National Quality Forum #: None
Numerator: Number of oral health patients with a diagnosis of HIV who had a periodontal screen or examination2 at least once in the measurement year
Denominator: Number of oral health patients with a diagnosis of HIV who received a clinical oral evaluation3 at least once in the measurement year
- Patients who had only an evaluation or treatment for a dental emergency in the measurement year4
- Edentulous patients (complete)
- Patients who were <13 years of age
- Does the patient have a diagnosis of HIV? (Y/N)
- Data reports required by HRSA/HAB, such as the Ryan White HIV/AIDS Program Services Report (RSR)
- Electronic Health Record/Electronic Medical Record may be another data source
- Sample of oral health services, patients
- Provider billing systems (Note: This will be dependent on the completeness and accuracy of coding of the procedures of interest.)
National goals, targets, or benchmarks for comparison
The HIV Quality Measures (HIVQM) Module is a tool within the Ryan White HIV/AIDS Services Report portal. It allows recipients to enter aggregate data specific to HRSA HAB Performance Measures. The HIVQM Module allows recipients to conduct point-in-time benchmarking across Ryan White HIV/AIDS Programs that use the module.
Outcome measures for consideration
Rate of tooth loss due to periodontal disease in the practice population.
Basis for selection
The American Academy of Periodontology's "Parameter on Periodontitis Associated with Systemic Conditions" indicates that "...some forms of periodontal disease may be more severe in individuals affected with immune system disorders. Patients infected with human immunodeficiency syndrome (HIV), may have especially severe forms of periodontal disease. The incidence of necrotizing periodontal diseases may increase with patients with acquired immunodeficiency syndrome (AIDS)."5
Department of Health and Human Services Clinical Practice Guidelines
1 "Patient" includes all patients aged 13 years or older.
2 A periodontal screen should include the assessment of medical and dental histories, the quantity and quality of attached gingival; bleeding; tooth mobility; and radiological review of the status of the periodontium and dental implants. "Appropriate screening procedures may be performed to determine the need for a comprehensive periodontal evaluation." (Source: American Academy of Periodontology. "Parameter on Comprehensive Periodontal Examination." J Periodontol. 2000; 71:847-848). A comprehensive periodontal examination (ADA CDT D0180) includes "the evaluation of periodontal conditions, probing and charting, evaluation and recording of the patient's dental and medical history and general health assessment. It may include the evaluation and recording or dental caries, missing or unerupted teeth, restorations, occlusal relationships, and oral cancer evaluation" (Source: American Dental Association. Current Dental Terminology: CDT 2009-2010.) The screening or examination may be performed and documented by either a licensed dentist or, where state regulations allow, by a dental hygienist, but the interpretation of data and diagnosis must be made by a licensed dentist.
3 Clinical oral evaluations include evaluation, diagnosis, and treatment planning. Pertinent ADA CDT codes for patient inclusion in the denominator may include the following: D0120- Periodic Oral Evaluation-established patient; D0150-Comprehensive oral evaluation, new or established patient; D0160-Detailed and Extensive Oral Evaluation; D0170-Re-evaluation, limited, problem focused (established patient; not postoperative visit); and D0180-Comprehensive Periodontal Evaluation-new or established patient.
4 Pertinent ADA CDT codes for patient exclusion may include the following: D9110- Palliative (emergency) treatment of dental pain-minor procedure; and D0140-Limited Oral Evaluation Problem Focused. However, the diagnostic and treatment procedures associated with emergency evaluation and treatment encounters (including those using these or other ADA CDT codes, as well as other procedures which may not be coded) should be considered when identifying patients for exclusion. ADA: Code on Dental Procedures and Nomenclature (CDT Code). Available online. Accessed January 2022.
5 American Academy of Periodontology. "Parameter on Periodontitis Associated with Systemic Conditions." J Periodontol. 2000; 71:876-879. Available online. Accessed January 2022.