J Am Dent Assoc. 2018 Sep;149(9):756-764.e1. doi: 10.1016/j.adaj.2018.05.001. Epub 2018 Jul 4.
Although sealants are highly effective in preventing caries in children, placement rates continue to be low. The authors' goals were to implement and assess the performance of 2 existing sealant quality measures against a manual audit of charts at 4 dental institutions and to identify measurement gaps that may be filled by using data from electronic health records.
The authors evaluated the performance of 2 quality measures designed for claims-based data: the Dental Quality Alliance (DQA) sealant measure, which includes patients at risk of developing elevated caries, and the Oregon Health Authority (OHA) sealant measure (irrespective of caries risk). The authors adapted and validated these measures at 4 sites: 3 dental schools and 1 large dental accountable care organization.
The overall modified DQA and modified OHA measure scores in the 6- through 9-year-old age group were 37.0% and 31.6% and in the 10- through 14-year-old age group were 15.8% and 6.6%, respectively. Results from the manual review of charts showed that 67.6% of children who did not receive sealants did not have any teeth to seal because their molars had not yet erupted, had been extracted, had been sealed previously, or had existing caries or restorations.
Both the DQA and OHA measures, which rely mainly on Current Dental Terminology procedure codes, led to underestimation of the care delivered from a practice perspective. Future sealant quality measures should exclude patients whose teeth cannot be sealed.
This study's results support the suitability of using electronic health record data for assessing the quality of oral health care, particularly for measuring sealant placement in children.
尽管窝沟封闭剂在预防儿童龋齿方面非常有效，但使用率仍然很低。作者的目标是在 4 家牙科机构对现有的 2 种窝沟封闭质量措施进行实施和评估，并根据电子健康记录数据来确定可能需要填补的测量空白。
作者评估了 2 种针对索赔数据设计的质量措施的性能：牙科质量联盟（DQA）窝沟封闭剂措施，其中包括有发生高龋风险的患者，以及俄勒冈健康管理局（OHA）窝沟封闭剂措施（不考虑龋齿风险）。作者在 4 个地点（3 所牙科学校和 1 个大型牙科负责医疗组织）对这些措施进行了调整和验证。
在 6 至 9 岁年龄组中，经过修正的 DQA 和修正的 OHA 措施的总体得分分别为 37.0%和 31.6%，在 10 至 14 岁年龄组中，得分分别为 15.8%和 6.6%。从图表的手动审查结果来看，有 67.6%未接受窝沟封闭的儿童没有任何需要封闭的牙齿，因为他们的磨牙尚未萌出、已被拔除、以前已被封闭、或有现有的龋齿或修复体。
这两种主要依赖当前牙科术语程序代码的 DQA 和 OHA 措施导致了从实践角度低估了所提供的护理。未来的窝沟封闭质量措施应排除无法进行封闭的患者。
本研究结果支持使用电子健康记录数据评估口腔保健质量的适宜性，特别是用于测量儿童窝沟封闭剂的放置。
