Objectives:A case-control study examined factors contributing to emergency dental clinic access for nontraumatic dental conditions (ED-NTDC) among individuals residing within 20 miles of 10 networked dental clinics comprising a dental safety net. Materials and Methods:Phase I: using dental diagnostic codes for ED-NTDC visits and dental prophylaxis visits that occurred from January 1, 2019 through May 19, 2019, interrogation of an integrated medical-dental electronic health record (EHR) identified cases (n = 1784) and controls (n = 18,612), respectively, matched by dental center. Unadjusted odds ratios (ORs) with 95% confidence intervals (CIs) and chi-squared p-values were determined using unadjusted bivariate logistic regression analysis for each demographic variable by comparing subgroup-specific proportions of cases and controls to a designated reference subgroup. Phase II: survey tools were designed and targeted to Phase I cases (n = 84) and controls (n = 113). Applying descriptive statistics, variability identified between case and control survey question responses defined additional potential candidate variables contributing to risk for ED-NTDC visits. Results:Statistically significant risk variables ORs were graphically depicted in a forest plot and included: age 18-35 (OR 1.4), 36-50 (OR 1.2), sex (male: OR 1.2), race (non-White: (OR 1.7)), payer status (self-pay: (OR 2.4); Medicaid: (OR 1.6), sliding fee: (OR 1.8)), and E-NTDC visits in medical (OR: 2.8) or dental (OR 2.0) settings in the prior 2 years. Twice-annual dental visit rates were higher among controls vs. cases. Cases vs. controls more frequently indicated: (1) a preference for pulling painful teeth; (2) dental visits were only necessary for dental emergencies; (3) delay in seeking dental care for emergent dental pain; (4) higher rates of dental fear. Economic factors, ("could not afford dental care" and "lack of insurance") especially in younger age tiers, strongly contributed to ED-NTDC visits. Conclusions:Barriers to oral health access for vulnerable populations persist. Public health initiatives targeting dental health maintenance and literacy require expansion.

The present study examined the impact of interruptions during the COVID-19 pandemic on the periodontal status of patients undergoing periodontal maintenance therapy (PMT). De-identified data on demographic and periodontal characteristics of patients undergoing PMT seen at the University of Colorado School of Dental Medicine from January 1, 2018, to May 31, 2022, were extracted from the institutional dental database. Independent associations of the length of time between pre- and post-pandemic PMT visits with clinical attachment loss (CAL), bleeding on probing (BOP), and plaque were assessed using linear or logit mixed models. Associations between the number of teeth lost in the interval between the pre- and post-pandemic PMT visits and patient characteristics were tested using a negative binomial model. The null hypothesis was tested at a significance level α < 0.05. Among 279 subjects who met the inclusion criteria, the interval between pre- and post-pandemic visits was 12−23, 24−35, and ≥36 months in 33.3%, 49.8%, and 16.8% of the subjects, respectively. Plaque was significantly associated with a longer period between pre- and post-pandemic PMT visits ( p  = 1.54 × 10 −3 ), whereas no association was observed for CAL and BOP ( p  = 0.39 and 0.10, respectively). Male sex ( p  = 0.023) and current smoking ( p  = 5.23 × 10 −3 ) positively correlated with the number of missing teeth in the interval between the visits, whereas the number of pre-pandemic PMT visits ( p  = 1.20 × 10 −4 ) had the opposite correlation. COVID-19−related PMT interruptions adversely affected plaque control, underscoring the importance of uninterrupted maintenance care. The COVID-19 pandemic had a major impact on patients who visit their dental professionals to maintain healthy gums and stable teeth. Usually, the more compliant these patients are, the better results they can achieve. However, during the pandemic, many patients could not come to get their teeth and gums cleaned as regularly as they could before the pandemic. The present study looked at whether the health of the teeth and gums of patients was affected by the amount of time that passed until a patient came for a dental visit after the pandemic at the University of Colorado. The study results showed that some criteria used to examine tooth and gum health were affected, but others were not. The authors concluded that overall, the length of the interruption to receive dental care after the COVID-19 pandemic caused damage to tooth and gum health. The study results stress the importance of regular dental visits.

