Krishna Aravamudhan

Clinical Decision Support Chairside Tools for Evidence-Based Dental Practice

Evidence-based clinical decision support (EB-CDS) tools designed for chairside use, help support the implementation of Evidence-Based Dentistry. EB-CDS tools organize available evidence and risk factors in order to facilitate clinical decision-making as well as to enhance rapid and effective transfer of knowledge to the patient at the point of care. Gingival recession, root exposure, caries, dental sealants, decay prevention and topical fluoride guides are presented and discussed. The Assess-Advise-Decide Approach, described in this article, better enables patients to determine which course of action is in line with their preferences and values.

Measuring quality: caries-related emergency department visits and follow-up among children: Caries-related emergency department visits and follow-up

OBJECTIVE This study validated two Dental Quality Alliance system-level measures of oral healthcare quality for children - caries-related emergency department (ED) visits and timely follow-up of those visits with a dentist - including formal validation of diagnosis codes used to identify caries-related ED visits and measurement of follow-up care. METHODS The measures were specified for implementation with administrative claims data and validated using data from the Florida and Texas Medicaid and Childrens Health Insurance Programs. Measure specification testing and measure score validation used administrative data for 7,007,765 children. We validated the diagnosis codes in claims data by comparisons with manual reviews of 300 records from a Florida hospital ED and calculation of the kappa statistic, sensitivity, and specificity. RESULTS Overall agreement in caries-related ED visit classifications between the claims data and record reviews was 87.7 percent with kappa = 0.71, sensitivity = 82 percent, and specificity = 90 percent. The calculated measure scores using administrative data found more than four-fold variation between programs with the lowest and highest caries-related ED visit rates (6.90/100,000 member months and 30.68/100,000 member months). The percentage of follow-up visits within 7 days and 30 days ranged from 22-39 percent and 34-49 percent, respectively. CONCLUSIONS These National Quality Forum endorsed measures provide valid methodologies for assessing the rate of caries-related ED visits, an important system-level outcome indicator of outpatient prevention and disease management, and the timeliness of follow-up with a dentist. There is significant variation in caries-related ED visits among state Medicaid programs, and most ED visits do not have follow-up with a dentist within 30 days.

American Dental Association’s Resources to support Evidence-Based Dentistry

Time and access have often been cited as barriers to implementing Evidence-Based Dentistry (EBD). This paper describes a new web-based resource launched by the American Dental Association to enable practitioners to incorporate evidence into treatment planning. The website offers a database of systematic reviews, critical summaries of systematic reviews, evidence-based clinical recommendations and links to external resources to enable practitioners to access evidence at the point of care. In addition the site offers an online space for clinicians to suggest clinical scenarios where evidence is lacking. This could potentially be a source of topics to drive future research. With the explosion in the use of information technology within a dental office, this web-site will serve as the one-stop resource for credible scientific information for practitioners.