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Appl Clin Inform 2023; 14(02): 245-253
DOI: 10.1055/a-2011-8167
Research Article

The Application of Dental Fluoride Varnish in Children: A Low Cost, High-Value Implementation Aided by Passive Clinical Decision Support

Paul J. Lukac 
1   Department of Pediatrics, University of California, Los Angeles, Los Angeles, California, United States
2   Office of Health Informatics and Analytics, University of California, Los Angeles, Los Angeles, California, United States
,
Douglas Bell
3   Department of Medicine, University of California, Los Angeles, Los Angeles, California, United States
,
Priya Sreedharan
2   Office of Health Informatics and Analytics, University of California, Los Angeles, Los Angeles, California, United States
,
Jeffrey A. Gornbein
4   Department of Biostatics, School of Public Health, University of California, Los Angeles, Los Angeles, California, United States
,
Carlos Lerner
1   Department of Pediatrics, University of California, Los Angeles, Los Angeles, California, United States
› Author Affiliations
Funding This research was supported by NIH National Center for Advancing Translational Science (NCATS) UCLA CTSI grant number: TL1TR001883.
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Abstract

Background Fluoride is vital in the prevention of dental caries in children. In 2014, the U.S. Preventive Services Task Force deemed fluoride varnish a recommended preventive service (grade B). Electronic health record-based clinical decision support (CDS) tools have shown variable ability to alter physicians' ordering behaviors.

Objectives This study aimed to increase the application of fluoride varnish in children while analyzing the effect of two passive CDS tools—an order set and a note template.

Methods Data on outpatient pediatric visits over an 18-month period before and after CDS implementation (October 15, 2020–April 15, 2022) were queried, while trends in application rate of fluoride were examined. We constructed a multiple logistic regression model with a primary outcome of whether a patient received fluoride at his/her visit. The primary predictor was a “phase” variable representing the CDS implemented. Physician interaction with CDS as well as the financial effects of the resulting service use were also examined.

Results There were 3,049 well-child visits of children aged 12 months to 5 years. The addition of a fluoride order to a “Well Child Check” order set led to a 10.6% increase in ordering over physician education alone (25.4 vs. 14.8%, p = 0.001), while the insertion of fluoride-specific text to drop-down lists in clinical notes led to a 6.2% increase (31.5 vs. 25.4%, p = 0.005). Whether a patient received topical fluoride was positively associated with order set implementation (odds ratio [OR] = 5.87, 95% confidence interval [CI]: 4.20–8.21) and fluoride-specific drop-down lists (OR = 7.81, 95% CI: 5.41–11.28). Female providers were more likely to use order sets when ordering fluoride (56.2 vs. 40.9% for males, p ≤ 0.0001). Added revenue totaled $15,084.

Conclusion The targeted use of order sets and note templates was positively associated with the ordering of topical fluoride by physicians.

Keywords

clinical decision support - electronic health record - fluoride

Protection of Human and Animal Subjects

This study was conducted for quality improvement and deemed exempt from review by the University of California, Los Angeles Institutional Review Board.




Publication History

Received: 16 August 2022

Accepted: 10 January 2023

Accepted Manuscript online:
12 January 2023

Article published online:
29 March 2023

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