BACKGROUND:The present study examined the impact of interruptions during the COVID-19 pandemic on the periodontal status of patients undergoing periodontal maintenance therapy (PMT). METHODS:De-identified data on demographic and periodontal characteristics of patients undergoing PMT seen at the University of Colorado School of Dental Medicine from January 1, 2018, to May 31, 2022, were extracted from the institutional dental database. Independent associations of the length of time between pre- and post-pandemic PMT visits with clinical attachment loss (CAL), bleeding on probing (BOP), and plaque were assessed using linear or logit mixed models. Associations between the number of teeth lost in the interval between the pre- and post-pandemic PMT visits and patient characteristics were tested using a negative binomial model. The null hypothesis was tested at a significance level α < 0.05. RESULTS:Among 279 subjects who met the inclusion criteria, the interval between pre- and post-pandemic visits was 12-23, 24-35, and ≥36 months in 33.3%, 49.8%, and 16.8% of the subjects, respectively. Plaque was significantly associated with a longer period between pre- and post-pandemic PMT visits (p = 1.54 × 10-3), whereas no association was observed for CAL and BOP (p = 0.39 and 0.10, respectively). Male sex (p = 0.023) and current smoking (p = 5.23 × 10-3) positively correlated with the number of missing teeth in the interval between the visits, whereas the number of pre-pandemic PMT visits (p = 1.20 × 10-4) had the opposite correlation. CONCLUSION:COVID-19-related PMT interruptions adversely affected plaque control, underscoring the importance of uninterrupted maintenance care. PLAIN LANGUAGE SUMMARY:The COVID-19 pandemic had a major impact on patients who visit their dental professionals to maintain healthy gums and stable teeth. Usually, the more compliant these patients are, the better results they can achieve. However, during the pandemic, many patients could not come to get their teeth and gums cleaned as regularly as they could before the pandemic. The present study looked at whether the health of the teeth and gums of patients was affected by the amount of time that passed until a patient came for a dental visit after the pandemic at the University of Colorado. The study results showed that some criteria used to examine tooth and gum health were affected, but others were not. The authors concluded that overall, the length of the interruption to receive dental care after the COVID-19 pandemic caused damage to tooth and gum health. The study results stress the importance of regular dental visits.

BACKGROUND:The aim of the present study was to examine whether age and sex affected the prevalence and severity of periodontal conditions in patients attending an academic dental clinic. METHODS:Electronic health record (EHR) data on the demographic characteristics and periodontal conditions of patients presented for a comprehensive periodontal evaluation were extracted from the institutional dental EHR database. Retrospective analysis of independent associations of age, sex, and other subject characteristics with periodontal conditions was determined using multinomial logistic regression. The null hypothesis stating that age and sex were not associated with the increased prevalence and/or severity of periodontal conditions was tested at a significance level α < 0.05. RESULTS:A total of 5027 subjects met the inclusion criteria. Clinical gingival health (CGH), gingivitis, and periodontitis were diagnosed in 4.2%, 5.2%, and 55.8% of patients, respectively. Severe periodontitis was diagnosed in 84.6% of the 4302 patients with periodontitis and was significantly associated with each year of age increase (odds ratio [OR] 1.13; 95% confidence interval [CI] 1.11, 1.15) and male sex (OR 2.02; 95% CI 1.30, 3.15). The combined effect of a 15-year age increase and male sex was reflected in the increased odds of severe periodontitis (OR 12.63; 95% CI 9.57, 16.67). The combined effect of older age and male sex is shown by the increased odds of severe periodontitis (OR 12.63; 95% CI 9.57, 16.67). Similar associations were found between age, male sex, and total periodontitis, but not CGH and gingivitis. CONCLUSION:Increasing age and male sex significantly correlated with increased odds of total and severe periodontitis. PLAIN LANGUAGE SUMMARY:Periodontitis, or inflammatory gum disease, affects many adults in the United States and worldwide. Various factors, such as smoking and diabetes mellitus, increase the risk of periodontitis and the severity of its symptoms. To determine if periodontitis occurs more commonly and is more severe according to patient age and sex, the study used health records from almost 8,000 patients attending dental clinics at the University of Texas School of Dentistry (Houston, TX) from 2007 to 2020. The results demonstrated that adult patients who were older or males had periodontitis more often than those who were younger or female, respectively. Periodontitis was also more severe in older or male patients. These results show that older adults and males can be considered vulnerable individuals when it comes to diagnosing periodontitis. Therefore, dentists should pay more attention to these patients, and individualized treatment methods need to be considered for providing dental care to the gums of these patients.

