Provider Adoption of mHealth in Rural Patient Care: Web-Based Survey Study.

Background: Physicians and patient-facing caregivers have increasingly used mobile health (mHealth) technologies in the past several years, accelerating during the COVID-19 pandemic. However, barriers and feedback surrounding adoption remain relatively understudied and varied across health systems, particularly in rural areas.

Objective: This study aims to identify provider adoption, attitudes, and barriers toward mHealth in a large, multisite, rural US health care system.

The PocketPerio application significantly increases the accuracy of diagnosing periodontal conditions in didactic and chairside settings.

The study aimed to determine the accuracy of diagnosing periodontal conditions using the developed web-based PocketPerio application and evaluate the user's perspective on the use of PocketPerio. First, 22 third-year dental students (DS3) diagnosed ten cases without PocketPerio (control) and with PocketPerio (test) during a mock examination. Then, 105 DS3, 13 fourth-year dental students (DS4), and 32 senior second-year International Standing Program students (ISP2) used PocketPerio chairside.

A retrospective analysis of the role of age and sex in outcomes of non-surgical periodontal therapy at a single academic dental center.

The present study examined the role of age and sex in the outcomes of non-surgical periodontal therapy (NSPT). De-identified demographic and periodontal characteristics of patients who presented for baseline periodontal evaluation, NSPT, and periodontal re-evaluation were abstracted from electronic health records. Independent associations of age and sex with severe periodontitis defined as ≥ 5 mm clinical attachment loss (CAL) and ≥ 6 mm probing depth (PD) were determined using multinomial logistic regression.

How decisions are made: Antibiotic stewardship in dentistry.

Background: We performed a preimplementation assessment of workflows, resources, needs, and antibiotic prescribing practices of trainees and practicing dentists to inform the development of an antibiotic-stewardship clinical decision-support tool (CDST) for dentists.

Methods: We used a technology implementation framework to conduct the preimplementation assessment via surveys and focus groups of students, residents, and faculty members. Using Likert scales, the survey assessed baseline knowledge and confidence in dental providers' antibiotic prescribing.

Identifying oral disease variables associated with pneumonia emergence by application of machine learning to integrated medical and dental big data to inform eHealth approaches.

Background: The objective of this study was to build models that define variables contributing to pneumonia risk by applying supervised Machine Learning-(ML) to medical and oral disease data to define key risk variables contributing to pneumonia emergence for any pneumonia/pneumonia subtypes.

Methods: Retrospective medical and dental data were retrieved from Marshfield Clinic Health System's data warehouse and integrated electronic medical-dental health records (iEHR). Retrieved data were pre-processed prior to conducting analyses and included matching of cases to controls by (a) race/ethnicity and (b) 1:1 Case: Control ratio.

DentaSeal: A school-based dental sealant efficiency assessment tool to support statewide monitoring and reporting: A field report.

Background: The evidence base supports effectiveness of dental sealants for prevention of childhood caries in school-aged children.

Objective: This study describes planning, development, usability testing and outcomes following implementation of DentaSeal, a web-based application designed to accurately track unique student data and generate reports for all Wisconsin school-based sealant placement (SP) programs.

Methods: Application software development was informed by a steering committee of representative stakeholders who were interviewed to inform design and provide feedback for design of DentaSeal during development and evaluation.

Development and Validation of a Non-Invasive, Chairside Oral Cavity Cancer Risk Assessment Prototype Using Machine Learning Approach.

Oral cavity cancer (OCC) is associated with high morbidity and mortality rates when diagnosed at late stages. Early detection of increased risk provides an opportunity for implementing prevention strategies surrounding modifiable risk factors and screening to promote early detection and intervention. Historical evidence identified a gap in the training of primary care providers (PCPs) surrounding the examination of the oral cavity.

How Medical-Dental EHR Integration Can Improve Diabetes Care.

Since the mid-1990s, poor oral health has been neglected as a public health threat, despite its recognition as epidemic in scale by the US Department of Health and Human Services Office of the Surgeon General. Americans' poor oral health influences their overall health and, from a population standpoint, incurs dire economic and human costs. This article describes how health information transfer within the Marshfield Clinic Health System's integrated medical and dental practice can improve diabetes care.

Longitudinal Observation of Outcomes and Patient Access to Integrated Care Following Point-of-Care Glycemic Screening in Community Health Center Dental Safety Net Clinics.

Rates of diabetes/prediabetes continue to increase, with disparity populations disproportionately affected. Previous field trials promoted point-of-care (POC) glycemic screening in dental settings as an additional primary care setting to identify potentially at-risk individuals requiring integrated care intervention. The present study observed outcomes of POC hemoglobin A1c (HbA1c) screening at community health center (CHC) dental clinics (DC) and compliance with longitudinal integrated care management among at-risk patients attending dental appointments.

