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  • Measure Summary
  • NQMC:010573
  • Oct 2015

Annual dental visit: percentage of members 2 to 20 years of age who had at least one dental visit during the measurement year.

National Committee for Quality Assurance (NCQA). HEDIS 2016: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2015. various p.
National Committee for Quality Assurance (NCQA). HEDIS 2016: Healthcare Effectiveness Data and Information Set. Vol. 2, technical specifications for health plans. Washington (DC): National Committee for Quality Assurance (NCQA); 2015. various p.

This is the current release of the measure.

This measure updates previous versions:

  • National Committee for Quality Assurance (NCQA). HEDIS 2015: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2014. various p.
  • National Committee for Quality Assurance (NCQA). HEDIS 2015: Healthcare Effectiveness Data and Information Set. Vol. 2, technical specifications for health plans. Washington (DC): National Committee for Quality Assurance (NCQA); 2014. various p.

Primary Measure Domain

Clinical Quality Measures: Access

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of members 2 to 20 years of age who had at least one dental visit during the measurement year. This measure applies only if dental care is a covered benefit in the organization's Medicaid contract.

Rationale

The average American adult has between 10 and 17 decayed, missing or filled permanent teeth. About half of all adults have gingivitis (gum inflammation) and 80 percent have experienced some degree of destruction of the bone supporting the teeth.

Tooth decay is the most common disease known to man. The number of cavities in school-age children has been declining since the 1940s, yet the average child still has at least:

  • 1 cavity in permanent teeth by age 9
  • 2.6 cavities in permanent teeth by age 12
  • 8 cavities in permanent teeth by age 17

Guidelines set by the American Academy of Pediatric Dentistry (AAPD) (2002), the American Dental Association (ADA) ("Baby's first teeth," 2002) and the American Academy of Pediatrics (AAP) (Hale, 2003) recommend the first dental visit occur for children by one year of age. Regular visits to the dentist provide access to cleaning, early diagnosis and treatment, as well as education on how to prevent problems.

Evidence for Rationale

American Academy of Pediatric Dentistry. Guideline on infant oral health. Pediatr Dent. 2002;2(24):46.

For the dental patient: baby's first teeth. J Am Dent Assoc. 2002 Feb;133(2):255. PubMed External Web Site Policy

Hale KJ. Oral health risk assessment timing and establishment of the dental home. Pediatrics. 2003 May;111(5 Pt 1):1113-6. [22 references] PubMed External Web Site Policy

National Committee for Quality Assurance (NCQA). HEDIS 2016: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2015. various p.

Primary Health Components

Dental care; access

Denominator Description

Medicaid members age 2 to 20 years as of December 31 of the measurement year (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

One or more dental visits with a dental practitioner during the measurement year (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

  • Dental caries (cavities) is one of the most common, preventable childhood diseases (National Institute of Dental and Craniofacial Research [NIDCR], 2000). Regular dental visits provide access to cleaning, early diagnosis and treatment, as well as to education about caring for teeth to prevent problems. Approximately 25 percent of our nation's children have multiple cavities, and tooth decay is the major cause of tooth loss in children (American Academy of Pediatric Dentistry [AAPD], 2014).
  • Every year in the United States, there are about 500 million visits to the dentist. In 2010, an estimated $108 billion was spent on dental services for oral health problems (National Center for Chronic Disease Prevention and Health Promotion [NCCDPHP], 2011).
  • Dental caries remains the most common chronic disease of children and it is four times more common than asthma among adolescents (NCCDPHP, 2013).
  • Oral health is essential to overall health. Dental diseases have a detrimental effect on quality of life in childhood and in older age (World Health Organization [WHO], 2003). Annual dental visits and oral care during infancy and continued throughout childhood and adolescence can significantly reduce the risks of developing oral disease (Dye et al., 2007).

Evidence for Additional Information Supporting Need for the Measure

American Academy of Pediatric Dentistry (AAPD). Fast facts. Chicago (IL): American Academy of Pediatric Dentistry (AAPD); 2014. 45 p.

