Finding Dental Harm to Patients through Electronic Health Record-Based Triggers.

BACKGROUND: Patients may be inadvertently harmed while undergoing dental treatments. To improve care, we must first determine the types and frequency of harms that patients experience, but identifying cases of harm is not always straightforward for dental practices. Mining data from electronic health records is a promising means of efficiently detecting possible adverse events (AEs). METHODS: We developed 7 electronic triggers (electronic health record based) to flag patient charts that contain distinct events common to AEs. These electronic charts were then manually reviewed to identify AEs. RESULTS: Of the 1,885 charts reviewed, 16.2% contained an AE. The positive predictive value of the triggers ranged from a high of 0.23 for the 2 best-performing triggers (failed implants and postsurgical complications) to 0.09 for the lowest-performing triggers. The most common types of AEs found were pain (27.5%), hard tissue (14.8%), soft tissue (14.8%), and nerve injuries (13.3%). Most AEs were classified as temporary harm (89.2%). Permanent harm was present in 9.6% of the AEs, and 1.2% required transfer to an emergency room. CONCLUSION: By developing these triggers and a process to identify harm, we can now start measuring AEs, which is the first step to mitigating harm in the future. KNOWLEDGE TRANSFER STATEMENT: A retrospective review of patients' health records is a useful approach for systematically identifying and measuring harm. Rather than random chart reviews, electronic health record-based dental trigger tools are an effective approach for practices to identify patient harm. Measurement is one of the first steps in improving the safety and quality of care delivered.

Utilization and Validity of the Dental Diagnostic System over Time in Academic and Private Practice.

INTRODUCTION: To fill the void created by insufficient dental terminologies, a multi-institutional workgroup was formed among members of the Consortium for Oral Health Research and Informatics to develop the Dental Diagnostic System (DDS) in 2009. The adoption of dental diagnosis terminologies by providers must be accompanied by rigorous usability and validity assessments to ensure their effectiveness in practice. OBJECTIVES: The primary objective of this study was to describe the utilization and correct use of the DDS over a 4-y period. METHODS: Electronic health record data were amassed from 2013 to 2016 where diagnostic terms and Current Dental Terminology procedure code pairs were adjudicated by calibrated dentists. With the resultant data, we report on the 4-y utilization and validity of the DDS at 5 dental institutions. Utilization refers to the proportion of instances that diagnoses are documented in a structured format, and validity is defined as the frequency of valid pairs divided by the number of all treatment codes entered. RESULTS: Nearly 10 million procedures ( n = 9,946,975) were documented at the 5 participating institutions between 2013 and 2016. There was a 1.5-fold increase in the number of unique diagnoses documented during the 4-y period. The utilization and validity proportions of the DDS had statistically significant increases from 2013 to 2016 ( P < 0.0001). Academic dental sites were more likely to document diagnoses associated with orthodontic and restorative procedures, while the private dental site was equally likely to document diagnoses associated with all procedures. Overall, the private dental site had significantly higher utilization and validity proportions than the academic dental sites. CONCLUSION: The results demonstrate an improvement in utilization and validity of the DDS terminology over time. These findings also yield insight into the factors that influence the usability, adoption, and validity of dental terminologies, raising the need for more focused training of dental students. KNOWLEDGE TRANSFER STATEMENT: Ensuring that providers use standardized methods for documentation of diagnoses represents a challenge within dentistry. The results of this study can be used by clinicians when evaluating the utility of diagnostic terminologies embedded within the electronic health record.

Treatment planning in dentistry using an electronic health record: implications for undergraduate education.

OBJECTIVE: Treatment planning, an essential component of clinical practice, has received little attention in the dental literature and there appears to be no consistent format being followed in the teaching and development of treatment plans within dental school curricula. No investigation, to our knowledge, has been carried out to explore the subject of treatment planning since the advent of electronic health record (EHR) use in dentistry. It is therefore important to examine the topic of treatment planning in the context of EHRs. METHODS: This paper reports on how 25 predoctoral dental students from two U.S. schools performed when asked to complete diagnosis and treatment planning exercises for two clinical scenarios in an EHR. Three calibrated clinical teaching faculty scored diagnosis entry, diagnosis-treatment (procedure) pairing, and sequencing of treatment according to criteria taught in their curriculum. Scores were then converted to percent correct and reported as means (with standard deviations). RESULTS: Overall, the participants earned 48.2% of the possible points. Participants at School 2 earned a mean of 54.3% compared with participants at School 1, who earned 41.9%. Students fared better selecting the appropriate treatment (59.8%) compared with choosing the correct diagnoses (41.9%) but performed least favorably when organizing the sequence of their treatment plans (41.7%). CONCLUSION: Our results highlight the need to improve the current process by which treatment planning is taught and also to consider the impact of technology on the fundamental skills of diagnosis and treatment planning within the modern educational setting.

Effects of cocoa products/dark chocolate on serum lipids: a meta-analysis.

Cocoa products, which are rich sources of flavonoids, have been shown to reduce blood pressure and the risk of cardiovascular disease. Dark chocolate contains saturated fat and is a source of dietary calories; consequently, it is important to determine whether consumption of dark chocolate adversely affects the blood lipid profile. The objective was to examine the effects of dark chocolate/cocoa product consumption on the lipid profile using published trials. A detailed literature search was conducted via MEDLINE (from 1966 to May 2010), CENTRAL and ClinicalTrials.gov for randomized controlled clinical trials assessing the effects of flavanol-rich cocoa products or dark chocolate on lipid profile. The primary effect measure was the difference in means of the final measurements between the intervention and control groups. In all, 10 clinical trials consisting of 320 participants were included in the analysis. Treatment duration ranged from 2 to 12 weeks. Intervention with dark chocolate/cocoa products significantly reduced serum low-density lipoprotein (LDL) and total cholesterol (TC) levels (differences in means (95% CI) were -5.90 mg/dl (-10.47, -1.32 mg/dl) and -6.23 mg/dl (-11.60, -0.85 mg/dl), respectively). No statistically significant effects were observed for high-density lipoprotein (HDL) (difference in means (95% CI): -0.76 mg/dl (-3.02 to 1.51 mg/dl)) and triglyceride (TG) (-5.06 mg/dl (-13.45 to 3.32 mg/dl)). These data are consistent with beneficial effects of dark chocolate/cocoa products on total and LDL cholesterol and no major effects on HDL and TG in short-term intervention trials.