Quality of care and patient safety have become focal points of health care in recent years. As a result, many organizations and institutions have developed programs and initiatives to improve quality of care and patient safety in Medicine. Dentistry, though, is yet to catch up on this 'quality'trend. While few localized attempts are being made to improve quality of dental patient care, we are unaware of any systematic or standardized approach to this topic in Dentistry. As the Agency for Healthcare Research and Quality (AHRQ) puts it, """"""""the ability to measure the quality of dental care is a key to improving it"""""""". The meticulous collection and documentation of personal health information throughout a patient's life can be one of the most important inputs to the provision of proper care. Our preliminary work shows, however, that fundamental clinic entries that either impact directly on (or serve as a surrogate for measuring) quality of dental care are often missing from many patient records. This implies that although most dental care providers agree on what should make up 'best practices';they are frequently wont, to fall short of their own standards. Consequently, there is need for a strategy that makes up for inevitable human inadequacies and helps dental professionals consistently meet well-accepted clinical guidelines so that the highest possible quality of care is provided. To this end, based on the immense success of its use in Medicine, our work proposes the use of a clinician checklist. It will help strengthen the existing structure of clinical information ascertainment and documentation, and ultimately facilitate quality of care audit/improvement. We will also develop a patient chart audit tool that will be used to benchmark quality of care, and evaluate the impact of our 'checklist'intervention over time, in a consistent manner.
Our specific aims are to: (1) Identify reasons why clinicians fail to consistently document pertinent clinical patient information and;benchmark quality of care by determining adherence to clinical best practices in dentistry. (2) Develop a clinician checklist and patient chart audit tool for general care dentistry. (3) Implement the clinician checklist and assess its effect on adherence to standard record taking practices and quality of patient care. Through a rigorously developed survey, we will identify why clinicians don't routinely follow consensus clinical best practices, following which we will create a clinician checklist and test it for validity and usability, making modifications as appropriate. An audit tool will also be developed and used to determine the baseline level of quality of care at both practices (teaching and faculty) of the Harvard Dental Center. We will then electronically implement the checklist within the teaching practice (academic laboratory) and faculty practice (private practice laboratory) and then evaluate its impact on the level of adherence to clinical best practices and quality of patient care using the audit tool. Beyond its direct impact, we expect that this work will present a model for the development and implementation of procedure and specialty- specific checklists for the purposes of preventing errors and improving quality of care in Dentistry.

Public Health Relevance

In medicine, checklists have proven to reduce errors and improve quality of patient care, not only in hospitals, but out- patient departments and rural settings of developing countries. In this project, we seek to identify why dental care providers fal to elicit and/or document essential clinical information and intervene by implementing a clinician checklist. Our work will help institute a culture of attention to best practices, improve the qualiy of patient care and present a model for the development and implementation of checklists for other clinical dental applications in the future.

National Institute of Health (NIH)
National Institute of Dental & Craniofacial Research (NIDCR)
Exploratory/Developmental Grants (R21)
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Oral, Dental and Craniofacial Sciences Study Section (ODCS)
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Fischer, Dena
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Harvard University
Schools of Dentistry
United States
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Tokede, Oluwabunmi; Ramoni, Rachel B; Patton, Michael et al. (2016) Clinical documentation of dental care in an era of electronic health record use. J Evid Based Dent Pract 16:154-160
Tokede, Oluwabunmi; Ramoni, Rachel; Kalenderian, Elsbeth (2014) The value of checklists. J Am Dent Assoc 145:696