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  • Measure Summary
  • NQMC:010060
  • Oct 2014
  • NQF-Endorsed Measure

Dental care: number of ED visits for caries-related reasons per 100,000 member months for all enrolled children.

American Dental Association (ADA). Dental Quality Alliance user guide for measures calculated using administrative claims data, version 2.0. Chicago (IL): Dental Quality Alliance (DQA); 2016 Jan 1. 27 p. [26 references]
Dental Quality Alliance (DQA). DQA measure specification sheet: ambulatory care sensitive emergency department visits for dental caries in children. Chicago (IL): Dental Quality Alliance (DQA); 2015. 8 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in April 2016.

Primary Measure Domain

Related Health Care Delivery Measures: Use of Services

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the number of emergency department (ED) visits for caries-related reasons per 100,000 member months for all enrolled children.

Note:

  • This measure only applies to programs such as Medicaid that provide both medical insurance and dental benefit.
  • This measure was developed for program-level reporting for such programs as Medicaid and the Children's Health Insurance Program that include both medical and dental benefits.

Rationale

There are approximately 1 million emergency department (ED) visits per year for non-traumatic dental conditions in the United States and more than 200,000 visits are made by children (Allareddy et al., "Hospital-based emergency department visits involving dental conditions," 2014; Seu, Hall, & Moy, 2012; Allareddy et al., "Hospital-based emergency department visits with dental conditions among children," 2014). Untreated dental caries (tooth decay) and its sequelae (e.g., dental infections) account for almost 80% of these visits (Seu, Hall, & Moy, 2012; Allareddy et al., "Hospital-based emergency department visits with dental conditions among children," 2014). Dental caries is preventable, and use of the ED for dental caries related conditions results in substantial costs (Allareddy et al., "Hospital-based emergency department visits involving dental conditions," 2014; Allareddy et al., "Hospital-based emergency department visits with dental conditions among children," 2014). Moreover, ED care for dental caries-related conditions is generally not definitive compared to that provided in primary care dental settings and often results in referral to primary care dental sites (Cohen et al., 2011; Hocker et al., 2012; Lewis, Lynch, & Johnston, 2003).

Evidence for Rationale

Allareddy V, Nalliah RP, Haque M, Johnson H, Rampa SB, Lee MK. Hospital-based emergency department visits with dental conditions among children in the United States: nationwide epidemiological data. Pediatr Dent. 2014 Sep-Oct;36(5):393-9. PubMed External Web Site Policy

Allareddy V, Rampa S, Lee MK, Allareddy V, Nalliah RP. Hospital-based emergency department visits involving dental conditions: profile and predictors of poor outcomes and resource utilization. J Am Dent Assoc. 2014 Apr;145(4):331-7. PubMed External Web Site Policy

Cohen LA, Bonito AJ, Eicheldinger C, Manski RJ, Macek MD, Edwards RR, Khanna N. Comparison of patient visits to emergency departments, physician offices, and dental offices for dental problems and injuries. J Public Health Dent. 2011;71(1):13-22. PubMed External Web Site Policy

Dental Quality Alliance (DQA). DQA measure specification sheet: ambulatory care sensitive emergency department visits for dental caries in children. Chicago (IL): Dental Quality Alliance (DQA); 2015. 8 p.

Hocker MB, Villani JJ, Borawski JB, Evans CS, Nelson SM, Gerardo CJ, Limkakeng AT. Dental visits to a North Carolina emergency department: a painful problem. N C Med J. 2012 Sep-Oct;73(5):346-51. PubMed External Web Site Policy

Lewis C, Lynch H, Johnston B. Dental complaints in emergency departments: a national perspective. Ann Emerg Med. 2003 Jul;42(1):93-9. PubMed External Web Site Policy

Seu K, Hall KK, Moy E. Emergency department visits for dental-related conditions, 2009. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2012 Nov. 12 p.  (Healthcare Cost and Utilization Project Statistical Brief; no. 143).

