Skip to main content

The AHRQ National Quality Measures Clearinghouse (NQMC, qualitymeasures.ahrq.gov) Web site will not be available after July 16, 2018 because federal funding
through AHRQ will no longer be available to support the NQMC as of that date. For additional information, read our full announcement.
  • Measure Summary
  • NQMC:009129
  • Jul 2013

Dental care: total amount that is paid on direct provision of care (reimbursed for clinical services) per member per month for all enrolled children during the reporting year.

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]
American Dental Association (ADA). DQA measure specification sheet: per member per month cost of clinical services. Chicago (IL): Dental Quality Alliance (DQA); 2013 Jul 19. 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: Cost

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the total amount that is paid on direct provision of care (reimbursed for clinical services) per member per month for all enrolled children during the reporting year.

Note:

  • This measure is reported at the "dental" services level. The measure specification can be adapted to include the option to report separate rates for "oral health" services and for "dental OR oral health" services.
  • Services provided by a dental hygienist would only be counted as a "dental" service if those services are provided under the supervision of a dentist. Services provided by independently practicing dental hygienists and other such providers would be classified as "oral health" services.

Rationale

Dental caries is the most common chronic disease in children in the United States. 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. Identifying caries early is important to reverse the disease process, prevent progression of caries, and reduce incidence of future lesions. Approximately three quarters of children younger than age 6 years did not have at least one visit to a dentist in the previous year.

Evidence for Rationale

American Dental Association (ADA). DQA measure specification sheet: per member per month cost of clinical services. Chicago (IL): Dental Quality Alliance (DQA); 2013 Jul 19. 8 p.

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

Edelstein BL, Chinn CH. Update on disparities in oral health and access to dental care for America's children. Acad Pediatr. 2009 Nov-Dec;9(6):415-9. PubMed External Web Site Policy

National Center for Health Statistics. Healthy People 2010 final review. Hyattsville (MD): National Center for Health Statistics; 2012. 560 p.

Primary Health Components

Dental care; cost; reimbursement; dental coverage; dental insurance loss ratio; children; adolescents

Denominator Description

Total dental member months for members enrolled in dental coverage for at least one month (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Total amount paid for dental services (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

Oral health is essential to the general health and well-being of all Americans. Poor oral health can have a significant impact on children's overall health, growth and development, and learning. Between 1990 and 2009, Medicaid dental expenditures grew from $756.1 million to $7.1 billion, or from 2.4% to 7.0% of total dental expenditures.

According to the Centers for Disease Control and Prevention (CDC), dental caries remains the most common chronic disease of children aged 5 to 17 years—4 times more common than asthma (59% versus 15%). Ten million United States (U.S.) school age children have untreated decay, and there are profound disparities by race, socioeconomic status and geographic location. The National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2004 shows that one in four children aged 2 to 5 years had one or more teeth affected by dental caries (untreated or filled, excluding missing teeth) and one in two children are affected by age 6 to 11 years. One in ten children aged 6 to 8 have dental caries in the permanent dentition (untreated or filled, excluding missing teeth) and one in two children are affected by age 12 to 15 years.

Data collected by the Centers for Medicare and Medicaid Services (CMS) indicate a lack of utilization of care at younger ages, lack of early prevention, and lack of adequate use of effective preventive modalities underscoring the need for improvement.

Evidence for Additional Information Supporting Need for the Measure

American Dental Association (ADA). Pediatric oral health quality and performance measures concept set: achieving standardization and alignment. Chicago (IL): Dental Quality Alliance (DQA); 2012. 24 p.

Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. Preventing chronic diseases: investing wisely in health: preventing dental caries with community programs. Atlanta (GA): Centers for Disease Control and Prevention; 2010.

Centers for Medicare & Medicaid Services. Annual EPSDT participation report, fiscal year: 2010. Baltimore (MD): Centers for Medicare & Medicaid Services; 2013. 153 p.

Centers for Medicare & Medicaid Services. National health expenditure data. [internet]. Baltimore (MD): Centers for Medicare & Medicaid Services; 2012. 

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

Jackson SL, Vann WF, Kotch JB, Pahel BT, Lee JY. Impact of poor oral health on children's school attendance and performance. Am J Public Health. 2011 Oct;101(10):1900-6. PubMed External Web Site Policy

U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2010. [internet]. Rockville (MD): U.S. Department of Health and Human Services; 2010. 

U.S. Department of Health and Human Services. Oral health in America: a report of the Surgeon General. Rockville (MD): U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000 Sep. 308 p.

