VA Validation of the DQA Adult Fluoride Quality Measure

Objectives: The purpose of this study was to validate the Dental Quality Alliance’s measure “Topical Fluoride for Adults at Elevated Caries Risk” using Department of Veterans Affairs electronic health record data. This measure has been previously validated using administrative enrollment and claims data.
Methods: Study sample included Veterans who were eligible for continuous and comprehensive care within VA dental service clinics; received a comprehensive or periodic oral exam during FY2016; and were considered moderate or high caries risk, defined as ≥3 CDT codes for specific single tooth restorations during FY2013-2016 (denominator). The intervention measured was receipt of ≥2 professionally applied fluoride treatments during FY2016 (numerator). The rate (numerator/denominator) was calculated overall at the national level and stratified by age groups. The rates by VISN, administrative parent facility and individual clinic level were also calculated.
Results: The study population consisted of 18,567 Veterans. Nationally, 51% received ≥2 professionally-applied fluoride treatments during the monitored period. A linear relationship was observed with age, with increased rates of Veterans receiving fluoride with increasing age (lowest rate=37% in the 18-34 age group and highest rate=55% in the 65-74 age group). The mean rate at the VISN (N=21) level was 52% (median=52%; range=35%-72%), while the mean at the administrative parent facility (N=139) was 51% (median=54%; range=2%-91%). At the individual clinic level (N=219) the mean rate was 51% (median=51%; range=0%-100%).
Conclusions: Nationally, 51% of moderate or high caries risk Veterans met the DQA’s measure for professionally-applied fluoride for adults. The wider ranges observed for meeting the measure at the administrative parent facility and clinic level may be due to different denominator sizes of some facilities/clinics, therefore, reliability testing for this measure in electronic health record data is required.