Dye BA, Tan S, Smith V, Lewis BG, Barker LK, Thornton-Evans G, Eke PI, Beltrán Aguilar ED, Horowitz AM, Li CH. Trends in oral health status: United States, 1988-1994 and 1999-2004. Vital Health Stat 11. 2007 Apr;(248):1-92. PubMed External Web Site Policy

National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). Oral health: preventing cavities, gum disease, tooth loss, and oral cancers. Atlanta (GA): Centers for Disease Control and Prevention (CDC); 2011. 4 p.

National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). Using fluoride to prevent and control tooth decay in the United States. [internet]. Atlanta (GA): Centers for Disease Control and Prevention (CDC); 2013 Jul 10. 

National Committee for Quality Assurance (NCQA). The state of health care quality 2015. Washington (DC): National Committee for Quality Assurance (NCQA); 2015. 205 p.

National Institute of Dental and Craniofacial Research (NIDCR). Oral health in America: a report of the Surgeon General. Rockville (MD): National Institutes of Health (NIH); 2000. 308 p.

World Health Organization (WHO). Dental diseases and oral health. Geneva (Switzerland): World Health Organization (WHO); 2003. 2 p.

Extent of Measure Testing

All HEDIS measures undergo systematic assessment of face validity with review by measurement advisory panels, expert panels, a formal public comment process and approval by the National Committee for Quality Assurance's (NCQA's) Committee on Performance Measurement and Board of Directors. Where applicable, measures also are assessed for construct validity using the Pearson correlation test. All measures undergo formal reliability testing of the performance measure score using beta-binomial statistical analysis.

Evidence for Extent of Measure Testing

Rehm B. (Assistant Vice President, Performance Measurement, National Committee for Quality Assurance, Washington, DC). Personal communication. 2015 Mar 16.  1 p.

State of Use

Current routine use

Current Use

Accreditation

Decision-making by businesses about health plan purchasing

Decision-making by consumers about health plan/provider choice

External oversight/Medicaid

External oversight/State government program

Internal quality improvement

Measurement Setting

Ambulatory/Office-based Care

Managed Care Plans

Professionals Involved in Delivery of Health Services

Dentists

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Ages 2 to 20 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Health and Well-being of Communities
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Staying Healthy

IOM Domain

Effectiveness

Case Finding Period

December 31 of the measurement year

Denominator Sampling Frame

Enrollees or beneficiaries

Denominator (Index) Event or Characteristic

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Time window precedes index event

Denominator Inclusions/Exclusions

Inclusions
Medicaid members age 2 to 20 years as of December 31 of the measurement year

Note:

  • Members must have been continuously enrolled during the measurement year.
  • Allowable Gap: No more than one gap in enrollment of up to 45 days during the measurement year. To determine continuous enrollment for a Medicaid beneficiary for whom enrollment is verified monthly, the member may not have more than a 1-month gap in coverage.
  • Visits for many 1-year-olds will be counted because the specification includes children whose second birthday occurs during the measurement year.

Exclusions
Unspecified

Value Set Information
Measure specifications reference value sets that must be used for HEDIS reporting. A value set is the complete set of codes used to identify the service(s) or condition(s) included in the measure. Refer to the NCQA Web site External Web Site Policy to purchase HEDIS Volume 2, which includes the Value Set Directory.

Exclusions/Exceptions

Does not apply to this measure

Numerator Inclusions/Exclusions

Inclusions
One or more dental visits (Dental Visits Value Set) with a dental practitioner during the measurement year

Exclusions
Unspecified

Value Set Information
Measure specifications reference value sets that must be used for HEDIS reporting. A value set is the complete set of codes used to identify the service(s) or condition(s) included in the measure. Refer to the NCQA Web site External Web Site Policy to purchase HEDIS Volume 2, which includes the Value Set Directory.

