Findings from a caries risk assessment registry quality improvement initiative in an oral health partnership model.

OBJECTIVES: This quality improvement study evaluates the impact of a caries risk assessment (CRA) registry on the following: percentage of children with a documented CRA, receipt of preventive and restorative services, and costs of care. METHODS: We used 2014-2019 data for patients aged 0-17 years from 22 locations in a group practice in Wisconsin. Paired t-tests and Wilcoxon signed-rank tests were used to evaluate changes over time in the following practice-level outcomes: CRA documentation, fluoride receipt, continuing care procedures, restorative procedures, total procedures, and inflation-adjusted costs of care. The same tests were used to compare average procedures and cost for patients a) enrolled and not enrolled in the registry, b) with and without CRA documentation, and c) at high and low caries risk. RESULTS: CRA documentation increased from 13 percent in 2014 to 87 percent in 2019 (P < 0.0001). There were statistically significant increases in the average number of continuing care procedures (from 1.47 to 1.54, P < 0.001), average total procedures (from 7.40 to 8.36, P < 0.001), and inflation-adjusted average cost (from $491.51 to $553.37, P < 0.001) after accounting for multiple comparisons. The average number of restorative procedures decreased, with borderline statistical significance. Average cost was stable for registry-enrolled patients and increased for those not enrolled. CONCLUSIONS: The registry achieved the primary goal of improving CRA documentation among children. This quality improvement initiative appears to have had value-enhancing effects by promoting increased receipt of preventive services and decreased restorative services, while maintaining stable average cost of care for registry-enrolled patients over time.

Developing a caries risk registry to support caries risk assessment and management for children: A quality improvement initiative.

OBJECTIVES: Health registries are commonly used in medicine to support public health activities and are increasingly used in quality improvement (QI) initiatives. Illustrations of dental registries and their QI applications are lacking. Within dentistry, caries risk assessment implementation and documentation are vital to optimal patient care. The purpose of this article is to describe the processes used to develop a caries risk assessment registry as a QI initiative to support clinical caries risk assessment, caries prevention, and disease management for children. METHODS: Developmental steps reflected Agency for Healthcare Research and Quality recommendations for planning QI registries and included engaging "champions," defining the project, identifying registry features, defining performance dashboard indicators, and pilot testing with participant feedback. We followed Standards for Quality Improvement Reporting Excellence guidelines. RESULTS: Registry eligibility is patients aged 0-17 years. QI tools include prompts to register eligible patients; decision support tools grounded in evidence-based guidelines; and performance dashboard reports delivered at the provider and aggregated levels at regular intervals. The registry was successfully piloted in two practices with documented caries risk assessment increasing from 57 percent to 92 percent and positive feedback regarding the potential to improve dental practice patient centeredness, patient engagement and education, and quality of care. CONCLUSIONS: The caries risk assessment registry demonstrates how dental registries may be used in QI efforts to promote joint patient and provider engagement, foster shared decision making, and systematically collect patient information to generate timely and actionable data to improve care quality and patient outcomes at the individual and population levels.