Applying Informatics to Bridge the Dental Health Divide Open Access

Golakoti, Madhavi (2016)

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Background: To reduce the burden of non-emergent dental visits to hospital ER, a coordinate effort to implement across-the-border informatics solutions that bring ease-of-access and affordability are vital in promoting overall health and wellbeing of communities in need of dental healthcare.

Purpose: The purpose of this study is to understand ER usage patterns pertaining to dental complaints at a major Atlanta area hospital. Increasing overcrowding at the ER with people seeking urgent dental care magnifies the profound financial burden on the system and further taxes the ER staff. Better insight into the communities-of-need will aid in increasing access to dental care and to reduce the burden of non-emergency visits to the ER

Methods: Data analysis of unique ER visits for dental care was performed using the hospital electronic health records data. Data for a one year period were analyzed and only unique visits to the ER for dental issues were considered for research. International classification of disease (ICD 9) dental diagnosis codes was used as the basis to analyze EMR data for dental services. Demographics of the patients that present at the ER with dental complaints were also evaluated to identify other relevant patient characteristics.

Results: Total of 3753 unique cases that visited the ER for dental care were identified. Analysis of ER data identified the top five diagnosis codes (Dx) that are used to code dental encounters at the ER- Unspecified disorder of the teeth and supporting structures Dx 525.9, Other and unspecified diseases of the oral soft tissues Dx 528.9, Periapical abscess without sinus Dx 522.5, Inflammatory conditions of jaw Dx 526.4 and Cellulitis and abscess of oral soft tissues Dx 528.3.Thirteen zip codes were identified contributing to the highest traffic (over 100 cases each) to the ER.

Conclusions: EMR data has a wealth of knowledge that can be leveraged to understand ER usage patterns, patient chief complaint and demographic details. This study enabled visibility into who is using the ER for non-emergency dental care, giving us knowledge that will help divert folks away from the ER and into community dental clinics for accessible, affordable and continuing dental care.

Table of Contents

Examination of Context and Background. 10

Figure 1: ADA Dental Divide in America. 12

Problem statement, Purpose and Research Question. 16

Theoretical and Conceptual Framework. 21

Figure 2: Conceptual Framework. 22

Figure 3: Dental Diversion program Context Diagram. 24

Significance. 25

Method and Rationale for Target Journal Selection. 27

Chapter 2: Review of the Literature. 27

Figure 4: Medicaid reimbursement rates. 30

Figure 5: Medicaid Dental Benefits by State. 31

Figure 6: Access to Dental Care. 34

Figure 7: GA Dental Shortage areas. 36

Figure 8: GA Mobile Dental Services by county. 41

Chapter 3: Methodology, Approach, and Solution. 43

Methodology and Approach. 43

Figure 9: Current State workflow diagram. 45

Figure 10: Future state workflow diagram. 47

Figure 11: Top Diagnosis codes used to code dental ED visits. 53

Figure 12: Zip codes representing the most dental ED visits. 54

Figure 13: Employment status of ED users. 56

Figure 14: Distribution of insured and uninsured ED users. 57

Figure 15: Ethnic makeup of ED users. 58

Proposed Solution. 59

Figure 16: Proposed solution. 59

Chapter 4: Discussion. 62

Chapter 5 - Journal Article. 66

References. 66

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