Extent of Measure Testing

In 2012, the Dental Quality Alliance (DQA) proposed a Starter Set of Pediatric Oral Health Performance Measures that could be calculated using administrative data. A multidisciplinary research team at the University of Florida was selected to conduct feasibility, reliability and validity testing of the measures through a competitive request for proposal (RFP) process. Testing processes followed guidance on quality measure scientific acceptability from the National Quality Forum.

For additional details regarding measure testing, including methodology and outcomes, refer to Testing Pediatric Oral Health Performance Measures in the Florida and Texas Medicaid and CHIP Programs (see also the "Companion Documents" field).

Evidence for Extent of Measure Testing

Dental Quality Alliance. Dental Quality Alliance measure activities. [internet]. Chicago (IL): Dental Quality Alliance; 2013 [accessed 2013 Jul 28].

Dental Quality Alliance. Request for proposals to establish feasibility, reliability and validity of implementation of claims based pediatric oral health measures developed by the Dental Quality Alliance. Chicago (IL): Dental Quality Alliance; 2012.

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.

State of Use

Current routine use

Current Use

Monitoring and planning

Measurement Setting

Managed Care Plans

Professionals Involved in Delivery of Health Services

Does not apply to this measure (e.g., measure is not provider specific)

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

  • Age less than 21 years for Medicaid programs
  • Age less than 19 years for Public Marketplaces

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
Total dental member months for members enrolled in dental coverage for at least one month

Note: Calculate total number of member months by summing the number of months enrolled in dental coverage for all members enrolled at least one month in dental coverage during the reporting year.

Exclusions
If age criterion is not met or there are missing or invalid field codes (e.g., date of birth), the enrollee does not get counted in the denominator.

Exclusions/Exceptions

Does not apply to this measure

Numerator Inclusions/Exclusions

Inclusions
Total amount paid for dental services

Note: Calculate total dental costs by summing paid amounts for all services with Service Code = D0100 - D9999 that were provided by a provider whose Provider Taxonomy Code = any of the National Uniform Claim Committee (NUCC) maintained Provider Taxonomy Codes in Table 1 of the original measure documentation.

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

Exclusions
Unspecified

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

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 high-risk subgroup (stratification by vulnerable populations)

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

Description of Allowance for Patient or Population Factors

The Dental Quality Alliance (DQA) encourages the measure results to be stratified by the following:

  • Age
  • Race
  • Ethnicity
  • Geographic location
  • Socioeconomic status
  • Payer type
  • Program/plan type

Such stratifications will enable implementers to identify variations in care by child and program characteristics, which can be used to inform quality improvement initiatives.

To stratify the measure results, the denominator population is divided into different subsets based on different characteristics of interest (e.g., age, race/ethnicity, geographic location, etc.) and the rates are reported for each sub-population.

Standard of Comparison

Internal time comparison

Original Title

Per member per month cost of clinical services (DEN 1).

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)

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 Research & Development (R&D) Committee 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).

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2013 Jul

Measure Maintenance

Annual

Date of Next Anticipated Revision

Unspecified

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]

American Dental Association (ADA). DQA measure specification sheet: per member per month cost of clinical services. Chicago (IL): Dental Quality Alliance (DQA); 2013 Jul 19. 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 February 26, 2014. The information was verified by the measure developer on April 4, 2014.

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.

NQMC Disclaimer

The National Quality Measures Clearinghouse™ (NQMC) does not develop, produce, approve, or endorse the measures represented on this site.

All measures summarized by NQMC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public and private organizations, other government agencies, health care organizations or plans, individuals, and similar entities.

Measures represented on the NQMC Web site are submitted by measure developers, and are screened solely to determine that they meet the NQMC Inclusion Criteria.

NQMC, AHRQ, and its contractor ECRI Institute make no warranties concerning the content or its reliability and/or validity of the quality measures and related materials represented on this site. Moreover, the views and opinions of developers or authors of measures represented on this site do not necessarily state or reflect those of NQMC, AHRQ, or its contractor, ECRI Institute, and inclusion or hosting of measures in NQMC may not be used for advertising or commercial endorsement purposes.

Readers with questions regarding measure content are directed to contact the measure developer.

About NQMC Measure Summaries

NQMC provides structured summaries containing information about measures and their development.

Measure Summary FAQs


Measure Summaries

New This Week

View more and sign up for our Newsletter

Get Adobe Reader