ESTABLISHING A QUALITY IMPROVEMENT CULTURE WITHIN A LARGE INTEGRATED MEDICAL-DENTAL HEALTH SYSTEM WITH A POPULATION BASED FOCUS.

Objectives: Quality improvement strategies have been an integral part of healthcare to attain improved care delivery and effective health outcomes. The dental quality initiative improvement (DQII) presented in this manuscript represents a case study of successful implementation of a quality improvement culture within a large integrated-medical-dental health system serving a largely rural population.

Methods: The key elements of DQII included steering committee establishment, definition or dental quality measures and development/implementation of a dental quality analytics dashboard (DQAD) that provides relevant data on dental quality measures.

Systematic review of studies examining contribution of oral health variables to risk prediction models for undiagnosed Type 2 diabetes and prediabetes.

Objective: To conduct systematic review applying "preferred reporting items for systematic reviews and meta-analyses statement" and "prediction model risk of assessment bias tool" to studies examining the performance of predictive models incorporating oral health-related variables as candidate predictors for projecting undiagnosed diabetes mellitus (Type 2)/prediabetes risk.

Materials And Methods: Literature searches undertaken in PubMed, Web of Science, and Gray literature identified eligible studies published between January 1, 1980 and July 31, 2018. Systematically reviewed studies met inclusion criteria if studies applied multivariable regression modeling or informatics approaches to risk prediction for undiagnosed diabetes/prediabetes, and included dental/oral health-related variables modeled either independently, or in combination with other risk variables.

Community Awareness and Oral Cancer Screening in Rural Wisconsin.

Oral cancer risks have been shown to be modified by improving public awareness and reducing barriers to preventive care. The purpose for this study was to assess oral cancer knowledge and awareness and provide oral cancer screenings and education to a population of rural farmers in Wisconsin. Attendees 18 years of age and older at a rural farming exposition in Wisconsin were invited to complete a 12-item oral cancer awareness paper survey and to receive a visual and tactile head and neck examination/ oral cancer screening.

Knowledge, Attitudes, Behaviors of Women Related to Pregnancy, and Early Childhood Caries Prevention: A Cross-Sectional Pilot Study.

Objective: Health education interventions during pregnancy can influence maternal oral health (OH), maternal OH-behaviors and children's OH. Interventions that can be delivered at anytime and anywhere, for example mobile-health (mHealth) provides an opportunity to address challenges of health education and support activation of women in underserved and rural communities to modify their health behavior. This pilot study was undertaken as a part of a mHealth initiative to determine knowledge, attitudes, and behaviors related to pregnancy and ECC prevention among women attending obstetrics/gynecology (OB/GYN) practices at a large rurally-based clinic.

Positioning operations in the dental safety net to enhance value-based care delivery in an integrated health-care setting.

Objectives: Impact of implementing data-driven performance metric-tracking across a 10-dental center infrastructure established by Family Heath Center of Marshfield (FHC-M) was examined for relative impact on achieving value-based care delivery in serving a patient population characterized by 88% Medicaid representation.

Methods: To track progress toward national benchmarks for preventive care delivery, dental quality analytics dashboard tracking was implemented in real time with sharing of performance metrics across centers. Compliance rate with Uniform Data Systems reporting requirements for sealant placement on permanent first molars in children aged 6-9 years of age at moderate-to-high risk of caries was targeted at FHC-M dental centers for comparison with those of other community health centers statewide and nationally.

Feasibility of establishing tele-dental approach to non-traumatic dental emergencies in medical settings.

Purpose: Non-traumatic dental condition visits (NTDCs) represent about 1.4% to 2% of all Emergency Department (ED) visits and are limited to palliative care only, while associated with high cost of care. Feasibility of establishing a tele-dental approach to manage NTDCs in ED and Urgent care (UC) settings was undertaken to explore the possibility of utilizing remote tele-dental consults.

Knowledgeability, attitude, and practice behaviors of primary care providers toward managing patients' oral health care in medical practice: Wisconsin statewide survey.

Background: In this study, the authors sought to explore the receptivity, preparedness, and rates of adoption of integrated medical-dental models of care (MOCs) in the practice setting among primary care providers (PCPs) treating patients with diabetes mellitus (DM).

Methods: The authors conducted an anonymous statewide survey targeting PCPs across a range of Wisconsin-based practice settings to evaluate knowledgeability, attitude, practice behaviors, and perceived barriers to oral health screening in a medical setting. Qualitative analytical approaches included thematic analyses applied to evaluate the status of and barriers to integrated medical-dental MOC adoption.