INTRODUCTION:Rural-based health care systems face unique concerns, including the struggle to recruit and retain quality clinicians. We evaluated health care providers' perceptions of their service line directors (SLDs) in the Marshfield Clinic Health System to understand how these perceptions affect job satisfaction in a rural health care setting. METHODS:Utilizing quantitative and qualitative methods, we reached out to providers within the health system, excluding SLDs to prevent bias. The survey, with a 43% response rate, encompassed 14 questions focusing on 8 domains of engagement. Data analyses included chi-squared tests, t tests, analysis of variance, and correlation matrices. To delve deeper into perceptions, a qualitative approach was employed, analyzing open-ended feedback. RESULTS:Of the 457 respondents, 70% reported satisfaction with their SLDs. High meeting frequencies with SLDs were positively correlated with satisfaction. The majority acknowledged the positive attributes of SLDs in domains like availability, recognition, and feedback. However, significant variations in perceptions arose between physicians and advanced practice clinicians and between surgeon and non-surgeon SLDs. Qualitative feedback elucidated themes including engagement, communication, and advocacy. Positive attributes, such as competence and proactivity, were mentioned frequently, while negatives highlighted disconnectedness and being uninformed. CONCLUSIONS:The quality of interactions with SLDs significantly influences clinician satisfaction. Regular, meaningful interactions - especially recognizing and providing feedback - enhance satisfaction. However, certain groups like advanced practice clinicians under surgeon SLDs felt less engaged. Our findings underscore the importance of tailored leadership training for SLDs and suggest organizational strategies to boost satisfaction, potentially affecting recruitment and retention in rural health care settings.

Background Physicians and patient-facing caregivers have increasingly used mobile health (mHealth) technologies in the past several years, accelerating during the COVID-19 pandemic. However, barriers and feedback surrounding adoption remain relatively understudied and varied across health systems, particularly in rural areas. Objective This study aims to identify provider adoption, attitudes, and barriers toward mHealth in a large, multisite, rural US health care system. We investigated (1) mHealth apps that providers use for their own benefit and (2) mHealth apps that a provider uses in conjunction with a patient. Methods We surveyed all patient-seeing providers within the Marshfield Clinic Health System with a brief, 16-item, web-based survey assessing attitudes toward mHealth, adoption of these technologies, and perceived barriers faced by providers, their peers, and the institution. Survey results were summarized via descriptive statistics, with log-binomial regression and accompanying pairwise analyses, using Kruskal-Wallis and Jonckheere-Terpstra tests for significance, respectively. Respondents were grouped by reported clinical role and specialty. Results We received a 38% (n/N=916/2410) response rate, with 60.7% (n=556) of those sufficiently complete for analyses. Roughly 54.1% (n=301) of respondents reported mHealth use, primarily around decision-making and supplemental information, with use differing based on provider role and years of experience. Self-reported barriers to using mHealth included a lack of knowledge and time to study mHealth technologies. Providers also reported concerns about patients’ internet access and the complexity of mHealth apps to adequately use mHealth technologies. Providers believed the health system’s barriers were largely privacy, confidentiality, and legal review concerns. Conclusions These findings echo similar studies in other health systems, surrounding providers’ lack of time and concerns over privacy and confidentiality of patient data. Providers emphasized concerns over the complexity of these technologies for their patients and concerns over patients’ internet access to fully use mHealth in their delivery of care.

