Caries Outcome Quality Measures Derived From An Electronic Health Record

Objectives: To develop caries outcomes measures for untreated decay and new caries experience using electronic health record data based on oral health measures defined by Healthy People 2020.
Methods: Methods to calculate new and untreated decay based on data collected in the electronic health record (EHR) were developed and implemented at two academic institutions and one Accountable Care Organization for years 2016, 2017 and 2018. Measures were adapted using procedures and methods from validated caries indices (White J, et. al. Developing and Testing Electronic Health Record-Derived Caries Indices. Caries Research, 2019). New caries experience is calculated as the percentage of dentate patients who experienced new tooth decay in the reporting year and also had a prior exam in the previous 3 years. New caries experience is identified as a tooth previously recorded as sound at last examination, that is now diagnosed with decay (D), filled due to decay (F) or extracted due to decay (M). The outcome measure reports the % of patients with new decay out of all comprehensive care patients seen for exam. Untreated decay is the percentage of dentate patients with an exam in the reporting year who had untreated active decay as measured at the end of the reporting year. Stratification variables included caries risk, age and gender.
Results: Results: New and untreated decay measures were successfully developed and implemented at 3 sites, reporting over 3 years of data. Untreated decay ranged from 10.4% to 34.8% across the sites/years (n=738,496). New decay ranged from 12.5% to 27.3% (n=459,421). New decay increased with caries risk: low=4%, moderate=15.5%, high/extreme=50.9%. The number of qualifying patients, untreated and new decay and percentages by site and year are reported in the table.
Conclusions: Caries outcome measures of new and untreated decay can be derived from the EHR. New decay is more common in patients assessed with high caries risk. Caries outcome measures, previously reported primarily in population health, can be implemented as quality measures to assess a caries prevention program (new decay) and appropriate and timely therapy of disease (untreated decay).