Development of a periodontitis risk assessment model for primary care providers in an interdisciplinary setting.

Background: Periodontitis (PD), a form of gum disease, is a major public health concern as it is globally prevalent and harms both individual quality of life and economic productivity. Global cost in lost productivity is estimated at US$54 billion annually. Moreover, current PD assessment applies only after the damage has already occurred.

Development of non-invasive diabetes risk prediction models as decision support tools designed for application in the dental clinical environment.

The objective was to develop a predictive model using medical-dental data from an integrated electronic health record (iEHR) to identify individuals with undiagnosed diabetes mellitus (DM) in dental settings. Retrospective data retrieved from Marshfield Clinic Health System's data-warehouse was pre-processed prior to conducting analysis. A subset was extracted from the preprocessed dataset for external evaluation (N) of derived predictive models.

Patient Awareness of Association of Diabetes and Periodontal Disease.

This cross-sectional study sought to assess the current awareness, knowledge, and behavior regarding diabetes mellitus (DM) and periodontal disease (PD) association among a convenience sample of patients from a large Wisconsin-based integrated medical-dental health care organization serving largely rurally based communities. An anonymous 10-question survey was distributed at regional medical and dental centers of dental and medical clinics of a single health care institution over a 4-week period, to achieve a cross-sectional sampling of patients aged 18 to 80 years. Among 946 respondents, 616 were female.

Patient awareness/knowledge towards oral cancer: a cross-sectional survey.

Background: Oral cancer (OC) is associated with multiple risk factors and high mortality rates and substantially contributes to the global cancer burden despite being highly preventable. This cross-sectional study sought to assess current knowledge, awareness, and behaviors of patients in rural communities surrounding OC risk.

Methods: An anonymous 21-question survey was distributed to patients in waiting rooms of a large integrated medical-dental health system serving north-central Wisconsin.

Tobacco use status from clinical notes using Natural Language Processing and rule based algorithm.

Background: This cross-sectional retrospective study utilized Natural Language Processing (NLP) to extract tobacco-use associated variables from clinical notes documented in the Electronic Health Record (EHR).

Objecitve: To develop a rule-based algorithm for determining the present status of the patient's tobacco-use.

Methods: Clinical notes (n= 5,371 documents) from 363 patients were mined and classified by NLP software into four classes namely: "Current Smoker", "Past Smoker", "Nonsmoker" and "Unknown".

Understanding patients' oral health information needs: Findings of a survey on use of patient portals in dentistry.

Background: Patient engagement through web-based patient health portals (PHP) can offer important benefits to patients and provider organizations by improving both quality and access to care. The authors studied the most relevant, patient-identified, oral health information available in the PHP to inform their assessment of patient-centered care.

Methods: The authors distributed a 17-question, paper-based survey to patients aged 18 through 80 years in the waiting rooms of 8 dental centers in Wisconsin.

Need for diagnostic-centric care in dentistry: A case study from the Marshfield Clinic Health System.

Background: The study objective was to evaluate the workflow of dental providers who use the existing electronic dental record (EDR) system at a large regional health care system to establish a diagnostic-centric culture as part of their dental practice. A further goal focused on identifying when improvements to the workflow and design of the EDR may be indicated.

Methods: Dental procedures performed on patients and corresponding International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses were retrospectively mined from Marshfield Clinic's enterprise data warehouse.

Integrating Medical-Dental Care for Diabetic Patients: Qualitative Assessment of Provider Perspectives.

Globally, periodontal disease and diabetes have achieved epidemic proportions and have become a top health care priority. Mutual bidirectional exacerbation of these conditions is promoting creation of cross-disciplinary integrated care delivery (ICD) models that bridge the traditionally siloed health care domains of dentistry and medicine. By engaging focus groups inclusive of both medical and dental providers and one-on-one interviews, this qualitative study investigated provider knowledgeability, receptiveness, and readiness to engage ICD and sought input from the medical-dental primary care practitioner participants on perceived opportunities, benefits, and challenges to achieving ICD models for patients with diabetes/prediabetes.

Medical care providers' perspectives on dental information needs in electronic health records.

Background: The authors conducted this study to identify the most relevant patient dental information in a medical-dental integrated electronic health record (iEHR) necessary for medical care providers to inform holistic treatment.

Methods: The authors collected input from a diverse sample of 65 participants from a large, regional health system representing 13 medical specialties and administrative units. The authors collected feedback from participants through 11 focus group sessions.