The present study examined the role of age and sex in the outcomes of non-surgical periodontal therapy (NSPT). De-identified demographic and periodontal characteristics of patients who presented for baseline periodontal evaluation, NSPT, and periodontal re-evaluation were abstracted from electronic health records. Independent associations of age and sex with severe periodontitis defined as ≥ 5 mm clinical attachment loss (CAL) and ≥ 6 mm probing depth (PD) were determined using multinomial logistic regression. The null hypothesis was rejected at α < 0.05. A total of 2866 eligible subjects were included in the analysis. Significantly lower odds of CAL ≤ 4 mm than CAL ≥ 5 mm (reference) were observed in adults aged 35–64 (odds ratio, OR, 0.19; 95% confidence interval, CI 0.13, 0.29) and ≥ 65 years (OR 0.13; 95% CI 0.07, 0.25) compared to those aged 18–34 years. Odds of PD < 4 mm versus PD ≥ 6 mm (reference) were lower in adults aged 35–64 years than those aged 18–34 years (OR 0.71; 95% CI 0.55, 0.90) and higher in females compared to males (OR 1.67; 95% CI 1.14, 2.44). These results suggest more compromised post-NSPT outcomes in older adults and males compared to the respective populations and highlight the need for personalized therapeutic strategies in these populations.

The study aimed to determine the accuracy of diagnosing periodontal conditions using the developed web-based PocketPerio application and evaluate the user’s perspective on the use of PocketPerio. First, 22 third-year dental students (DS3) diagnosed ten cases without PocketPerio (control) and with PocketPerio (test) during a mock examination. Then, 105 DS3, 13 fourth-year dental students (DS4), and 32 senior second-year International Standing Program students (ISP2) used PocketPerio chairside. Statistical analysis was performed using a non-parametric paired two-tailed test of significance with the Wilcoxon matched-pairs signed rank test. The null hypothesis that PocketPerio did not increase the accuracy of periodontal diagnoses was rejected at α < 0.01. Periodontal diagnoses made using PocketPerio correlated with those made by periodontics faculty (“gold standard") in all cases. During the mock examination, PocketPerio significantly increased the accuracy of periodontal diagnoses compared to the control (52.73 vs. 13.18%, respectively). Chairside, PocketPerio significantly increased the accuracy of primary (100 vs. 40.0%) and secondary (100 vs. 14.25%) periodontal diagnoses compared to the respective controls. Students regardless of their training year felt more confident in diagnosing periodontal conditions using PocketPerio than their current tools, provided positive feedback on its features, and suggested avenues for its further development.

BACKGROUND:The evidence base supports effectiveness of dental sealants for prevention of childhood caries in school-aged children.OBJECTIVE:This study describes planning, development, usability testing and outcomes following implementation of DentaSeal, a web-based application designed to accurately track unique student data and generate reports for all Wisconsin school-based sealant placement (SP) programs.METHODS:Application software development was informed by a steering committee of representative stakeholders who were interviewed to inform design and provide feedback for design of DentaSeal during development and evaluation. Software development proceeded based on wireframes developed to build architectural design. Usability testing followed and informed any required adjustments to the application. The DentaSeal prototype was beta tested and fully implemented subsequently in the public health sector.RESULTS:The DentaSeal application demonstrated capacity to: 1) track unique student SP data and longitudinal encounter history, 2) generate reports and 3) support administrative tracking. In 2019, DentaSeal captured SP data of 47 school-based programs in Wisconsin that sponsored > 7,000 program visits for 184,000 children from 62 counties. Delivery of > 548,000 SP services were catalogued.CONCLUSIONS:For public health initiatives targeting reduction in caries incidence, web-based applications such as DentaSeal represent useful longitudinal tracking tools for cataloguing SP in school-based program participants.