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Analysis by subgroup (stratification by individual factors, geographic factors, etc.)

Description of Allowance for Patient or Population Factors

The measure reports six age stratifications and a total rate.

  • 2 to 3 years
  • 4 to 6 years
  • 7 to 10 years
  • 11 to 14 years
  • 15 to 18 years
  • 19 to 20 years
  • Total

The total is the sum of the age stratifications.

Standard of Comparison

External comparison at a point in, or interval of, time

External comparison of time trends

Internal time comparison

Original Title

Annual dental visit (ADV).

Measure Collection Name

HEDIS 2016: Health Plan Collection

Measure Set Name

Access/Availability of Care

Submitter

National Committee for Quality Assurance - Health Care Accreditation Organization

Developer

National Committee for Quality Assurance - Health Care Accreditation Organization

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

National Committee for Quality Assurance's (NCQA's) Measurement Advisory Panels (MAPs) are composed of clinical and research experts with an understanding of quality performance measurement in the particular clinical content areas.

Financial Disclosures/Other Potential Conflicts of Interest

In order to fulfill National Committee for Quality Assurance's (NCQA's) mission and vision of improving health care quality through measurement, transparency and accountability, all participants in NCQA's expert panels are required to disclose potential conflicts of interest prior to their participation. The goal of this Conflict Policy is to ensure that decisions which impact development of NCQA's products and services are made as objectively as possible, without improper bias or influence.

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2015 Oct

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

This measure updates previous versions:

  • National Committee for Quality Assurance (NCQA). HEDIS 2015: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2014. various p.
  • National Committee for Quality Assurance (NCQA). HEDIS 2015: Healthcare Effectiveness Data and Information Set. Vol. 2, technical specifications for health plans. Washington (DC): National Committee for Quality Assurance (NCQA); 2014. various p.

Source(s)

National Committee for Quality Assurance (NCQA). HEDIS 2016: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2015. various p.

National Committee for Quality Assurance (NCQA). HEDIS 2016: Healthcare Effectiveness Data and Information Set. Vol. 2, technical specifications for health plans. Washington (DC): National Committee for Quality Assurance (NCQA); 2015. various p.

Measure Availability

Source available for purchase from the National Committee for Quality Measurement (NCQA) Web site External Web Site Policy.

For more information, contact NCQA at 1100 13th Street, NW, Suite 1000, Washington, DC 20005; Phone: 202-955-3500; Fax: 202-955-3599; Web site: www.ncqa.org External Web Site Policy.

Companion Documents

The following are available:

  • National Committee for Quality Assurance (NCQA). The state of health care quality 2015. Washington (DC): National Committee for Quality Assurance (NCQA); 2015 Oct. 205 p.
  • National Committee for Quality Assurance (NCQA). HEDIS 2016: Healthcare Effectiveness Data and Information Set. Vol. 2, technical update. Washington (DC): National Committee for Quality Assurance (NCQA); 2015 Oct 1. 12 p.

For more information, contact the National Committee for Quality Assurance (NCQA) at 1100 13th Street, NW, Suite 1000, Washington, DC 20005; Phone: 202-955-3500; Fax: 202-955-3599; Web site: www.ncqa.org External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI on August 7, 2003. The information was verified by the measure developer on October 24, 2003.

This NQMC summary was updated by ECRI on May 25, 2005. The information was verified by the measure developer on December 15, 2005.

This NQMC summary was updated by ECRI Institute on May 15, 2008. The information was verified by the measure developer on June 17, 2008.

This NQMC summary was updated by ECRI Institute on March 27, 2009. The information was verified by the measure developer on May 29, 2009.

This NQMC summary was updated by ECRI Institute on February 4, 2010 and on June 7, 2011.

This NQMC summary was retrofitted into the new template on July 1, 2011.

This NQMC summary was updated by ECRI Institute on September 18, 2012, August 2, 2013, February 3, 2014, April 15, 2015, and again on February 19, 2016.

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