Measuring quality of dental care

Background. 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 Jill Boylston Herndon, PhD; Scott L. Tomar, DMD, MPH, DrPH; Frank A. Catalanotto, DMD; Nancy Rudner, DrPH; I-Chan Huang, PhD; Krishna Aravamudhan, BDS, MS; Elizabeth A. Shenkman, PhD; James J. Crall, DDS, ScD risk of experiencing caries: sealants for 6to 9-year-olds, sealants for 10to 14-year-olds, and topical fluoride. Methods. 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. Results. Agreement between administrative data and dental records was 95% for sealants (k 1⁄4 0.82) and 90% for topical fluoride (k 1⁄4 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 (c 1⁄4 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 6to 9-year-olds (range, 21.0-31.3%;c1⁄4 548.6; P< .01) compared with sealants for 10to 14-year-olds (range, 8.4-11.1%; c 1⁄4 22.7; P < .01), overall sealant placement rates were lower for 10to 14-year-olds. Conclusions. These evidence-based, caries prevention processof-care quality measures can be implemented feasibly and validly using administrative claims data. Practical Implications. 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 D ental caries is the most common chronic disease in children in the United States, and more than one-fifth of children living in poverty have untreated dental caries. Untreated dental caries causes significant shortand long-term adverse consequences for children’s health and functional status. Substantial disparities exist in children’s oral health status and use of dental services in the United States. Two Institute of Medicine (IOM) reports have identified a lack of quality measures as a barrier to improving oral health and reducing oral health disparities. The IOM defines health care quality as “the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” Concerned about the lack of oral health care quality measures, the Centers for Medicare and Medicaid Services (CMS) requested that the American Dental Association (ADA) lead the formation of a group of stakeholders to advance performance measurement in dentistry. An ADA-led multi-agency steering committee formed the Dental Quality Alliance (DQA) in 2010 with 1 of its key objectives being to “identify and develop evidence-based oral health care performance measures and measurement panying online continuing education ://jada.ada.org/ce/home. ican Dental Association. All rights prevention services.