Referral rate for obstructive sleep apnea in a pre-doctoral dental clinic using the STOP-Bang Questionnaire.

OBJECTIVES: Obstructive sleep apnea (OSA) is a common condition that can result in significant illness when untreated. Only 10%-20% of individuals with OSA are believed to be properly diagnosed. Consequently, dentists are encouraged to identify patients at high risk for OSA. The aim of this study was to determine whether patients in a dental school student clinic were referred for evaluation of OSA when appropriate. MATERIALS AND METHODS: All patients 18 or older admitted to the College of Dentistry between July 2017 and March 2020 completed a medical history form. Data were extracted from their responses to determine a STOP-Bang score, as well as data regarding a previous diagnosis of OSA and a list of referrals. Students are expected to refer patients appropriately where there are indications of a high risk of undiagnosed disease. In the case of a sleep apnea evaluation, this would include any patient whose STOP-Bang score was 5 or greater, per the lecture on sleep disorders. For patients identified as high risk, notes and referral forms were reviewed to determine if the appropriate referral occurred. RESULTS: Of the 21,312 new patients, 1098 (5.2%) were identified as high-risk for OSA. Of those, 398 (36%) had not been previously diagnosed with OSA. None of these 398 patients received a referral for further evaluation of OSA. CONCLUSION: The rate of referral for further evaluation for patients deemed at high risk for OSA was inadequate. Continued education and changes to the electronic health record are needed to ensure those at high-risk for OSA are appropriately managed.

Accuracy of Parental Self-Report of Medical History in a Dental Setting: Integrated Electronic Health Record and Nonintegrated Dental Record.

Purpose: The purpose of this study was to evaluate the extent of concordance and significance of inaccuracies between a parent-reported medical history in a nonintegrated electronic dental record (EDR) and an integrated electronic health record (EHR). Methods: In a retrospective institutional review board chart review, a single trained examiner compared medical histories in an EDR with the same patient's history from an EHR for concordance in sociodemographic, medical condition, allergy, and medication variables deemed significant to dental care. Of 4,282 possible patient comparisons, 291 patients were randomly sampled and compared. Concordance between record types was generated for each variable using the EHR as the ideal standard. Data were analyzed using percent match comparison and logistic regression. Results: Only 10 of 45 variables (22 percent) met the standard to match. Present conditions were more likely to be unreported than falsely reported in the EDR (58 percent). Logistic regression revealed multiple significant associations between sociodemographic variables and concordance between the EDR and EHR on specific medical conditions and medications. Conclusions: Discrepancies exist between parent-reported medical histories (EDR) and composite health histories (EHR), with the potential to compromise patient safety and create an opportunity for medical error. Social determinants of health are associated with true-positive and true-negative reporting of medications and medical conditions. EHRs allow clinicians access to a greater depth of health history information in real time compared to nonintegrated health records, but medical history-taking skills should remain at the forefront of dental education and dental practice.

Clinical Integration in a Dental School Clinic Through an Enhanced Patient Intake Process.

Dental care in the U.S. is based on a general practice model of care delivery that can be enhanced by the integration of the dentists and allied dental professionals. There are 25 U.S. dental schools with associated dental hygiene programs, presenting distinctive opportunities for educating the dental health care team. Integrated educational clinical experiences are believed to positively influence teamwork and quality of care that parallels the authentic general practice environment. Lean management, developed by Toyota and used in a variety of types of organizations including health care, provides a distinctive blend of engineering principles and operations management to enhance business and operations processes. A fundamental principle of Lean management is the elimination of waste and preservation of only those value-added components of a process. The faculty and staff of The Ohio State University College of Dentistry, trained in Lean process improvement, applied techniques to enhance and integrate an inefficient patient intake (admissions) process. The aim of this initiative was to improve patient throughput in the patient intake process and to provide dental and dental hygiene students with enhanced educational experiences from improved clinical integration. These goals were achieved through streamlining patient flow and relocating major phases of the process. Although new patient retention and cancellation/no-show rates remained mostly unchanged, this enhancement project resulted in improved access to care, improved continuity of care, expanded scope of dental services offered, improved patient satisfaction, and enhanced dental and dental hygiene student collaboration and teamwork. These outcomes suggest that process improvement initiatives can serve as valuable opportunities for integration of the dental health care team.

Gifts from orthodontists to general dentists.

OBJECTIVES: To determine how often general dentists receive gifts from orthodontists, the value and number of the gifts they receive, and how they perceive the motivation behind the gift. MATERIALS AND METHODS: This was a questionnaire-based study. A questionnaire was constructed and tested for validity and reliability. An electronic version of survey was sent via email to 1300 general dentists. RESULTS: The validity and reliability of the survey was confirmed. Two hundred fifty-four valid responses were received (20%). Eighty-five percent of responding general practitioners reported that they received gifts from an orthodontist. Almost 100% reported that they referred patients to orthodontists. About one-third of the responding general practitioners reported that their office provided orthodontic care. There were statistically significant correlations between the number of annual patient referrals the general practitioners reported making and the number and value of the gifts they received from the orthodontists. Female general practitioners reported receiving a higher number of gifts of greater total value than male practitioners. General practitioners who reported providing orthodontic treatment did not differ from those who did not in the number of referrals they made annually and the number and value of the gifts they received. Quality of care was the most common reason general practitioners reported for their referral to an orthodontist. Forty-four percent of the responders reported that they received discounted orthodontic treatment. CONCLUSIONS: General practitioners refer patients to orthodontists and receive gifts from them. The number and value of the gifts reflects the number of referrals they make.