BACKGROUND:We performed a preimplementation assessment of workflows, resources, needs, and antibiotic prescribing practices of trainees and practicing dentists to inform the development of an antibiotic-stewardship clinical decision-support tool (CDST) for dentists. METHODS:We used a technology implementation framework to conduct the preimplementation assessment via surveys and focus groups of students, residents, and faculty members. Using Likert scales, the survey assessed baseline knowledge and confidence in dental providers' antibiotic prescribing. The focus groups gathered information on existing workflows, resources, and needs for end users for our CDST. RESULTS:Of 355 dental providers recruited to take the survey, 213 (60%) responded: 151 students, 27 residents, and 35 faculty. The average confidence in antibiotic prescribing decisions was 3.2 ± 1.0 on a scale of 1 to 5 (ie, moderate). Dental students were less confident about prescribing antibiotics than residents and faculty (P < .01). However, antibiotic prescribing knowledge was no different between dental students, residents, and faculty. The mean likelihood of prescribing an antibiotic when it was not needed was 2.7 ± 0.6 on a scale of 1 to 5 (unlikely to maybe) and was not meaningfully different across subgroups (P = .10). We had 10 participants across 3 focus groups: 7 students, 2 residents, and 1 faculty member. Four major themes emerged, which indicated that dentists: (1) make antibiotic prescribing decisions based on anecdotal experiences; (2) defer to physicians' recommendations; (3) have limited access to evidence-based resources; and (4) want CDST for antibiotic prescribing. CONCLUSIONS:Dentists' confidence in antibiotic prescribing increased by training level, but knowledge did not. Trainees and practicing dentists would benefit from a CDST to improve appropriateness of antibiotic prescribing.

OBJECTIVE The frequency of Preventable Infectious Dental Disease (PIDD) visits in medical centers was examined pre and post establishment of expanded dental access and adoption of an integrated medical-dental care delivery model. METHODS A retrospective observational study of patient attributes and frequency of unscheduled PIDD visits between January 1, 1990 and February 29, 2020. Chi-squared tests compared (a) the number of PIDD visits (pre/post dental center establishment), (b) age at first diagnosis, (c) gender, (d) race, (e) primary insurance at the time of PIDD visits and (f) healthcare setting where visit occurred. RESULTS System-wide, 21,957 unique patients were documented with a total of 34,892 PIDD visits as the primary diagnosis. Patients between 18-30 years and patients with Medicaid had the highest frequency of PIDD visits in medical settings. Following the establishment of dental centers, reduced relative risk of PIDD visits was observed for patients with no health insurance or self-pay/other coverage. PIDD visits in primary care settings was 0.87 times as likely as PIDD visits at ED/UCs after dental centers opened. CONCLUSIONS The number of PIDD visits to medical centers increased before the dental infrastructure was established, followed by a decline afterwards, inclusive of disparity populations. Some residual persistence of PIDD visits to primary care settings was identified. This study reinforced importance of dental healthcare access for achieving appropriate PIDD management while reducing PIDD visits to medical settings.

Since the mid-1990s, poor oral health has been neglected as a public health threat, despite its recognition as epidemic in scale by the US Department of Health and Human Services Office of the Surgeon General. Americans' poor oral health influences their overall health and, from a population standpoint, incurs dire economic and human costs. This article describes how health information transfer within the Marshfield Clinic Health System's integrated medical and dental practice can improve diabetes care. This article also considers ethics and equity implications of improving MDP electronic health record interoperability in this large, rural Wisconsin organization.

