Assessing the validity of existing dental sealant quality measures - PubMed (original) (raw)

. 2018 Sep;149(9):756-764.e1.

doi: 10.1016/j.adaj.2018.05.001. Epub 2018 Jul 4.

Suhasini Bangar, Ana Neumann, Krishna Kumar Kookal, Alfa Yansane, Oluwabunmi Tokede, Enihomo Obadan-Udoh, Elizabeth Mertz, Kristen Simmons, Joshua Even, Joanna Mullins, Joel White, Elsbeth Kalenderian, Muhammad Walji

Assessing the validity of existing dental sealant quality measures

Shwetha V Kumar et al. J Am Dent Assoc. 2018 Sep.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Practical implications: 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.

Keywords: Dental sealants; caries; caries risk assessment; oral health; quality of care.

Copyright © 2018 American Dental Association. Published by Elsevier Inc. All rights reserved.

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Figures

Figure.

Figure.

List of reasons for patients included in the denominator (modified Dental Quality Alliance and modified Oregon Health Authority measures) not receiving a sealant treatment and their frequency of occurrence (n = 2,433). * Other reasons are the patient’s first visit was in the middle of or late in 2014, the parents declined sealants, the patient was referred to an outside specialist, sealant placement was not complete, or the patient was not at elevated caries risk according to the Dental Quality Alliance methods for identifying risk.

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