Decision Support to Improve Dental Care for Medically Compromised Patients

Chronic conditions such as diabetes, heart disease, pulmonary disease, and conditions that cause xerostomia (dry mouth), impact the quality and safety of dental care patients receive. Dentists often fail to follow guidelines for these conditions because they are either unaware of their patients’ chronic conditions or the guidelines. Clinical decision support (CDS) embedded within electronic dental records (EDRs) offers a method of informing and activating dentists to follow these guidelines for their patients with chronic conditions.

This study evaluated the eDental Guides CDS system that integrated dental and medical records with clinical guidelines to improve the quality and safety of dental care for medically complex patients. The three main components to the eDental Guides were a patient medical summary, individualized treatment recommendations, and clinical guidelines. The CDS also had three strategies designed to alert dental providers to the individualized treatment recommendations: (1) active pop-up alerts in front of the EDR that requires the dentist to reference the personalized guidelines; (2) passive alerts in the clinic schedule that encouraged, but did not require, reference to personalized guidelines; and (3) flashing control alerts with a web link to general guidelines.

The specific aims of this project were as follows:

• Determine the impact that the three alert strategies have on increasing the use of and adherence to evidence-based guidelines. 
• Determine the impact of the three alert strategies on improving dental care utilization and reducing emergency visits due to adverse events. 
• Develop strategies to integrate the eDental Guides CDS within community-based health information exchange formats to allow use by community dentists. 

Fifteen dental clinics from HealthPartners, an integrated health system in Minnesota, were randomized to one of the three alert types. During the 12-month study, there was increased utilization of the eDental Guides CDS regardless of the alert type. Overall, the pop-up alert was more effective in encouraging providers to review care recommendations compared to the passive and control alerts; however, the passive alert was the most preferred by dental providers because it was the least intrusive. The project team concluded that future dental care delivery systems and EDRs should expand the use of CDS at the point of care to help dental care professionals integrate medical knowledge into routine clinical practice.