Oral cavity cancer (OCC) is associated with high morbidity and mortality rates when diagnosed at late stages. Early detection of increased risk provides an opportunity for implementing prevention strategies surrounding modifiable risk factors and screening to promote early detection and intervention. Historical evidence identified a gap in the training of primary care providers (PCPs) surrounding the examination of the oral cavity. The absence of clinically applicable analytical tools to identify patients with high-risk OCC phenotypes at point-of-care (POC) causes missed opportunities for implementing patient-specific interventional strategies. This study developed an OCC risk assessment tool prototype by applying machine learning (ML) approaches to a rich retrospectively collected data set abstracted from a clinical enterprise data warehouse. We compared the performance of six ML classifiers by applying the 10-fold cross-validation approach. Accuracy, recall, precision, specificity, area under the receiver operating characteristic curve, and recall–precision curves for the derived voting algorithm were: 78%, 64%, 88%, 92%, 0.83, and 0.81, respectively. The performance of two classifiers, multilayer perceptron and AdaBoost, closely mirrored the voting algorithm. Integration of the OCC risk assessment tool developed by clinical informatics application into an electronic health record as a clinical decision support tool can assist PCPs in targeting at-risk patients for personalized interventional care.

Background:The objective of this study was to build models that define variables contributing to pneumonia risk by applying supervised Machine Learning-(ML) to medical and oral disease data to define key risk variables contributing to pneumonia emergence for any pneumonia/pneumonia subtypes. Methods:Retrospective medical and dental data were retrieved from Marshfield Clinic Health System's data warehouse and integrated electronic medical-dental health records (iEHR). Retrieved data were pre-processed prior to conducting analyses and included matching of cases to controls by (a) race/ethnicity and (b) 1:1 Case: Control ratio. Variables with >30% missing data were excluded from analysis. Datasets were divided into four subsets: (1) All Pneumonia (all cases and controls); (2) community (CAP)/healthcare associated (HCAP) pneumonias; (3) ventilator-associated (VAP)/hospital-acquired (HAP) pneumonias and (4) aspiration pneumonia (AP). Performance of five algorithms were compared across the four subsets: Naïve Bayes, Logistic Regression, Support Vector Machine (SVM), Multi-Layer Perceptron (MLP) and Random Forests. Feature (input variables) selection and ten-fold cross validation was performed on all the datasets. An evaluation set (10%) was extracted from the subsets for further validation. Model performance was evaluated in terms of total accuracy, sensitivity, specificity, F-measure, Mathews-correlation-coefficient and area under receiver operating characteristic curve (AUC). Results:In total, 6,034 records (cases and controls) met eligibility for inclusion in the main dataset. After feature selection, the variables retained in the subsets were: All Pneumonia (n = 29 variables), CAP-HCAP (n = 26 variables); VAP-HAP (n = 40 variables) and AP (n = 37 variables), respectively. Variables retained (n = 22) were common across all four pneumonia subsets. Of these, the number of missing teeth, periodontal status, periodontal pocket depth more than 5 mm and number of restored teeth contributed to all the subsets and were retained in the model. MLP outperformed other predictive models for All Pneumonia, CAP-HCAP and AP subsets, while SVM outperformed other models in VAP-HAP subset. Conclusion:This study validates previously described associations between poor oral health and pneumonia. Benefits of an integrated medical-dental record and care delivery environment for modeling pneumonia risk are highlighted. Based on findings, risk score development could inform referrals and follow-up in integrated healthcare delivery environment and coordinated patient management.