Primary Health Components

Dental care; dental caries; emergency department (ED) visits; children

Denominator Description

All member months for enrollees 0 through 20 years during the reporting year (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of emergency department (ED) visits with caries-related diagnosis code among all enrolled children (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

This system-level measure focuses specifically on dental caries-related emergency department (ED) visits because: (1) dental caries (tooth decay) plays a central role in dental disease among children, (2) dental caries incidence can reduced through routine and preventive dental care, and (3) dental caries, once present, can be effectively managed in outpatient settings with early identification and treatment. Consequently ED visits for caries-related reasons by children is a system-level outcome representing an avoidable deterioration in oral health and overall health due to untreated dental caries. This outcome can be positively impacted by evidenced-based processes of care delivered in outpatient dental settings.

Dental caries is the most common chronic disease in children in the United States (Centers for Disease Control and Prevention [CDC], 2013). In 2009 to 2010, 14% of children aged 3 to 5 years had untreated dental caries. Among children aged 6 to 9 years, 17% had untreated dental caries, and among adolescents aged 13 to 15, 11% had untreated dental caries (Dye, Li, & Thorton-Evans, 2012). Untreated dental decay among children has significant short- and long-term adverse consequences (Tinanoff & Reisine, 2009). Among the more significant of these outcomes is emergency department visits for dental caries-related problems (e.g., tooth pain, abscesses).

Dental conditions, primarily from untreated dental caries (tooth decay), are responsible for the majority of non-traumatic dental-related ED visits among children (Allareddy et al., 2014). Non-traumatic dental-related ED visits have been increasing over time. An analysis of the trends in ED visits with non-traumatic dental-related International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes for the overall population using the National Hospital Ambulatory Medical Care Survey data found that non-traumatic dental-related ED visits increased by 4% annually on average over the period 1997 to 2007, exceeding the rate of growth both for ED visits in general and for ED visits for non-dental ambulatory care sensitive conditions (Okunseri et al., 2012).

ED care for dental caries-related problems is generally not definitive compared to that provided in primary care dental settings and often results in referral to primary care dental sites (Cohen et al., 2011; Hocker et al., 2012). However, these ED visits could be significantly reduced through routine clinical oral evaluations, receipt of evidence-based preventive services, and adoption of good oral health habits by children and their caregivers (American Academy of Pediatric Dentistry, 2013; Ahovuo-Saloranta et al., 2013; Beauchamp et al., 2008; National Institute for Health and Clinical Excellence [NICE], 2004; Tinanoff & Reisine, 2009; Weyant et al., 2013).

Evidence for Additional Information Supporting Need for the Measure

Ahovuo-Saloranta A, Forss H, Walsh T, Hiiri A, Nordblad A, Makela M, Worthington HV. Sealants for preventing dental decay in the permanent teeth. Cochrane Database Syst Rev. 2013;3:CD001830. PubMed External Web Site Policy

Allareddy V, Nalliah RP, Haque M, Johnson H, Rampa SB, Lee MK. Hospital-based emergency department visits with dental conditions among children in the United States: nationwide epidemiological data. Pediatr Dent. 2014 Sep-Oct;36(5):393-9. PubMed External Web Site Policy

American Academy of Pediatric Dentistry. Guideline on periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents. Pediatr Dent. 2013 Sep-Oct;35(5):E148-56. PubMed External Web Site Policy

Beauchamp J, Caufield PW, Crall JJ, Donly K, Feigal R, Gooch B, Ismail A, Kohn W, Siegal M, Simonsen R, American Dental Association Council on Scientific Affairs. Evidence-based clinical recommendations for the use of pit-and-fissure sealants: a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc. 2008 Mar;139(3):257-68. PubMed External Web Site Policy

Centers for Disease Control and Prevention (CDC). Children's oral health. [internet]. Atlanta (GA): Centers for Disease Control and Prevention (CDC); 2013 [accessed 2015 Jan 11].

Cohen LA, Bonito AJ, Eicheldinger C, Manski RJ, Macek MD, Edwards RR, Khanna N. Comparison of patient visits to emergency departments, physician offices, and dental offices for dental problems and injuries. J Public Health Dent. 2011;71(1):13-22. PubMed External Web Site Policy

Dye BA, Li X, Thornton-Evans G. Oral health disparities as determined by selected healthy people 2020 oral health objectives for the United States, 2009-2010. NCHS Data Brief. 2012 Aug;(104):1-8. PubMed External Web Site Policy

Hocker MB, Villani JJ, Borawski JB, Evans CS, Nelson SM, Gerardo CJ, Limkakeng AT. Dental visits to a North Carolina emergency department: a painful problem. N C Med J. 2012 Sep-Oct;73(5):346-51. PubMed External Web Site Policy

National Institute for Health and Clinical Excellence (NICE). Dental recall -- recall interval between routine dental examinations. London (UK): National Institute for Health and Clinical Excellence (NICE); 2004 Oct.  (Clinical guideline; no. 19). 

