The primary goal of this application is to use health information technology (HIT) to improve the quality and safety of dental care for patients with serious chronic medical conditions. Chronic medical conditions such as diabetes, heart disease, pulmonary disease, and conditions that cause xerostomia (dry mouth) have a profound effect on the quality and safety of dental care, if neglected. Clinical guidelines have been developed for dentists to make practice changes to reduce this risk, but disseminating evidence-based guidelines is not sufficient to change clinical practice. The emergence of electronic dental records (EDRs) in dental offices offers a powerful tool to improve the quality and safety of care by dentists. The use of clinical decision support (CDS) software in EDRs, when integrated with electronic medical records (EMRs), can inform dentists when changes in clinical protocol are needed for patients with medical conditions and provide personalized, evidence-based recommendations to do so. We have recently completed research supported by AHRQ RFA-HS-07-006: Ambulatory Safety and Quality Program (R18 HS017270) using this CDS technology and found that the use of CDS increased dentist use of personalized clinical guidelines by 440% and significantly improved their point-of- care procedures compared with a control group. However, despite this success, the CDS alerts triggered a response by only 25% of all dental providers, leaving 75% as non-responsive to the system. Thus, we plan to extend this research to determine which components of the CDS increase use by more dental providers and be the first to employ a Health Information Exchange, MnHIE, to translate this CDS into use by community dental providers. We will employ a three-arm, 2-year, prospective, group-randomized clinical trial to compare two CDS strategies designed to increase utilization of the CDS and employ MnHIE to access a patient's medical information for use by the CDS. The two strategies compare a Passive Alert CDS that utilizes both dentist and patient reminders, with quick reference to personalized guidelines in the progress notes versus an Active Script CDS that utilizes an active step-by-step script of the personalized guidelines for dentists to follow and document.

Public Health Relevance

The primary goal of this application is to evaluate the effectiveness of clinical decision support that employs an integrated electronic health record (EHR) system that includes an eMedical Record, eDental Record, and a Personal eHealth Record to improve the quality and safety of dental care for patients with chronic illnesses including diabetes, heart disease, pulmonary disease, and conditions that cause xerostomia (dry mouth). If these medical conditions are not identified and addressed in routine dental care, the quality and safety of care is adversely affected. This study will inform dentists of how to use EHRs to improve care for patients.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration and Dissemination Projects (R18)
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Health Care Technology and Decision Science (HTDS)
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Nunley, Angela
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Healthpartners Institute
United States
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