Introduction: Rates of diabetes/prediabetes continue to increase, with disparity populations disproportionately affected. Previous field trials promoted point-of-care (POC) glycemic screening in dental settings as an additional primary care setting to identify potentially at-risk individuals requiring integrated care intervention. The present study observed outcomes of POC hemoglobin A1c (HbA1c) screening at community health center (CHC) dental clinics (DC) and compliance with longitudinal integrated care management among at-risk patients attending dental appointments. Materials and Methods: POC HbA1c screening utilizing Food and Drug Administration (FDA)-approved instrumentation in DC settings and periodontal evaluation of at-risk dental patients with no prior diagnosis of diabetes/prediabetes and no glycemic testing in the preceding 6 months were undertaken. Screening of patients attending dental appointments from October 24, 2017, through September 24, 2018, was implemented at four Wisconsin CHC-DCs serving populations with a high representation of disparity. Subjects meeting at-risk profiles underwent POC HbA1c screening. Individuals with measures in the diabetic/prediabetic ranges were advised to seek further medical evaluation and were re-contacted after 3 months to document compliance. Longitudinal capture of glycemic measures in electronic health records for up to 2 years was undertaken for a subset (n = 44) of subjects with available clinical, medical, and dental data. Longitudinal glycemic status and frequency of medical and dental access for follow-up care were monitored. Results: Risk assessment identified 224/915 (24.5%) patients who met inclusion criteria following two levels of risk screening, with 127/224 (57%) qualifying for POC HbA1c screening. Among those tested, 62/127 (49%) exhibited hyperglycemic measures: 55 in the prediabetic range and seven in the diabetic range. Moderate-to-severe periodontitis was more prevalent in patients with prediabetes/diabetes than in individuals with measures in the normal range. Participant follow-up compliance at 3 months was 90%. Longitudinal follow-up documented high rates of consistent access (100 and 89%, respectively), to the integrated medical/DC environment over 24 months for individuals with hyperglycemic screening measures. Conclusion: POC glycemic screening revealed elevated HbA1c measures in nearly half of at-risk CHC-DC patients. Strong compliance with integrated medical/dental management over a 24-month interval was observed, documenting good patient receptivity to POC screening in the dental setting and compliance with integrated care follow-up by at-risk patients.

OBJECTIVES:Quality improvement strategies have been an integral part of healthcare to attain improved care delivery and effective health outcomes. The dental quality initiative improvement (DQII) presented in this manuscript represents a case study of successful implementation of a quality improvement culture within a large integrated-medical-dental health system serving a largely rural population.METHODS:The key elements of DQII included steering committee establishment, definition or dental quality measures and development/implementation of a dental quality analytics dashboard (DQAD) that provides relevant data on dental quality measures. Qualitative metrics were applied to look at the improvement in performance for the various measures relative to quality benchmarks.RESULTS:DQII facilitated improved oversight of care continuity and provider performance surrounding quality measures at granular and/or institutional level. Improvement associated with care delivery performance relative to benchmarks was observed.CONCLUSIONS:DQII further advanced the quality improvement culture prevalent in our learning healthcare environment with its focus on value-based care delivery. DQII initiative and establishment of DQAD provided ability to track performance in operational care delivery for dental providers in a clinical setting in real time.

Introduction: To conduct a statewide survey among Wisconsin-based dental providers evaluating current knowledgeability, attitudes and practice behaviors surrounding management of patients with diabetes/prediabetes in the dental setting. The study explored perceptions on feasibility, value, barriers, and current status of integrated care model (ICM) adoption by dental practices Materials and Methods: A 32-question paper-based survey was mailed to all licensed dentists and dental hygienists practicing in Wisconsin. The study was conducted over a 4 week period in 2019. The survey instrument was adapted from a previous validated survey and was expanded to include questions on ICM adoption. Content and validity analyses and beta testing were conducted prior to dissemination of the survey. Descriptive statistics and chi-square tests were applied for data analyses. Thematic analyses was performed on open-ended questions. Results: Survey response rate was 12% ( N = 854/7,356) representing 41% dentists and 59% dental hygienists. While 68% reported educating patients on oral health-diabetes association, only 18% reported medical consultations to inform dental treatment, and “frequent” (22%) or “occasional” (40%), medical triage. Knowledge-based questions were correctly answered by >70% of participants. While 50% valued chair-side glycemic screening and 85% supported non-invasive chair-side screening to identify at-risk patients,>88% relied on patient-reported diabetic status. Barriers to ICM adoption included time investment (70%), patient activation/cooperation (62%), cost (50%), insurance coverage (50%), infrequent interdisciplinary communication (46%), lack of equipment (33%) and provider (31%). Conclusion: Low rates of ICM adoption, chair-side testing, medical consultation and triage, and need for educational curricula reform were identified.