Quality Evaluation of Tobacco Screening and Cessation by Dental Professionals

Objectives:
Tobacco screening and cessation by dental health care providers is an essential component in the promotion of good oral and general health. Although evidence-based information on tobacco screening and cessation is widely available, rates of patient screening for tobacco use and cessation interventions in dental offices remain low. With the expansion of electronic health records (EHRs) in dentistry, structured data is now available for quality measurement research and evaluation.
Methods: We implemented, adapted and tested the Meaningful Use Stage 2 Tobacco Measure, designed for medical offices, in three dental schools and a large dental accountable care organization. In the primary measure, an automated EHR query identified patients 18 years and older who were screened for tobacco use one or more times within 24 months and who received cessation counseling intervention if identified as a tobacco user. A sub-sample was manually reviewed to determine feasibility and validity of the automated query.
Results: Our study population included 143,870 patients across all four sites with 77.8-100% screened for tobacco use. A total of 18,118 patients were tobacco users and males showed higher rates of tobacco use than females. Rates for tobacco use among males ranged from 11.5% - 25.2% and for females 5.8% - 14.4% across all sites. When evaluating cessation intervention for tobacco users, 5,611 (3.2%) received a tobacco cessation intervention with significant differences among study sites.
Conclusions: Process-of-care quality measurement research can provide valuable information towards personalized and precision oral health care. Our results indicated that the majority of dental patients receive tobacco screening; however, tobacco cessation intervention rates need improvement. Using data from EHRs, dentistry can perform clinical quality evaluations, identify gaps and opportunities for improving patient care including rates of tobacco screening and tobacco cessation.