Diagnostic Documentation and Impact on Quality of Patient Care. Khalid Moidu, MD, PhD Lyle McClellan, DDS Joel White, DDS, MS

Transcription

1 Diagnostic Documentation and Impact on Quality of Patient Care Khalid Moidu, MD, PhD Lyle McClellan, DDS Joel White, DDS, MS

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3 Dentistry is an Important Partner Hospital Based Care AMC ED Specialists Primary Care Primary Care Physicians Integrated Dental Service Retail Clinics Employer Health Services Self Care Based on Bellin Health Fitness, Nutrition, Wellness Community Events & Screenings Health Portal 24/7 On call Nurse

4 Information in Medical Curriculum An analysis of medical curriculum in 1980, reports that a medical student must assimilate: 47,900 facts 29,900 concepts that exist in standard medical text books. This is at a rate of: 24/per hour for first two years, and 9/per hour during the clinical phase J. ANDERSON:A. GRAHAM A problem in medical education: is there an information overload? Department of Medicine, King's College Hospital Medical School, London Medical Education,: 14: 1:

5 Smoking Observation in the Catalog

6 Patient Profile Gaps In Care

7 Analytics lookup in EMR

8 Pop View - Count of Diabetics, Heart failure and Hyper Tension. User is able to view detailed list [Venn diagram] by hover mouse on numbers. All these numbers are having tool tips in Venn diagram. Clicking on the count, user will be redirected to Facility vise listing page.

9 List with Dockable Search Function

10 Preventive care checklist. Preventive care check list will be shown by clicking on second image column in report grid.

11 APH Pediatrics Residency

12 "Dentists may empirically know that a patient is at high risk for caries or that they are treating a failed restoration, but they are not directly attaching a diagnosis code to the condition they are treating." Dr. Mark Wolf, Ph.D., Associate Dean for Pre-Doctoral Clinical Education New York University

13 Diagnostic Documentation and Impact on Quality of Patient Care Lyle McClellan, DDS Director of Doctor Development

14 Preventive Care Costs Less

15 Willamette Dental Group

16 We Are Pioneers

17 Focus on Prevention

18 First in Proactive Dental Care

19 Vital to our Mission Willamette Dental Group Mission To deliver proactive patient care through a partnership with our patients to stop the disease-repair cycle by means of evidence-based methods of prevention and treatment.

20 Diagnosis is necessary.

21 Diagnosis Before Treatment

22 Dx drives Tx

23 Dx mandatory

24 Quick and Easy

25 Dx drives Tx

26 Dx drives Tx

27 Dx drives Tx

28 Expert Tab Clinical Support

29 Diagnosis is Mandatory

30 Individualized Care

31 Proactive Care

32 Patient Partnership

33 DDS Diagnostic Terminology Diagnosis drives treatment World Health Organization (WHO) has International Classification of Diseases (ICD) o Lacks granularity for dentistry, 100,000+ terms International Health Terminology Standards Development Organization (IHTSDO) has SNOMED-CT o Inclusive of SNODENT I and SNODENT 2 (7,700+ terms) Need for an interface terminology in dentistry o Incorporated within an Electronic Health Record o Granular for dentistry o Easy to use

34 What Benefit Does WDG Derive?

35 Measures to Support Quality Improvement Process of Care Measures (PoCs) Appropriateness of Care Measures (AoCs) Outcome of Care Measures (OoCs)

36 Then What?

37 Obsolete?

38 Don t have to drill?

39 That s Proactive Dental Care!

40 Diagnosis Has Been Key

41 Triple Aim

42 Tooth Decay

43 Diagnostic Documentation and Impact on Quality of Patient Care Joel White, DDS, MS

44 Disclosure Full time UCSF faculty Practice, Teach and Research NIH (NIDCR) supported grants as investigator Previously a paid consultant for Skourtes Institute (nonprofit foundation for development and implementation of CAMBRA/PEMBRA/PDCP and data analytics) and Willamette Dental Group (quality improvement) Contributed toward Intellectual Property for DDS (dental diagnostic system, Harvard), CAMBRA/PEMBRA/PDCP (clinic decision support and standardized care in the electronic health record, UCSF)

