Implementing Dental Quality Measures in Practice Project Summary Each year in the US, over 195,000 active dental practitioners provide care to more than 127 million patients, costing more than $117 billion annually. Despite this national investment in oral health, there is little understanding of the return in terms of quality. Although there is strong evidence for effective strategies for treating and preventing caries, oral health remains a significant burden for both children and adults. We are currently faced with an uneven oral healthcare delivery system where a few lucky patients receive evidence- based and person-centered care. Our current quality measurement work has shown that we can use data captured in electronic health records to accurately measure the quality of dental care. We have also demonstrated that there is a large gap between the current state of how dental clinics perform and the desired performance, especially for dental caries. In our current award (R01DE024166), we discovered that a large proportion of patients (44%-77%) were not being treated for their existing dental caries. Even when treated, 13% to 24% of existing patients were being diagnosed again with new decay within 6 months of their last treatment. Our overarching goal is to provide the right care to the right patient at the right time. In order to do this, we first need to setup a practice-level learning health system (LHS) supported by an effective informatics infrastructure, relevant data governance and a culture of learning that drives evidence-based dental practice. Hence as the next step in our research agenda, the objective of this application is to improve dental care quality relating to caries management strategies, the oral health condition with the highest impact, by developing a multi-component intervention, that includes key components of an LHS. We will conduct the study at four large and diverse dental institutions: UT Houston, the University of California San Francisco, HealthPartners and Willamette Dental Group/Skourtes Institute. In Aim 1, we identify and understand the contributing factors (conduct problem analysis) leading to the current level of performance through chart reviews, patient and provider interviews, and targeted clinic observations. In Aim 2, we design and develop strategies to improve the quality of dental caries management at the institutions, using a human- centered design approach for developing effective and actionable Audit and Feedback and EHR-based Clinical Decision Support. In Aim 3, we implement and evaluate the improvement strategies and determine their impact on quality measure performance, acceptability, fidelity and identify the barriers and facilitators for its use. Early and continuous engagement of key stakeholders in all phases of the project will increase the likelihood of developing, implementing and adopting sustainable solutions. The outcomes of our research will arm dental providers with both the knowledge and know-how to measure and improve the quality of dental caries management resulting in better oral health, and subsequently better general health, for our patients.

Project Narrative There is a great need to improve the quality of dental care delivered to patients. Currently, dentistry does not have broadly accepted quality measures that inform the need for improvements in care. In this project we seek to first understand the reasons for suboptimal performance with regard to caries management at four large dental institutions, and then develop and evaluate system-level approaches to improve the quality of caries management.