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Featured Fellow: Dr. Elsbeth Kalenderian Prioritizes Quality Improvement and Patient Safety in Dentistry

 Dr. Elsbeth Kalenderian

NYAM Fellow Elsbeth Kalenderian, DDS, MPH, PhD is Chair of the Department of Oral Health Policy and Epidemiology at the Harvard School of Dental Medicine. She is also Chief of Quality at Harvard Dental Center. Dr. Kalenderian’s focus is on quality improvement with a goal to improve patient safety in the dental world. She believes that a first step toward that effort is standardizing the way dental diagnoses are documented, followed by developing a data repository and determining innovative measures of quality in dental care.

“We have been thinking about patient safety for a long time,” Dr. Kalenderian said. “We believe there is little patient safety focus in dentistry. There is in medicine, but none of that is transferring to dentistry and that’s a shame. We have a NIH grant in the patient safety arena to start transferring it to dentistry. However, when I first came to Harvard, we couldn’t start thinking about patient safety because step one was to document the diagnosis.”

Dr. Kalenderian led a workgroup that developed the EZCodes dental diagnostic terminology in 2009, funded by a National Institutes of Health grant. The EZCodes, which comprise 1355 terms, were built upon existing best practices. The EZCodes dental diagnostic terminology has been adopted by 15 dental institutions in the U.S. and Europe, as well as Willamette Dental Group, a set of 54 practices in the Pacific Northwest. Four schools are now pooling data, including dental diagnostic data, into the largest dental diagnostic data repository in the U.S., with over a million unique patients. This allows tying dental diagnoses to treatment and thus performing meaningful epidemiologic and outcomes oral health research.

“Having a structured diagnosis documented is extremely important to figure out the quality of care provided,” Dr. Kalenderian said. “In dentistry we’ve never had that because it’s never been mandatory, in part because the community never had a specific dental diagnostic terminology.”

Use of the EZCodes dental diagnostic terminology will empower clinicians to be able to document the types and frequency of conditions they encounter and enhance communication between them and other clinicians, thereby enabling outcomes tracking and data sharing across sites; allow epidemiologists to evaluate disease patterns, determinants, and outcomes and assess in-depth variations in health care, health care quality, costs of care, and treatment effectiveness and outcomes; and help students hone their diagnostic skills.

“The most important thing to realize is that in medicine, the medical world has made it mandatory for doctors to put down what the medical diagnosis is in a standardized way and document the treatment using a standard code,” Dr. Kalenderian emphasized. “Insurance companies use the data for many things, including looking for upcoding, and potential fraud. More importantly, insurance companies, hospitals, and quality assurance organizations want to know if people with the same disease are getting the same treatment and if people with the same treatment are getting the same outcomes. And if not, why not. You can’t get answers to these kind of questions if you don’t have a structured documented diagnosis that is tied to a treatment in the first place.”

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Posted on January 17, 2014

Gina Ravosa
Director of Marketing & Communications
The New York Academy of Medicine
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New York, NY 10029
(212) 822-7285


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