J Am Dent Assoc. 2017 Sep;148(9):634-643.e1. doi: 10.1016/j.adaj.2017.04.017. Epub 2017 Jun 16.
Patients with diabetes are at increased risk of developing oral complications, and annual dental examinations are an endorsed preventive strategy. The authors evaluated the feasibility and validity of implementing an automated electronic health record (EHR)-based dental quality measure to determine whether patients with diabetes received such evaluations.
The authors selected a Dental Quality Alliance measure developed for claims data and adapted the specifications for EHRs. Automated queries identified patients with diabetes across 4 dental institutions, and the authors manually reviewed a subsample of charts to evaluate query performance. After assessing the initial EHR measure, the authors defined and tested a revised EHR measure to capture better the oral care received by patients with diabetes.
In the initial and revised measures, the authors used EHR automated queries to identify 12,960 and 13,221 patients with diabetes, respectively, in the reporting year. Variations in the measure scores across sites were greater with the initial measure (range, 36.4-71.3%) than with the revised measure (range, 78.8-88.1%). The automated query performed well (93% or higher) for sensitivity, specificity, and positive and negative predictive values for both measures.
The results suggest that an automated EHR-based query can be used successfully to measure the quality of oral health care delivered to patients with diabetes. The authors also found that using the rich data available in EHRs may help estimate the quality of care better than can relying on claims data.
Detailed clinical patient-level data in dental EHRs may be useful to dentists in evaluating the quality of dental care provided to patients with diabetes.
糖尿病患者发生口腔并发症的风险增加，年度牙科检查是一种被认可的预防策略。作者评估了实施基于电子健康记录（EHR）的自动牙科质量测量的可行性和有效性，以确定是否对糖尿病患者进行了此类评估。
作者选择了一个针对索赔数据开发的牙科质量联盟（Dental Quality Alliance）措施，并对其规格进行了调整，以适应 EHR。自动查询在 4 家牙科机构中确定了糖尿病患者，并对图表的一个子样本进行了人工审查，以评估查询的性能。在评估初始 EHR 措施后，作者定义并测试了一个经修订的 EHR 措施，以更好地捕捉糖尿病患者接受的口腔护理。
在初始和修订的措施中，作者分别使用 EHR 自动查询在报告年度中确定了 12960 名和 13221 名糖尿病患者。与修订后的措施（范围为 78.8%-88.1%）相比，措施得分在各站点之间的差异更大（范围为 36.4%-71.3%）。对于两个措施，自动查询的敏感性、特异性、阳性预测值和阴性预测值均在 93%或以上。
结果表明，基于 EHR 的自动查询可成功用于测量向糖尿病患者提供的口腔卫生保健质量。作者还发现，与依赖索赔数据相比，使用 EHR 中可用的丰富数据可能有助于更好地估计护理质量。
牙科 EHR 中的详细临床患者级数据可能对牙医评估向糖尿病患者提供的牙科护理质量有用。
