Development and Implementation of a Uniform Dental School-Wide Electronic Treatment Consenting Process for Patients.

One approach to enhancing quality care outcomes and patient safety is through effective implementation of clinical risk reduction strategies. Clinical risk identification at The Ohio State University College of Dentistry revealed lack of a standardized informed consenting process for patients. The purpose of this project was to develop and implement a uniform college-wide informed consenting process. An operating procedure was also developed. The resulting consenting documents used a uniform approach in which clinics could use a basic readable and processable informed consent template. The template was edited for appropriate content suitable for an electronic health record. Implementing an operating procedure along with associated contemporary uniform electronic informed consent forms was realized through efforts of a core team with informed consenting experience. The core team developed the template and the majority of all documents before editing all division-based consents. This method relied on growing expertise and momentum. Outcomes of chart audits following implementation of the new electronic informed consent forms showed a transitory increase in missing consent forms. Subsequently, the number of missing consent forms decreased to near pre-implementation levels. Patient refunds related to missing informed consent issues dropped, and patient satisfaction remained high throughout the project. Other institutions can use this project as a guide for developing their own uniform consent forms and process.

Analyzing Dental Students' Clinic Production Using Time-Based Relative Value Units: Ten-Year Cross-Cohort Mapping.

The analysis of dental students' clinical production/participation has been used to assess whether a prospective graduate is capable of unsupervised and independent practice (that is, competent to perform that practice). This method and others have inherent biases that may not accurately reflect whether the student has mastered the associated concepts and techniques required for dentistry. The aim of this study was to assess an informatics system that assigned curriculum meta-tags with time-based relative educational value units (ReVUs) to each clinical procedure performed by Medical University of South Carolina (MUSC) students. The system has been used since 1998, but for this study the complete data sets for the MUSC graduating classes of 2007 through 2016 were mapped using microcompetency codes for the dental procedures. In total, 421,494 procedures were formatted and analyzed using software developed to aggregate disparate data sets from clinical activities into a common format for evaluation. The results showed that the ten classes (cohorts) were very consistent with cohort high ReVUs averaging 7,317.1 points, cohort mean ReVUs being 5,180.2 points, and cohort low ReVUs averaging 3,381 points. A detailed analysis of student effort by dental subspecialty found that preventive activities represented 13.4%, patient assessment 32.6%, periodontology 2.8%, restorative dentistry 16.3%, prosthodontics 21.9%, endodontics 6.7%, and oral surgery 5.7% of the total points in the clinical part of the curriculum. In this system, point thresholds can be easily generated to monitor students' progress towards competence for each defined competency and thus assess their progress towards acquiring the skills required for unsupervised, independent practice.

Does use of an electronic health record with dental diagnostic system terminology promote dental students' critical thinking?

The Consortium for Oral Health Research and Informatics (COHRI) is leading the way in use of the Dental Diagnostic System (DDS) terminology in the axiUm electronic health record (EHR). This collaborative pilot study had two aims: 1) to investigate whether use of the DDS terms positively impacted predoctoral dental students' critical thinking skills measured by the Health Sciences Reasoning Test (HSRT), and 2) to refine study protocols. The study design was a natural experiment with cross-sectional data collection using the HSRT for 15 classes (2013-17) of students at three dental schools. Characteristics of students who had been exposed to the DDS terms were compared with students who had not, and the differences were tested by t-tests or chi-square tests. Generalized linear models were used to evaluate the relationship between exposure and outcome on the overall critical thinking score. The results showed that exposure was significantly related to overall score (p=0.01), with not-exposed students having lower mean overall scores. This study thus demonstrated a positive impact of using the DDS terminology in an EHR on the critical thinking skills of predoctoral dental students in three COHRI schools as measured by their overall score on the HSRT. These preliminary findings support future research to further evaluate a proposed model of critical thinking in clinical dentistry.

An evidenced-based scoring index to determine the periodontal prognosis on molars.

BACKGROUND: This retrospective study evaluates and assigns scores to six prognostic factors and derives a quantitative scoring index used to determine the periodontal prognosis on molar teeth. METHODS: Data were gathered on 816 molars in 102 patients with moderate-to-severe periodontitis. The six factors evaluated (age, probing depth, mobility, furcation involvement, smoking, and molar type) were assigned a numeric score based on statistical analysis. The sum of the scores for all factors was used to determine the prognosis score for each molar. Only patients with all first and second molars at the initial examination qualified for the study. All patients were evaluated a minimum of 15 years after treatment. RESULTS: The post-treatment time ranged from 15 to 40 years and averaged 24 years. When the study was completed, 639 molars survived (78%), and, of those surviving molars, 588 survived and were periodontally healthy (92%). In molars with lower scores (scores 1-3), the 15-year survival rates ranged from 98% to 96%. In molars with middle scores (scores 4-6), the 15-year survival rates ranged from 95% to 90%, and, for molars with higher scores (scores 7-10), the survival rates ranged from 86% to 67%. CONCLUSION: The present results indicate that the periodontal prognosis of molars diagnosed with moderate-to-severe periodontitis can be calculated using an evidence-based scoring index.