Background The emergence of health information technology provides an opportunity to improve the quality and safety of dental care, particularly for medically compromised patients.
Objective: Evaluate the effectiveness of reminders prompting dental providers to utilize guidelines to improve the quality and safety of dental care for patients with diabetes mellitus, congestive heart failure, and pulmonary disease., and 4) xerostomia.
Methods: A 3- arm, 2-year prospective, cluster-randomized clinical trial was implemented within 15 HealthPartners Dental Group (HPDG) clinics and 102 providers. A patient alert (PHR) and provider alert (EDR) were tested against regular care. Outcomes were defined as correction of medical, caries risk, and periorisk documentation in dental records, and average of preventive and periodontic encounters. Intervention effect was tested using pair-wise comparisons of correction rates in the post-implementation period and pair-wise comparisons of changes between post-and pre implementation for preventive and periodontic encounters. Generalized linear models were used to analyze the data.
Results: Data included 7,750 dental patients, mean age 54, and 54% female. Results indicated that rates of correction for documentation of condition, caries risk or periodontic did not differ across intervention arms. Average number of preventive dental encounters increased more in the EDR compared to control arm for diabetes (p=.006) and COPD (p=.01) patients, while average preventive dental encounters (p=0.046) and average periodontic encounters (p=.01) were higher in the PHR as compared to the control arm for COPD.
Conclusions: The project demonstrated that utilization of clinical guidelines for medically compromised patients can be improved with clinical decision support using e-dental records with provider and patient activation strategies. However, negative results regarding changes in care and documentation suggest providers require more robust decision support systems which readily record that guideline-based care was provided.