45 Big Picture Role of Electronic Health Record Dental Diagnostic Terminology First step-must have Clinic Decision Support Guidance to dental team Practice Guidelines Best Practices Quality Improvement Process of Care, Appropriateness of Care, Outcomes of Care Patient Safety Reduce/Eliminate Hazards and Harm Triple Aim Better Care, Better Health, Lower Cost

46 1998 Toronto Codes Z Codes 1999

47 Harmonization Reference Set(s) Courtesy: MF Walji

48 Diagnostic Terminology in an Electronic Health Record=Interface Terminology Line Entry and Big Elevator Bar-circa 2001

49 Where to look for a Diagnostic Term: Treatment History

50 Setting Diagnosis field as Mandatory

51 Adding diagnosis in Chart Add Clicking Demo

52 Adding diagnosis in Chart Add Typing Demo

53 Diagnosis in Treatment Planning

54 Clinic Decision Support Diagnosis and Most Frequent Procedures!!

55 DDS to ICD to Dental Claim Form (paper or electronic works the same way)

56 DDS-CDT Diagnosis-Procedure Pairs WDG, HSDM, UTH, UCSF 2,521,692 Number of procedures from all sites 2,080,800 Number of procedures where the CDT does not have an alphabetical suffix 2,032,404 Number of procedures where there is a diagnostic description (all "Not entered" are removed) 1,985,281 Number of procedures with an adjudicated result

57 There was a steady increase in the use of the DDS over the study period-utilization 100% Trend over time Utilization % 50% WDG UCSF Harvard 0% WDG 97% 97% UCSF 23% 39% 54% Harvard 19% 32% 38%

58 Correct use of the DDS over 3 years-accuracy Overall accuracy for DDS-CDT all pairs (69%) Overall accuracy for Diagnosis-Procedures (84%) Trend over time 100% Validity % Harvard WDG UCSF 50% Harvard 75% 76% 77% WDG 62% 77% UCSF 54% 65% 69%

59 Most frequently used valid diagnosis-procedure pairs

60 Most frequently used NOT valid DDS-CDT pairs Diagnostic Procedures DON T need a diagnosis!! Quality Improvement Oppurtunity

61 Beyond Quality Assurance

62 Papers

63 Papers-Journal of Evidenced Based Dental Practice

64 UH2/3 Multi-level Evaluation Framework Children s Oral Health Disparities Standardized Caries Prevention Program Aim 2: Cost benefit by payer group over time. Aim 3: Evaluate context of Medicaid policy across plans. Aim 1: Comparatively assess the oral health status of OHP vs. CP children over time. Principal Evaluation Question: Does the caries prevention program reduce disparities in caries burden over time between Oregon Health Plan (OHP) and Commercial Plan (CP) children? Additional Evaluation Question: Is the caries prevention program sustainable over time under current policy and fiscal conditions? Additional Evaluation Questions: How does this policy environment impact the practice & sustainability of the caries prevention program? Where does WDG place among dental contractors using traditional metrics?

65 Funding Acknowledgements G08LM (NLM): Development of an Inter University Oral Health Research Data Base (BigMouth) R01DE (NIDCR): A Cognitive Approach To Refine And Enhance Use Of A Dental Diagnostic Terminology (DDS) R01DE (NIDCR): A Whole Systems Approach To Implementing Standardized Dental Diagnostic Terms (DDS Dissemination) R01DE (NIDCR): Implementing Dental Quality Measures in Practice R01DE (NIDCR): Developing a Patient Safety System for Dentistry Foundational work for: UH2DE (NIDCR): Evaluating Standardized Preventive Care to Reduce Dental Disparities in Children

66 Thank You!! Questions? Comments?