eHealth Records to Improve Dental Care for Patients with Chronic Illnesses

Patients with chronic medical conditions have significant dental care implications including the increased risk of dental conditions such as periodontal disease and cavities, but also the risk of medical complications arising during or after dental treatment. Despite involvement with patients with chronic conditions, dentists lack robust training on these conditions. The result is a less than ideal ability to identify medical issues during dental care and to modify treatment accordingly.

The use of eDental Records (EDRs) is increasing, and presents an opportunity to utilize technology to improve the quality and safety of care by dentists. This project conducted a randomized clinical trial to evaluate the impact of two clinical decision support (CDS) interventions designed to improve the quality and safety of dental care in patients with medically complex conditions, with particular focus on diabetes mellitus, xerostomia, chronic obstructive pulmonary disease, and congestive heart failure.

The main objectives of this project were to:

• Determine the effectiveness of integrated electronic medical record (EMR)-based interventions toward changing dentist and patient behavior.
• Determine the impact of an integrated EMR-based intervention upon the use of emergency and/or restorative dental care.
• Produce and distribute a generalizable, replicable model of evidence-based care recommendations for implementing an integrated health information technology system for diabetes and other chronic illness management within dental care practices throughout the United States.

Two CDS interventions were implemented, one into the EDR targeted to providers, the other into the patient’s personal health record (PHR) targeted to the patient. Fifteen dental practices, representing 102 dental care providers, were randomly assigned to one of the intervention arms or to the control group. The CDS was designed to promote the use of clinical care guidelines for complex medical conditions. Both interventions provided alerts about a patient’s chronic condition and provided links to personalized, condition specific, evidence-based guidelines. For patients without a PHR, notification came via email or the mail. Providers were given information about the implication of the condition during the dental visit and patients were encouraged to discuss their condition with their provider.

Data collected over a 2 year period showed that providers and patients increased their access to the guidelines by 440 percent and 221 percent respectively during the first 6 months. The accuracy of providers documenting medical history and the preventive care recommended in the guidelines increased. No impact on complications was found, although complications were relatively low. However, it is important to note that dental providers’ use of the CDS system declined after the first 6 months despite the continued use of alerts. Despite the decline, the project findings supported the use of CDS for dental patients to enhance decisionmaking and to improve the quality and safety of care for patients with medical conditions.