Okunseri C, Okunseri E, Thorpe JM, Xiang Q, Szabo A. Patient characteristics and trends in nontraumatic dental condition visits to emergency departments in the United States. Clin Cosmet Investig Dent. 2012;4:1-7. PubMed External Web Site Policy

Tinanoff N, Reisine S. Update on early childhood caries since the Surgeon General's Report. Acad Pediatr. 2009 Nov-Dec;9(6):396-403. PubMed External Web Site Policy

Weyant RJ, Tracy SL, Anselmo TT, Beltran-Aguilar ED, Donly KJ, Frese WA, Hujoel PP, Iafolla T, Kohn W, Kumar J, Levy SM, Tinanoff N, Wright JT, Zero D, Aravamudhan K, Frantsve-Hawley J, Meyer DM, American Dental Association Council on Scientific Affairs Expert Panel on Topical Fluoride Caries Pr. Topical fluoride for caries prevention: executive summary of the updated clinical recommendations and supporting systematic review. J Am Dent Assoc. 2013 Nov;144(11):1279-91. PubMed External Web Site Policy

Extent of Measure Testing

The Dental Quality Alliance is an organization of major stakeholders in oral healthcare delivery that develops oral healthcare measures through consensus-building processes. Dental Quality Alliance measures are developed through an environmental scan of measure concepts that are evaluated through a modified Delphi consensus process using expert panels. Measure concepts rated high on importance, feasibility, and validity are selected for measure development. Developed measures are tested for feasibility, reliability and validity following measure scientific acceptability guidance from the National Quality Forum. Measures are also evaluated through a formal public comment process. Measures that complete testing are presented to the full Dental Quality Alliance membership for formal approval.

Evidence for Extent of Measure Testing

Dental Quality Alliance. Dental Quality Alliance measure activities. [internet]. Chicago (IL): Dental Quality Alliance; 2015. 

Dental Quality Alliance. Pediatric oral health quality and performance measures: environmental scan. Chicago (IL): Dental Quality Alliance; 2012. 31 p.

Dental Quality Alliance. Request for proposals: testing pediatric oral health performance measures ER use and general anesthesia for caries related reasons. Chicago (IL): Dental Quality Alliance; 2013.

Herndon JB. Testing pediatric oral health performance measures: emergency room use and general anesthesia for caries-related reasons. Chicago (IL): Dental Quality Alliance (DQA); 2014 Dec.

State of Use

Current routine use

Current Use

Monitoring and planning

Measurement Setting

Unspecified

Professionals Involved in Delivery of Health Services

Allied Health Personnel

Dentists

Physicians

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Does not apply to this measure

Target Population Age

Age less than or equal to 20 years

Target Population Gender

Either male or female

IOM Care Need

Not within an IOM Care Need

IOM Domain

Not within an IOM Domain

Case Finding Period

The reporting year

Denominator Sampling Frame

Enrollees or beneficiaries

Denominator (Index) Event or Characteristic

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All member months for enrollees 0 through 20 years during the reporting year

Note: Per 100,000 member months.

Exclusions
Medicaid/Children's Health Insurance Program (CHIP) programs should exclude those individuals who do not qualify for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefits.

Exclusions/Exceptions

Does not apply to this measure

Numerator Inclusions/Exclusions

Inclusions
Number of emergency department (ED) visits with caries-related diagnosis code among all enrolled children

Note: Identify all ED visits for caries-related reasons occurring during eligible member months:

  1. Identify a health care encounter as an ED visit if any of the following are met:
    • Specific Current Procedural Terminology (CPT) codes for ED visit for evaluation or management (refer to the original measure documentation for specific CPT codes); OR
    • Revenue code 0450-0459 (Emergency Room [ER]) or 0981 (professional fees for ER services); OR
    • Centers for Medicare & Medicaid Services (CMS) place of service code for professional claims - 23 (Emergency Room)
  2. Count only one visit per member per day.
  3. Child must be less than 21 years on date of visit.
  4. Identify an ED visit as being caries related if:
    1. Any of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes in Table 1 of the original measure documentation is listed as a FIRST-LISTED diagnosis code associated with the visit

