While medicine has long made use of standardized terminologies (i.e. ICD 9,), to record diagnoses, dentistry has not enjoyed the presence of a widely used, available set of standardized dental diagnostic terms. In 2009, 21 dental schools that all use the same EHR software system, developed a standardized dental diagnostic terminology called EZcodes, which was recently validated as part of an R01 award (1R01DE021051). The EZcodes are currently implemented in 14 dental schools and as such, more than 3,100 dental academic providers use this terminology during more than 1 million patient visits annually. The full promise of the EZcodes will only be realized if they are in use beyond the "laboratory" of the academic dental clinics. Thus, in the proposed work, we will implement the EZcodes within the 54-office Willamette Dental Group (WDG). OBJECTIVE: The objective of this work is to develop a tested, generalizable process for effectively implementing the EZcodes. We will create an Implementation Toolkit (EZ-IT), determine the impact of the EZ-IT on the attitudes of dental providers, as well as the diagnosis-orientation of the culture of the organization, and determine the impact of the program on utilization rates and valid entry of diagnostic terms.
SPECIFIC AIMS : (1) We will develop the EZ-IT for implementing dental diagnostic terms. (2) We will determine the impact of the program on inner context ("culture") surrounding diagnostic terms. (3) We will determine the impact of the program on valid entry of diagnostic terms. DESIGN AND METHODS: Headed by the Harvard School of Dental Medicine, and aided by domain experts, the effort will be implemented at WDG. We will iteratively develop the EZ-IT to its dissemination form following laboratory testing, assessment within an implementation at WDG and workgroup review. Next, we will disseminate the EZ-IT. Before, during and after the implementation of the EZ-IT we will assess the impact of the EZcodes on the culture through the use of surveys and interviews. Lastly, all patient visits and associated diagnosis and treatment data for the specified study period will be analyzed. Descriptive statistics of the overall utilization and then within each category of diagnosis will be computed. The validation of the diagnostic term entry will be performed by assessing the validity of EZcodes-treatment code (CDT) pairs.

Public Health Relevance

While medicine has long made use of various terminologies (i.e. ICD 9), to record diagnoses in a standardized fashion, dentistry has not enjoyed the presence of a widely used, available set of standardized dental diagnostic terms. In 2009, 21 dental schools that all use the same EHR software system, developed a standardized dental diagnostic terminology called EZcodes, which was recently validated as part of an R01 award (1R01DE021051). In this proposal, we will implement the EZcodes in a large private dental practice setting, through iterative testing and development of an implementation toolkit, measuring of the impact of the EZcodes'implementation on the organization's culture before and after implementation, and determine the impact of the EZcodes'implementation on valid entry of diagnostic terms.

Agency
National Institute of Health (NIH)
Type
Research Project (R01)
Project #
5R01DE023061-02
Application #
8737879
Study Section
Dissemination and Implementation Research in Health Study Section (DIRH)
Program Officer
Clark, David
Project Start
Project End
Budget Start
Budget End
Support Year
2
Fiscal Year
2014
Total Cost
Indirect Cost
Name
Harvard Medical School
Department
Dentistry
Type
Schools of Dentistry/Oral Hygn
DUNS #
City
Boston
State
MA
Country
United States
Zip Code
02115