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

Abstract

Background: Fluoride is vital in the prevention of dental caries in children. In 2014, the US Preventive Services Task Force (USPSTF) deemed fluoride varnish a recommended preventive service (grade B). Electronic health record (EHR)-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 (10/15/2020 – 4/15/2022) 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 3049 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 = .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 = .005). Whether a patient received topical fluoride was positively associated with order set implementation (OR 5.87, 95% 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 = <.0001). Added revenue totaled $15,084. Conclusions: The targeted use of order sets and note templates was positively associated with the ordering of topical fluoride by physicians.

Clinical Decision Support Tool to Promote Adoption of New Neonatal Hyperbilirubinemia Guidelines

“…For example, CDS tools have been shown to reduce medication errors as well as increase compliance with vaccination and other guideline recommended preventative measures. [7][8][9][10][11][12][13] Given the complexity of hyperbilirubinemia evaluations, several popular tools currently exist for hyperbilirubinemia This article is protected by copyright. All rights reserved.…”