      OR

    2. (a) Any of the ICD-9-CM diagnosis codes in Table 2 of the original measure documentation is listed as a FIRST-LISTED diagnosis AND (b) Any of the ICD-9-CM diagnosis codes in Table 1 of the original measure documentation is listed as an ADDITIONAL LISTED diagnosis. (Codes from Table 2 must be accompanied by a code from Table 1 to qualify.)

Refer to the original measure documentation for administrative codes and additional information.

Exclusions
Unspecified

Numerator Search Strategy

Encounter

Data Source

Administrative clinical data

Type of Health State

Proxy for Health State

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Ratio

Interpretation of Score

Does not apply to this measure (i.e., there is no pre-defined preference for the measure 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

Primary Stratification Variables

  1. Age: Less than 1; 1 to 2; 3 to 5; 6 to 7; 8 to 9; 10 to 11; 12 to 14; 15 to 18; 19 to 20
  2. Emergency Department (ED) Disposition Stratification: Discharged from ED; Inpatient Admissions

Note:

  • Numerator cases are stratified based on age on date of ED visit.
  • Stratify the numerator by whether visit resulted in an inpatient admission or did not result in an inpatient admission.
  • Refer to the original measure documentation for additional information on stratifications.

Standard of Comparison

Internal time comparison

Original Title

Ambulatory care sensitive emergency department visits for dental caries in children.

Measure Collection Name

Dental Caries in Children: Prevention & Disease Management

Submitter

Dental Quality Alliance - Health Care Quality Collaboration

Developer

Dental Quality Alliance - Health Care Quality Collaboration

Funding Source(s)

The Dental Quality Alliance with support from the American Dental Association Foundation

Composition of the Group that Developed the Measure

Dental Quality Alliance (DQA) Measure Development and Maintenance Committee (MDMC)

Financial Disclosures/Other Potential Conflicts of Interest

To ensure that a collaborative and balanced approach is followed, the Dental Quality Alliance (DQA) requests that all individuals nominated to the Measure Development and Maintenance Committee (MDMC) and its Workgroups complete a standard conflict of interest form.

Disclosed conflicts are not confidential. Unless the individual is disqualified to serve, his or her disclosures will be shared with the other members and be published with the report. Disclosure allows the DQA to maintain a transparent process and convene a balanced group.

For additional information on conflict of interest procedures, refer to Procedure Manual for Performance Measure Development: A Voluntary Consensus Process (see also the "Companion Documents" field).

Endorser

National Quality Forum

NQF Number

2689

Date of Endorsement

2015 Sep 2

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2014 Oct

Measure Maintenance

Annual

Date of Next Anticipated Revision

January 1, 2017

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in April 2016.

Source(s)

American Dental Association (ADA). Dental Quality Alliance user guide for measures calculated using administrative claims data, version 2.0. Chicago (IL): Dental Quality Alliance (DQA); 2016 Jan 1. 27 p. [26 references]

Dental Quality Alliance (DQA). DQA measure specification sheet: ambulatory care sensitive emergency department visits for dental caries in children. Chicago (IL): Dental Quality Alliance (DQA); 2015. 8 p.

Measure Availability

Source available from the American Dental Association (ADA) Web site External Web Site Policy.

For more information, contact ADA at 211 E. Chicago Ave, Chicago, IL 60611; Phone: 312-440-2500; Web site: www.ada.org External Web Site Policy.

Companion Documents

The following are available:

  • American Dental Association (ADA). Procedure manual for performance measure development: a voluntary consensus process. Chicago (IL): Dental Quality Alliance (DQA); 2013 Apr 23. 36 p.
  • Herndon JB. Testing pediatric oral health performance measures in the Florida and Texas Medicaid and CHIP programs. Chicago (IL): Dental Quality Alliance (DQA); 2013 Aug. 25 p.

NQMC Status

This NQMC summary was completed by ECRI Institute on August 3, 2015. The information was verified by the measure developer on September 16, 2015.

The information was reaffirmed by the measure developer on April 28, 2016.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

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