greatest for topical fluoride (χ(2) = 5,887.1; P < .01); 18% to 37% of children with an elevated risk of experiencing caries received at least 2 topical fluoride applications during the reporting year. Although there was greater variation in performance for sealants for 6- to 9-year-olds (range, 21.0-31.3%; χ(2) = 548.6; P < .01) compared with sealants for 10- to 14-year-olds (range, 8.4-11.1%; χ(2) = 22.7; P < .01), overall sealant placement rates were lower for 10- to 14-year-olds.
These evidence-based, caries prevention process-of-care quality measures can be implemented feasibly and validly using administrative claims data.
The measures can be used to assess, monitor, and improve the proportion of children with an elevated risk of experiencing dental caries who receive evidence-based caries prevention services.
作者开展了一项研究，以验证以下3项基于证据的医疗服务过程质量指标，这些指标聚焦于患龋风险较高儿童的龋齿预防：6至9岁儿童使用窝沟封闭剂、10至14岁儿童使用窝沟封闭剂以及使用局部用氟化物。
牙科质量联盟依据循证指南，制定了在计划和项目层面通过行政数据实施的指标。为验证这些指标，作者使用了来自佛罗里达州和德克萨斯州医疗补助计划及儿童健康保险计划以及全国商业牙科福利计划的数据。从414份随机选取的牙科诊所记录中提取数据，以验证行政数据用于准确计算这些指标的情况。作者还评估了总体指标表现上具有统计学意义的差异。
窝沟封闭剂方面行政数据与牙科记录的一致性为95%（κ = 0.82），局部用氟化物方面为90%（κ = 0.78）。局部用氟化物的敏感性和特异性分别为90.7%和88.5%，窝沟封闭剂的敏感性和特异性分别为77.8%和98.8%。总体指标表现的差异在局部用氟化物方面最大（χ(2) = 5,887.1；P <.01）；在报告年度，18%至37%患龋风险较高的儿童接受了至少2次局部用氟化物治疗。尽管6至9岁儿童窝沟封闭剂使用情况的差异（范围为21.0% - 31.3%；χ(2) = 548.6；P <.01）比10至14岁儿童窝沟封闭剂使用情况的差异（范围为8.4% - 11.1%；χ(2) = 22.7；P <.01）更大，但10至14岁儿童的总体窝沟封闭剂放置率较低。
这些基于证据的龋齿预防医疗服务过程质量指标可通过行政索赔数据切实有效地实施。
这些指标可用于评估、监测和提高患龋风险较高的儿童接受循证龋齿预防服务的比例。
