Using Electronic Dental Records to Assess Osteoradionecrosis Risk in Irradiated Head and Neck Cancer.

OBJECTIVE: Over the last 2 decades, investigations have demonstrated a decreased trend in the likelihood of osteoradionecrosis of the jaw (ORNJ) after extraction. The aim of this study was to explore the potential risk factors for ORNJ in irradiated head and neck cancer by using patients' electronic dental records (EDRs). METHODS: Patients diagnosed with head and neck cancer who had irradiation between January 2010 and December 2020 were included in this retrospective cohort analysis. Patient charts showing evidence of "head and neck cancer," "oral cancer," "radiotherapy," "radiation," and "oral complication" were identified by an informatics analyst querying the EDR. Subsequently, the charts were manually reviewed, and data quality was assessed on 3 dimensions: completeness, accuracy, and consistency. The patient, tumor, systemic condition/drug, oral condition, treatment/trauma, and radiation were all categorized as potential risk factors. RESULTS: A total of 359 patients were included. With the exception of radiation-related factors, we found that the data quality was generally sufficient to support the research. Multivariate logistic regression analysis demonstrated that the following factors were significant in predicting the occurrence of ORNJ development in irradiated head and neck cancer: smoking (odds ratio [OR], 9.0; 95% CI, 1.9 to 43.0; P = 0.006), steroid use (OR, 6.4; 95% CI, 1.3 to 30.8; P = 0.021), oral health status (OR, 23.7; 95% CI, 2.7 to 211.0; P = 0.005), and postirradiation extraction (OR, 3.8; 95% CI, 1.0 to 14.4; P = 0.050). CONCLUSIONS: A 10-y retrospective analysis of data from an EDR revealed that smoking, steroid use, poor oral status, and postirradiation extraction are all factors linked to an increased risk of developing ORNJ. The quality of EDR data may be systematically assessed by determining the completeness, accuracy, and consistency of the underlying data. Radiation-related factors in particular were poorly documented, highlighting the need for collecting or incorporating this information into the EDR. KNOWLEDGE TRANSFER STATEMENT: EDRs can be used to identify risk factors for developing ORNJ in irradiated head and neck cancer and can help clinicians with selecting treatments by incorporating risk and complication considerations.

An International Working Definition for Quality of Oral Healthcare.

To assess and improve the quality of oral healthcare, we must first agree on what constitutes good care. Currently there is no internationally accepted definition for quality of oral healthcare. Therefore, the purpose of the study was to establish a working definition for quality of oral healthcare that would help to advance further improvements in the field of quality improvement in oral healthcare. The development of the working definition included a 3-step approach: 1) literature screening; 2) expert-based compilation of an initial list of topics, leaning on the National Academy of Medicine framework for quality of care; and 3) a World Café with voting, which took place during the annual general meeting of the International Association for Dental Research in 2018. Following this approach, the collective intelligence of involved participants yielded a comprehensive list of items, prioritized by relevance. The resulting working definition comprises 7 domains­patient safety, effectiveness, efficiency, patient-centeredness, equitability, timeliness, access to care­and 30 items, which together characterize quality of oral healthcare. This aspirational working definition provides the potential to facilitate further conversations and activities aiming at quality improvement in oral healthcare. KNOWLEDGE TRANSFER STATEMENT: This special communication describes the development of a working definition for quality of oral healthcare. The findings of this study are intended to raise awareness of the relevance of quality improvement initiatives in oral healthcare. The working definition described here has the potential to facilitate further conversations and activities aiming at quality improvement in oral healthcare.

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.

Strategic Shift to a Diagnostic Model of Care in a Multi-Site Group Dental Practice.

BACKGROUND: Documenting standardized dental diagnostic terms represents an emerging change for how dentistry is practiced. We focused on a mid-sized dental group practice as it shifted to a policy of documenting patients' diagnoses using standardized terms in the electronic health record. METHODS: Kotter's change framework was translated into interview questions posed to the senior leadership in a mid-size dental group practice. In addition, quantitative content analyses were conducted on the written policies and forms before and after the implementation of standardized diagnosis documentation to assess the extent to which the forms and policies reflected the shift. Three reviewers analyzed the data individually and reached consensuses where needed. RESULTS: Kotter's guiding change framework explained the steps taken to 97 percent utilization rate of the Electronic Health Record and Dental Diagnostic Code. Of the 96 documents included in the forms and policy analysis, 31 documents were officially updated but only two added a diagnostic element. CONCLUSION: Change strategies established in the business literature hold utility for dental practices seeking diagnosis-centered care. PRACTICAL IMPLICATIONS: A practice that shifts to a diagnosis-driven care philosophy would be best served by ensuring that the change process follows a leadership framework that is calibrated to the organization's culture.