Original Contributions
Caries Prevention
Measuring quality of dental care: Caries prevention services for children

https://doi.org/10.1016/j.adaj.2015.03.017Get rights and content

Abstract

Background

The authors conducted a study to validate the following 3 evidence-based, process-of-care quality measures focused on dental caries prevention for children with an elevated risk of experiencing caries: sealants for 6- to 9-year-olds, sealants for 10- to 14-year-olds, and topical fluoride.

Methods

Using evidence-based guidelines, the Dental Quality Alliance developed measures for implementation with administrative data at the plan and program levels. To validate the measures, the authors used data from the Florida and Texas Medicaid programs and Children’s Health Insurance Programs and from national commercial dental benefit plans. Data were extracted from 414 randomly selected dental office records to validate the use of administrative data to accurately calculate the measures. The authors also assessed statistically significant variations in overall measure performance.

Results

Agreement between administrative data and dental records was 95% for sealants (κ = 0.82) and 90% for topical fluoride (κ = 0.78). Sensitivity and specificity were 90.7% and 88.5% for topical fluoride and 77.8% and 98.8% for sealants, respectively. Variation in overall measure performance was greatest for topical fluoride (χ2 = 5,887.1; P < .01); 18% to 37% of children with an elevated risk of experiencing caries received at least 2 topical fluoride applications during the reporting year. Although there was greater variation in performance for sealants for 6- to 9-year-olds (range, 21.0-31.3%; χ2 = 548.6; P < .01) compared with sealants for 10- to 14-year-olds (range, 8.4-11.1%; χ2 = 22.7; P < .01), overall sealant placement rates were lower for 10- to 14-year-olds.

Conclusions

These evidence-based, caries prevention process-of-care quality measures can be implemented feasibly and validly using administrative claims data.

Practical Implications

The measures can be used to assess, monitor, and improve the proportion of children with an elevated risk of experiencing dental caries who receive evidence-based caries prevention services.

Section snippets

Measure specification

On the basis of expert ratings of measure concepts identified through the environmental scan, identified gaps in measurement, and evidence regarding the effectiveness of different processes of care, the DQA identified professionally applied topical fluoride and pit-and-fissure sealants on permanent molars as primary candidates for caries prevention process-of-care measures associated with improved health outcomes (that is, to reduce dental caries and associated sequelae). The DQA developed the

Sample characteristics

Table 1 provides the member characteristics for each of the programs. Across the 5 programs, there were 6,956,669 members aged 0 to 20 years enrolled for at least 1 month. Table 2 summarizes the number of children eligible for each measure’s denominator and numerator.

Critical data element validation

Of the 600 records requested, we received 414 (69%), exceeding the targeted number of 400. The 414 records represented 631 dates of service. Table 3 summarizes the agreement between the dental records and administrative data for

Discussion

The purpose of this study was to validate 3 caries prevention, process-of-care quality measures. Our results indicate that these measures can be implemented feasibly and validly by using administrative claims data at the program and plan levels. Our testing included validation of the critical data elements used to calculate the measure scores and the overall quality measure scores. Our critical data element validation findings are similar to the results of a study whose investigators used data

Conclusions

Professionally applied topical fluoride and timely application of pit-and-fissure sealants to permanent molars are effective caries prevention services. In this study, we validated 3 evidence-based, process of care, caries prevention quality measures: Topical Fluoride for Children at Elevated Caries Risk, Sealants for 6–9 Year-Old Children at Elevated Caries Risk, and Sealants for 10–14 Year-Old Children at Elevated Caries Risk. Based on the study findings, NQF endorsed these 3 measures,17

Dr. Herndon was an associate professor, Department of Health Outcomes and Policy and Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, when this article was written. She now is a principal consultant, Key Analytics and Consulting, Gainesville, FL, and a methodology consultant, Dental Quality Alliance, Chicago, IL. She also is a courtesy research associate professor, Departments of Economics, Community Dentistry and Behavioral Science, and

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    Dr. Herndon was an associate professor, Department of Health Outcomes and Policy and Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, when this article was written. She now is a principal consultant, Key Analytics and Consulting, Gainesville, FL, and a methodology consultant, Dental Quality Alliance, Chicago, IL. She also is a courtesy research associate professor, Departments of Economics, Community Dentistry and Behavioral Science, and Pediatrics, University of Florida, Gainesville, FL.

    Dr. Tomar is a professor and chair, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL.

    Dr. Catalanotto is a professor, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL.

    Dr. Rudner is an associate director, Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL.

    Dr. Huang was an associate professor, Department of Health Outcomes and Policy and Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, when this article was written. He now is an associate member, Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN.

    Dr. Aravamudhan is the director, Center for Dental Benefits, Coding and Quality, and lead staff, Dental Quality Alliance, American Dental Association Practice Institute, Chicago, IL.

    Dr. Shenkman is a professor and chair, Department of Health Outcomes and Policy, and director, Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL.

    Dr. Crall is a professor and chair, Division of Public Health and Community Dentistry, School of Dentistry, University of California – Los Angeles, Los Angeles, CA; chair, Dental Quality Alliance Measures Development and Maintenance Committee, and 2015 chair, Dental Quality Alliance, Chicago, IL.

    Disclosure. None of the authors reported any disclosures.

    This study was funded by the Dental Quality Alliance and the American Dental Association Foundation.

    The measures identified in this manuscript were conceptualized by the Dental Quality Alliance, which continues to serve as the steward maintaining these measures and supporting implementation.

    The authors thank the following members of the Dental Quality Alliance Measures Development and Maintenance Committee who developed the measures and oversaw and provided guidance for the testing efforts: Craig W. Admundson, DDS; Robert D. Compton, DDS; Christine Farrell, RDH, BSDH, MPA; Jed J. Jacobson, DDS, MS, MPH; and DQA Executive Committee liaisons to the MDMC. The authors also recognize the outstanding programming assistance provided by Yijun Sun, Howard Xu, Sunil Chilruvi, and Deepa Ranka; record review assistance by Carla Bredehoeft and Charlie Gwin; and research assistance by Kaitlin Sovich, Deina Bossa, Ryan Brown, Alex Craen, and Tyler Wildes. The authors also gratefully acknowledge the Florida Agency for Health Care Administration, the Florida Healthy Kids Corporation, the Texas Health and Human Services Commission, and DentaQuest for providing data for measure testing.

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